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A CT-Based Novel Way to Define Ethmoidal Foramina Topography in Human Orbits: Not So Variable After All
Tiziana Tamborrino1,2, Denise Bonente2, Ludovica Livi3
1Department of Molecular and Developmental Medicine, University of Siena.
The Journal of Craniofacial Surgery
|May 11, 2026
Summary
New indexes standardize ethmoidal foramina localization for orbital surgery. Relative Depth Index (RDI) and RDI watershed index (RDIwi) improve accuracy in identifying anterior and posterior ethmoidal foramina positions.
Area of Science:
- Anatomy
- Neurosurgery
- Medical Imaging
Background:
- Ethmoidal foramina connect critical orbital, cranial, and nasal cavities.
- These foramina house arteries linked to intracranial vascular anomalies and epistaxis.
- Precise ethmoidal foramina topography is crucial for orbital surgery neuronavigation.
Purpose of the Study:
- To develop and validate new topographic indexes for ethmoidal foramina.
- To standardize the anteroposterior and vertical positioning of ethmoidal foramina.
- To assess the utility of these indexes for neuronavigation in orbital surgery.
Main Methods:
- Retrospective analysis of computed tomography scans.
- Development of relative depth index (RDI), relative height index (RHI), and RDI watershed index (RDIwi).
- Measurement and standardization of ethmoidal foramina positions using devised indexes.
Main Results:
- The RDI watershed index (RDIwi) effectively classified ethmoidal foramina types.
- Median and average RDIs predicted anteroposterior localization within approximately 2 mm in 50% of cases.
- Average digital RHI showed limited effectiveness for vertical standardization.
Conclusions:
- Median and average RDIs are effective parameters for localizing ethmoidal foramina in the anteroposterior direction.
- These indexes show promise for enhancing neuronavigation accuracy in orbital surgery.
- Standardization of ethmoidal foramina topography is vital for surgical precision.
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