A Consistent Endoscopic Landmark to Identify the Anterior Ethmoidal Artery

David C. Mundy, Carol H. Yan, Matthew A. Tyler, Zara M. Patel

Research output: Contribution to journalArticlepeer-review


Objective: The anterior ethmoidal artery (AEA) is an important structure to identify during endoscopic sinus surgery. Although identification on imaging is easily taught, a consistent endoscopic landmark for the AEA, independent of anatomic ethmoid cell variation, is lacking, leaving many surgeons unclear about the exact location without dependence on navigation. Here, we describe a consistent endoscopic landmark, regardless of anatomical ethmoid variation. Methods: We prospectively enrolled adult patients undergoing endoscopic surgery involving frontal and ethmoid sinuses in this observational study. The AEA landmark was defined simply as the septation or ridge one step back along the ethmoid skull base from the posterior table of the frontal sinus. The gold standard to calculate the sensitivity of our endoscopic landmark was an image-navigation system, registered to within 1.5 mm accuracy, locating the AEA within three planes. Both endoscopic and computerized tomography (CT) images of the pointer at the landmark were taken simultaneously. The concordance of endoscopic to navigation images was independently assessed by three blinded rhinologists. Results: Forty patients were included in our study with 73 sides analyzed. Diagnoses included chronic rhinosinusitis without polyps (52.5%), with polyps (22.5%), recurrent acute sinusitis (15%), sinonasal tumors (7.5%), and odontogenic sinusitis (2.5%). The AEA was accurately identified using our endoscopic landmark in 97.3% of the cases (71/73). Of the two cases in which the AEA was not found within the landmark, the artery was located ≤1 mm posteriorly. Conclusion: We describe a consistent endoscopic landmark to identify the AEA, conserved across various clinical diagnoses and anatomic variations in sinus structure. Level of Evidence: 3 Laryngoscope, 134:1096–1099, 2024.

Original languageEnglish (US)
Pages (from-to)1096-1099
Number of pages4
Issue number3
StatePublished - Mar 2024

Bibliographical note

Publisher Copyright:
© 2023 The American Laryngological, Rhinological and Otological Society, Inc.


  • anterior ethmoidal artery
  • chronic rhinosinusitis
  • computed tomography
  • endoscopic sinus surgery
  • ethmoid sinus
  • frontal sinus
  • sinus anatomy
  • skull base

PubMed: MeSH publication types

  • Observational Study
  • Journal Article


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