Analysis of the Relationship between the Location of the Anterior Ethmoid Artery and Keros Classification

Poteet, Perry; Cox, Matthew D.; Wang, Ran A; Fitzgerald, Ryan T.; Kanaan, Alissa

doi:10.1177/0194599817696302

Cited by 23 publications

(29 citation statements)

References 18 publications

(25 reference statements)

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“…Our study confirms the findings by Poteet et al . that higher Keros classification is associated with AEA emerging below the level of the skull base.…”

Section: Discussionsupporting

confidence: 93%

“…found the AEA to be located below the skull base in approximately 12.5% of the nasal cavities studied. Recently, Poteet et al . further described the position of the AEA with respect to the skull base in a retrospective CT study of 101 maxillofacial scans; they found that the AEA was located below the skull base in 25.7% of cases and more often in Keros type 3 than Keros type 1 or type 2 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Given the findings by Poteet et al., we aimed to determine the reliability of the SOEC in comparison with the Keros classification in predicting the course of the AEA relative to the skull base. In doing so, we found that the presence of a SOEC is associated with a significant increase in the distance between the skull base and AEA (1.32 vs 0.47 mm).…”

Section: Discussionmentioning

confidence: 99%

“…Keros developed a widely accepted classification system based on skull base height to identify patients at increased risk of surgical injury during ethmoidectomy. Both a higher Keros classification and male sex are associated with a greater chance that the AEA will emerge below the skull base …”

mentioning

confidence: 99%

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Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

Sharbel

White

et al. 2019

Int Forum Allergy Rhinol

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Background:We previously showed that the supraorbital ethmoid cell (SOEC) is a reliable landmark for identifying the anterior ethmoid artery (AEA). Recent data have suggested that Keros classification is also a dependable predictor. We aim to characterize the location of the AEA and its relation to the skull base in patients with and without SOEC using the Keros classification. Methods:Retrospective radiographic evaluation of computed tomography (CT) scans of 76 patients (40 with SOEC, 36 without) was conducted. Distance of AEA from skull base and prevalence of AEA outside of the skull base were measured on each side and compared between groups using the 2-sample t test and χ 2 test, respectively. Subgroup analysis was carried out based on the Keros classification.Results: Mean distance of AEA from the skull base was 1.32 ± 1.5 mm in patients with SOEC and 0.47 ± 1.08 mm in those without (p < 0.001). Prevalence of AEA outside of the skull base was 53.8% in those with SOEC and 18.1% in those without (p < 0.001). Comparing patients with SOEC to those without, AEA was found below the skull base in 30% vs 0% of cases with Keros type 1 (p = 0.45), 58% vs 14.5% with Keros type 2 (p < 0.001), and 60% vs 50% with Keros type 3 (p = 0.72). Conclusion:The presence of SOEC is associated with a higher prevalence of the AEA coursing below the level of the skull base in all Keros types, thus placing the artery at greater risk for injury. Careful surgical planning is needed to avoid potential orbital complications. C 2019 ARS-AAOA, LLC.

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“…Our study confirms the findings by Poteet et al . that higher Keros classification is associated with AEA emerging below the level of the skull base.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

Sharbel

White

et al. 2019

Int Forum Allergy Rhinol

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“…The mean distance between the AEA and the skull base in the current study was 1.37 AE 1.98 mm (range: 0-8.35 mm) that is near to mean distance measured by Ko et al study 39 (1.65 AE 1.9, with range: 0-6.7 mm). On the other hand, Simmen et al 7 and Poteet et al 38 found that the artery was lying 3.7 mm (range: 1-8 mm) away from the skull base.…”

Section: Discussionmentioning

confidence: 95%

Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications

El‐Anwar

Khazbak

Eldib

et al. 2020

J Neurol Surg B Skull Base

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Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24–10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41–129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57–141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0–8.35 mm). The AEA types in relation to skull base was type 1 (0–2 mm from skull base; 64.6%), type 2 (2–4 mm; 22.2%), type 3 (4–6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0–25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5–10 mm), 31.9% type 3 (10–15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

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Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review

Ramkumar

Brar

Marks

et al. 2023

Int Forum Allergy Rhinol

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BackgroundBiological sex is increasingly recognized as a critical variable in health care. The authors reviewed the current literature regarding sex‐based differences in rhinology to summarize the data and identify critical knowledge gaps.MethodsA scoping review was conducted. Publications reporting sex‐based differences in anatomy, physiology, and pathology focusing on disease prevalence, disease burden, and outcomes in rhinology were identified.ResultsSeventy‐five relevant manuscripts were identified. While paranasal sinuses are of similar size at birth, they become larger in males leading to differences in ostium location. Females outperform males in olfactory identification but only in the 18‐ to 50‐year age group. Estrogen and progesterone administration can impact muscarinic and α1‐adrenergic nasal mucosa receptor density. Chronic rhinosinusitis (CRS) and CRS without nasal polyps are more prevalent in females while CRS with nasal polyps is more prevalent in males. CRS symptom burden is higher in females before and after endoscopic sinus surgery; however, no difference in endoscopic sinus surgery utilization was found based on sex. Allergic rhinitis is more common in males before puberty and in females after puberty. Epistaxis is more prevalent in males and postmenopausal females compared with premenopausal females, perhaps from differences in sex‐hormonal and hypertension status. In nasopharyngeal carcinoma, the incidence of sinus abnormalities was higher in males than females.ConclusionsAlthough many sex‐based differences exist in rhinology, further research is necessary to offer evidence‐based treatment guidelines. Gonadal hormones should be studied as a therapeutic in rhinologic pathology as baseline physiologic differences exist such as those found in nasal mucosa receptor density.

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Analysis of the Relationship between the Location of the Anterior Ethmoid Artery and Keros Classification

Cited by 23 publications

References 18 publications

Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications

Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review

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