Surgical and Radiologic Anatomy

, Volume 41, Issue 5, pp 543–550 | Cite as

Anatomical variations of anterior ethmoidal artery at the ethmoidal roof and anterior skull base in Asians

  • Baharudin AbdullahEmail author
  • Eng Haw Lim
  • Hazama Mohamad
  • Salina Husain
  • Mohd Ezane Aziz
  • Kornkiat Snidvongs
  • De Yun Wang
  • Kamarul Imran Musa
Original Article



The variations of the anterior ethmoidal artery (AEA) in different populations should be recognized by surgeons to prevent unwarranted complications during surgery. The aim of this study was to assess the anatomical variations of AEA in Asian population.


A cross-sectional study of 252 AEA identified by computed tomography (CT) of the paranasal sinuses. The multiplanar CT images were acquired from SOMATOM® Definition AS+ and reconstructed to axial, coronal and sagittal view at 1 mm slice thickness.


42.5% of AEA was within skull base (grade I), 20.2% at skull base (grade II) and 37.3% coursed freely below skull base (grade III). The prevalence of supraorbital ethmoid cell (SOEC) and suprabullar cell (SBC) was 29.8% and 48.0%. The position of AEA at skull base has significant association with SOEC (p < 0.001), but not with SBC (p = 0.268). Type I Keros was 42.1% and Type 11 Keros was 57.9%. When lateral lamella’s height is longer, the probability increases for AEA to course freely within the ethmoid sinus (p = 0.016). The mean distance of AEA from skull base was 1.93 ± 2.03 mm, orbital floor 21.91 ± 2.47 mm and nasal floor 49.01 ± 3.53 mm.


The position of AEA at skull base depends on the presence of SOEC and length of lateral lamella, but not with SBC. When compared to European population, the mean distance between AEA and nasal floor is shorter in Asians.


Anterior ethmoidal artery Ethmoid cell Suprabullar cell Supraorbital ethmoid cell Cribriform plate Skull base 


Author contributions

BA, MEA, HM and EHL: protocol/project development. BA, MEA, HM and EHL: data collection or management. BA, EHL, HM, MEA, KIM, SH, KS and DYW: data analysis. BA, EHL, HM, MEA, KIM, SH, KS and DYW: manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

KS has been on the speakers’ bureau for Merck Sharp and Dohme, Glaxo Smith Kline and Mylan. All other authors have no financial disclosures or conflicts of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical SciencesUniversiti Sains Malaysia Health CampusKubang KerianMalaysia
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryUniversiti Kebangsaan Malaysia Medical CentreBandar Tun RazakMalaysia
  3. 3.Department of Radiology, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianMalaysia
  4. 4.Department of Otolaryngology Head and Neck Surgery, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand
  5. 5.Department of Otolaryngology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  6. 6.Department of Community Medicine, School of Medical SciencesUniversiti Sains Malaysia Health CampusKubang KerianMalaysia

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