Surgical and Radiologic Anatomy

, Volume 41, Issue 5, pp 491–499 | Cite as

Anatomical variations of anterior ethmoidal artery and their significance in endoscopic sinus surgery: a systematic review

  • Baharudin AbdullahEmail author
  • Eng Haw Lim
  • Salina Husain
  • Kornkiat Snidvongs
  • De Yun Wang



Anterior ethmoidal artery (AEA) is at risk of injury in endoscopic sinus surgery due to its location. The aim of this review was to assess the anatomical variations of AEA and their significance.


A literature search was performed on PUBMED, SCOPUS AND EMBASE. The following keywords were used: ethmoidal artery; anterior ethmoidal artery; anterior ethmoidal canal; ethmoid sinus; ethmoid roof; skull base. The search was conducted over a period of 6 months between October 2016 and April 2017.


105 articles were retrieved. 76 articles which were either case reports or unrelated topics were excluded. Out of the 29 full text articles retrieved, 16 articles were selected; 3 were cadaveric dissection, 5 combined cadaveric dissection and computed tomography (CT) and the rest were of CT studies. All studies were of level III evidence and a total of 1985 arteries were studied. Its position at the skull base was influenced by the presence of supraorbital ethmoid cell (SOEC) and length of the lateral lamella of cribriform plate (LLCP). Inter population morphological variations contribute to the anatomical variations.


The average diameter of AEA was 0.80 mm and the intranasal length was 5.82 mm. 79.2% was found between the second and third lamellae, 12.0% in the third lamella, 6% posterior to third lamella and 1.2% in the second lamella. Extra precaution should be taken in the presence of a well-pneumatized SOEC and a long LLCP as AEA tends to run freely below skull base.


Anterior skull base Endoscopic sinus surgery Sinus anatomy Skull base Endoscopic skull base surgery 


Author contributions

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

Compliance with ethical standards

Conflict of interest

K. S. has been on the speakers’ bureau for Merck Sharp & 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 Otolaryngology-Head and Neck Surgery, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianMalaysia
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
  3. 3.Department of Otolaryngology Head and Neck Surgery, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand
  4. 4.Department of Otolaryngology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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