‘’Foramen Ethmoidale Anterius’un Orbita İçerisindeki Lokalizasyonunun Bilgisayarlı Tomografi Görüntüleri Üzerinden Değerlendirilmesi’’
Öz
Giriş ve Amaç: Foramen ethmoidale anterius, çoğunlukla m. obliquus superior’un alt ucunun medialinde, etmoid kemiğin orbital laminasının üst sınırında yer alır. Foramenden geçen aynı isimli arterlere klinik yaklaşımda for. ethmoidale anterius ve posterius’un yerleşimi büyük önem taşımaktadır. Endonazal flep yerleştirilmesi veya büyük çaplı menengiyomlara endoskopik yaklaşım gereken durumlarda preoperatif veya intraoperatif olarak arteria ethmoidale anterior ve posterior’un eksternal yaklaşımla ligasyonu gerekebilir. Bu gibi durumlarda ethmoidal arterlerin bulunmasını kolaylaştırmak veya tehikeli olabilecek bölgeleri tanımlamak amacıyla bu çalışma yapılmıştır.
Gereç ve Yöntem: Tıp Fakültesi Hastanesine başvuran 200 erişkin hastanın çok kesitli BT görüntüleri retrospektif olarak değerlendirildi. Çalışmadan dışlanma kriterleri: Kötü görüntü kalitesi, kafa tabanı veya paranazal sinüs cerrahisi öyküsü, konjenital fasiyal anomali, etmoid çatıda erozyona neden olan mevcut veya önceki hastalık öyküsü, 18 yaşından küçük ve 70 yaşından büyük olmak. Foramen ethmoidale anterius’tan midsagital hatta, FEA ile orbita medial anterior noktası olan crista lacrimalis anterior’a, for. ethmoidale anterius ve posterius arasındaki mesafe, for. ethmoidale anterius ile canalis opticus ve for. ethmoidale anterius ile orbita üst sınırı arasındaki uzaklık ölçülmüştür. Bulgular yaş ve cinsiyete göre değerlendirilmiştir.
Bulgular: Çalışmaya alınan olguların yaş ortalaması 46 ± 14 idi. Foramen ethmoidale anterius’un orbita tavanına vertikal uzaklığı ortalama 11.5 mm, midsagital hatta uzaklık 12.1 ± 1.1 mm; crista lacrimalis anterior’a uzaklığı 21.0 mm; for. ethmoidale posterius’a uzaklığı ortalama 12.5 mm; for. ethmoidale posterius’un canalis opticus’a uzaklığı 7.2 mm bulunmuştur. Foramen’in midsagital hatta ve orbita tavanına uzaklığının erkeklerde ortalama 0.5 mm daha fazla olması istatistiksel olarak anlamlıydı (p sırasıyla 0.001 ve 0.017).
Tartışma ve Sonuç: Bu çalışmada crista lacrimalis anterior’dan for. ethmoidale anterius’a, buradan for. ethmoidale posterius’a ve for. ethmoidale posterius’tan canalis opticusa ortalama mesafe sırasıyla 21 – 12 - 7 mm olarak hesaplandı. Endoskopik sinüs cerrahisi veya orbita medial duvarını ilgilendiren cerrahi yaklaşımlara yol göstermeyi amaçlayan bazı çalışmalarda bu değerler temelde 24 – 12 – 6 mm ve 21 – 14 – 7 mm olarak ön görülmektedir. Türkiye populasyonu baz alınarak yapılan bu çalışmada literatürle uyumlu olsa da cerrahi girişimlerde anlamlı olabilecek küçük farklılıkların izlenmiş olması dikkat çekicidir.
Anahtar Kelimeler
arteriyal ligasyon epistaksis ethmoid kemik intraorbital meningiom orbita kırıkları
Kaynakça
- Abed SF, Shams P, Mmed SS, Adds PJ, Uddin JM. A Cadaveric Study of the Morphometric and Geometric Relationships of the Orbital Apex. 2011;30(2):72–6.
- Berens AM, Davis GE, Moe KS. Transorbital endoscopic identification of supernumerary ethmoid arteries. Allergy Rhinol (Providence). 2016 Jan 1;7(3):144-146.
- Cecchini G. Anterior and Posterior Ethmoidal Artery Ligation in Anterior Skull Base Meningiomas: A Review on Microsurgical Approaches. World Neurosurg. 2015;84(4):1161–5.
- Celik S, Asim M, Kazak Z, Govsa F. Computer-assisted analysis of anatomical relationships of the ethmoidal foramina and optic canal along the medial orbital wall. Eur Arch Oto-Rhino-Laryngology. 2015;272(11):3483–90.
- Cornelis MM, Lubbe DE. Pre-caruncular approach to the medial orbit and landmarks for anterior ethmoidal artery ligation: a cadaveric study. Clin Otolaryngol. 2016;41(6):777-781.
- Felding UA, Karnov K, Clemmensen A, Thomsen C, Darvann TA, Buchwald C Von, et al. An Applied Anatomical Study of the Ethmoidal Arteries: Computed Tomographic and Direct Measurements in Human Cadavers. J Craniofac Surg. 2018;29(1):212–6.
- Floreani S, Nair S, Switajewski M, Wormald P. Endoscopic Anterior Ethmoidal Artery Ligation: A Cadaver Study. Laryngoscope. 2006;116(7):1263-1267.
- Gotwald TF, Menzler A, Beauchamp NJ, Zur Nedden D, Zinreich SJ. Paranasal and Orbital Anatomy Revisited: Identification of the Ethmoid Arteries on Coronal CT Scans. Crit Rev Comput Tomogr. 2003;44(5):263–78.
- Gupta A, Ghosh S, Roychoudhury A. Radiological and clinical correlations of the anterior ethmoidal artery in functional endoscopic sinus surgery. J Laryngol Otol. 2022;136(2):154-157.
- Karakas P, Bozk G. Morphometric measurements from various reference points in the orbit of male Caucasians. 2002;358–62.
- McDonald SE, Robinson PJ, Nunez DA. Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery. J Laryngol Otol. 2008;(June 2007):264–7.
- Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Abarca-Olivas J, Sánchez-Del Campo F, Gras-Albert JR. Radiological Anatomy of the Ethmoidal Arteries: CT Cadaver Study. Acta Otorrinolaringol (English Ed. 2011;62(5):367–74.
- Naidoo Y, Wormald PJ. Endoscopic and Open Anterior/Posterior Ethmoid Artery Ligation. Atlas Endosc Sinus Skull Base Surg. 2019;25-32.e1.
- Piagkou M, Skotsimara G, Dalaka A, Kanioura E, Korentzelou V, Skotsimara A, et al. Bony Landmarks of the Medial Orbital Wall : An Anatomical Study of Ethmoidal Foramina. 2014;577(July 2013):570–7.
- Sahu N, Casiano RR. Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus. Int Forum Allergy Rhinol. 2019;9(5):562–6.
- Vatanasapt P, Thanaviratananich S, Chaisiwamongkol K. Landmark of ethmoid arteries in adult Thai cadavers: application for sinus surgery. J Med Assoc Thai. 2012 Nov;95 Suppl 11:S153-6.
Öz
The locations of the anterior and posterior ethmoidal foramen have a great importance in the clinical approach to the arteries of the same name passing through foramens. In cases where endonasal flap placement or endoscopic approach to higher diameter meningiomas are required, ligation of anterior and posterior ethmoidal arteries with an external approach is performed preoperatively or intraoperatively. In such cases, this study was conducted to facilitate the detection of ethmoidal arteries or to identify potentially dangerous areas.Cross-section CT images of 200 adult patients were evaluated retrospectively. Exclusion criteria from the study were: History of skull base or paranasal sinus surgery, congenital facial anomaly, history of current or previous disease causing erosion of the ethmoid roof, being younger than 18 years old and older than 70 years of age, and poor image quality. The mean horizontal distance from anterior ethmoidal foramen to the midsagittal line, distance from anterior ethmoidal foramen to anterior orifice of the optic canal, distance between the anterior and posterior ethmoidal foramen, distance between the anterior ethmoidal foramen and upper border of the orbita and from the anterior lacrimal crest to the anterior ethmoidal foramen were measured. Findings were evaluated according to age, right-left side and gender.The mean age of the subjects included in the study was 46±14 years. The mean distance of the anterior ethmoidal foramen to the roof of the orbit was 11.5 mm, to the midsagittal line was 12.1±1.1 mm; to anterior lacrimal crest was 21.0 mm; to the posterior ethmoidal foramen was 12.5 mm; the distance of the posterior ethmoidal foramen to the optic canal was 7.2 mm. The mean distance of the anterior ethmoidal foramen to the midsagittal line and the orbital roof was 0.5 mm longer in males, which was statistically significant (p is 0.001 and 0.017, respectively).In this study, the mean distance from the anterior lacrimal crest to the anterior ethmoidal foramen, from there to the posterior ethmoid foramen and from the posterior ethmoid foramen to the optic canal was calculated as 21–12-7 mm, respectively. In some studies aiming to guide surgical approaches involving medial wall of the orbit or the endoscopic sinus surgery, these values are mainly predicted as 24–12–6 mm and 21–14–7 mm, respectively. Although this study, based on the Turkish population, is compatible with the literature, it is noteworthy that small differences that may be significant were observed in surgical interventions.
Anahtar Kelimeler
Arterial ligation epistaxis ethmoid bone intraorbital meningioma orbital fractures
Kaynakça
- Abed SF, Shams P, Mmed SS, Adds PJ, Uddin JM. A Cadaveric Study of the Morphometric and Geometric Relationships of the Orbital Apex. 2011;30(2):72–6.
- Berens AM, Davis GE, Moe KS. Transorbital endoscopic identification of supernumerary ethmoid arteries. Allergy Rhinol (Providence). 2016 Jan 1;7(3):144-146.
- Cecchini G. Anterior and Posterior Ethmoidal Artery Ligation in Anterior Skull Base Meningiomas: A Review on Microsurgical Approaches. World Neurosurg. 2015;84(4):1161–5.
- Celik S, Asim M, Kazak Z, Govsa F. Computer-assisted analysis of anatomical relationships of the ethmoidal foramina and optic canal along the medial orbital wall. Eur Arch Oto-Rhino-Laryngology. 2015;272(11):3483–90.
- Cornelis MM, Lubbe DE. Pre-caruncular approach to the medial orbit and landmarks for anterior ethmoidal artery ligation: a cadaveric study. Clin Otolaryngol. 2016;41(6):777-781.
- Felding UA, Karnov K, Clemmensen A, Thomsen C, Darvann TA, Buchwald C Von, et al. An Applied Anatomical Study of the Ethmoidal Arteries: Computed Tomographic and Direct Measurements in Human Cadavers. J Craniofac Surg. 2018;29(1):212–6.
- Floreani S, Nair S, Switajewski M, Wormald P. Endoscopic Anterior Ethmoidal Artery Ligation: A Cadaver Study. Laryngoscope. 2006;116(7):1263-1267.
- Gotwald TF, Menzler A, Beauchamp NJ, Zur Nedden D, Zinreich SJ. Paranasal and Orbital Anatomy Revisited: Identification of the Ethmoid Arteries on Coronal CT Scans. Crit Rev Comput Tomogr. 2003;44(5):263–78.
- Gupta A, Ghosh S, Roychoudhury A. Radiological and clinical correlations of the anterior ethmoidal artery in functional endoscopic sinus surgery. J Laryngol Otol. 2022;136(2):154-157.
- Karakas P, Bozk G. Morphometric measurements from various reference points in the orbit of male Caucasians. 2002;358–62.
- McDonald SE, Robinson PJ, Nunez DA. Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery. J Laryngol Otol. 2008;(June 2007):264–7.
- Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Abarca-Olivas J, Sánchez-Del Campo F, Gras-Albert JR. Radiological Anatomy of the Ethmoidal Arteries: CT Cadaver Study. Acta Otorrinolaringol (English Ed. 2011;62(5):367–74.
- Naidoo Y, Wormald PJ. Endoscopic and Open Anterior/Posterior Ethmoid Artery Ligation. Atlas Endosc Sinus Skull Base Surg. 2019;25-32.e1.
- Piagkou M, Skotsimara G, Dalaka A, Kanioura E, Korentzelou V, Skotsimara A, et al. Bony Landmarks of the Medial Orbital Wall : An Anatomical Study of Ethmoidal Foramina. 2014;577(July 2013):570–7.
- Sahu N, Casiano RR. Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus. Int Forum Allergy Rhinol. 2019;9(5):562–6.
- Vatanasapt P, Thanaviratananich S, Chaisiwamongkol K. Landmark of ethmoid arteries in adult Thai cadavers: application for sinus surgery. J Med Assoc Thai. 2012 Nov;95 Suppl 11:S153-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Makaleler |
| Yazarlar | |
| Erken Görünüm Tarihi | 18 Eylül 2023 |
| Yayımlanma Tarihi | 30 Eylül 2023 |
| Gönderilme Tarihi | 30 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 6 Sayı: 2 |
Kaynak Göster
