Anterior ethmoidal notch

Last revised by Jeevan K Karuppannan on 11 Feb 2024

The anterior ethmoidal notch contains the anterior ethmoidal artery and has significant rates of anatomic variation that is seen during functional endoscopic sinus surgery (FESS).

The anterior ethmoidal notch lies in the medial wall of the superomedial orbit, adjacent to the anterior ethmoid air cells

  • the notch can be identified bilaterally in 95-100% of patients on coronal reformats, and when not seen bilaterally is present unilaterally 1

During FESS the anterior ethmoidal artery is considered "protected" if the notch is adjacent to the fovea ethmoidalis or lateral lamella. The anterior ethmoidal artery is at increased risk of injury during FESS if there are pneumatized supraorbital anterior ethmoid air cells (occurs in ~30% of patients) 1.

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