Arteria ethmoidalis anterior'un topografik özelliklerinin görüntüleme yöntemleri kullanılarak incelenmesi
Yükleniyor...
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Arteria ethmoidalis anterior; orbita içerisinde a. ophthalmica’nın distal bölümünden
dallanarak orbita medial duvarındaki foramen ethmoidale anterius’tan orbita’yı terk eder. Daha
sonra labyrinthus ethmoidalis içerisinde değişen uzunluklarda ilerleyerek lamina cribrosa
üzerinden fossa cranii anterior’a girer. Bu üç boşluktaki seyri sırasında önemli yapılarla yakın
ilişki içerisindedir. Orbita içerisindeki, paranazal sinüslerdeki ve cavitas nasi’yi ilgilendiren
varyasyon veya hastalıklarla yakından ilişkilidir. Çalışmadaki amacımız a. ethmoidalis
anterior’un başlangıcından uç dalına kadarki seyri sırasında ilişkili olduğu önemli anatomik
yapılarla ilişkisini araştırmaktır. Bu amaçla; Ege Üniversitesi Tıp Fakültesi Anatomi Anabilim
Dalı kadavra mateyali arşivinden belirlenen altı kafa yarımı ve iki basis crani’de a. ethmoidalis
anterior’un seyri gösterilmiş, Radyoloji Anabilim Dalı görüntü arşivinden elde edilen 200
olguya (400 taraf) ait BT görüntüleri üzerinden de arterin belirlenmesinde işlevsel olabilecek
yapılarla ilişkisi araştırılmıştır. Sonuçlar istastistiksel olarak çalışılmış, literatürle
karşılaştırılarak değerlendirilmiştir. Çalışmamızda a. ethmoidalis anterior çapı ortalama;
kadavralar üzerinden 0,82 mm, BT görüntüleri üzerinden 0,89 mm ölçüldü. Bu arter çoğunlukla
a. ophthalmica’dan dallanıp canalis opticus’un 19,5 mm önünde, crista lacrimalis anterior’un
21 mm gerisindeki foramen ethmoidale anterius’tan orbita’yı terk eder. Labyrinthus
ethmoidalis içerisinde %71 oranında bulla ethmoidalis ile concha nasalis media arasında kafa
tabanından ortalama 3,7 mm aşağıda, 5,6 mm seyrederek lamina cribrosa’ya girer. Labyrinthus
ethmoidalis’teki seyri sırasında concha nasalis inferior’un tutunduğu üst kemik noktasına
uzaklığı yaklaşık 29, palatum durum’a uzaklığı ise 49 mm’dir. Keros ve TMS sınıflaması ile a.
ethmoidalis anterior’un kafa tabanından uzaklığı arasında anlamlı bir ilişki vardır. Yenigün
sınıflaması ile foramen ethmoidale anterius’un orbita’daki yeri arasındaki ilişki bulunsa da
istatistiksel olarak anlamlı değildir, crista galli havalanması olan olgularda bu foramen’in ön
kemik yapılardan derinliğinin azaldığını söyleyebiliriz. Cerrahi girişimlerde a. ethmoidalis
anterior zedelenme riskini belirlemek için orbita içerisinde Yenigün sınıflaması ile 21-12-7
kuralının; cavitas nasi’de Keros, TMS ve Joshi sınıflamasının birlikte değerlendirilmesi yararlı
olacaktır. Çalışmamızın; bölgeyle ilgili klinik bulguların etiyolojisinin araştırılmasında
klinisyene, bölgeye yapılacak girişimlerde güvenli alanlar oluşturmayı amaçlayan cerraha ve
bölge anatomisinin karmaşık özelliklerini standardize etmeye çalışan radyolog ile diğer
araştırmacılara katkı sağlayacağını düşünüyoruz.
Anterior ethmoidal artery; one of the orbital branches of the ophthalmic artery and leaves the orbita from the anterior ethmoidal foramen on the medial wall of the orbit. Then, it goes through the ethmoidal labyrinth and enters the anterior cranial fossa over the cribriform plate. The artery is in close relationship with important structures during its course in these three cavities. It is closely related to variations or diseases in the orbita, paranasal sinuses and nasal cavity. Our aim in this study is to investigate the relationship between the anterior ethmoidal artery and the important anatomical structures during its course from the beginning to the end branch. For this purpose; the course of the artery was shown in six head halves and two cranial base, determined from the cadaver material archive of Ege University Faculty of Medicine, Department of Anatomy; the relationship between the structures and the artery was investigated using the CT images of 200 cases (400 sides) obtained from the image archive of the Department of Radiology. In our study, the mean diameter of the anterior ethmoidal artery was 0.82 mm on cadavers and 0.89 mm on CT images. This artery mostly branches from the ophthalmic artery and leaves the orbit through the anterior ethmoidal foramen; placed 19.5 mm anterior to the optic canal and 21 mm behind the anterior lacrimal crista. Within the ethmoidal labyrinth, the artery was located between the ethmoidal bulla and the middle nasal concha at a rate of 71% and extends approximately 5.6 mm in length. During this course, the distance from the base of the skull was 3.7 mm. During its course in the ethmoidal labyrinth, the distance of the artery to the upper bone point of the lower nasal turbinate was approximately 29 mm, and the distance to the hard palate was 49 mm. There is a significant relationship between Keros and TMS classification and the distance of the anterior ethmoidal artery from the skull base. Although there is a relationship between the Yenigun classification and the place of the anterior ethmoidal foramen in the orbit, it is not statistically significant. In cases with crista galli pneumatization, we can say that the depth of this foramen decreases from the anterior bone structures. In order to determine the risk of injury to the anterior ethmoidal artery during surgical interventions into the orbit, Yenigün classification and rule ‘21-12-7’ will guide the surgeon. For the procedures to be performed in the nasal cavity, it will be useful to evaluate Keros, TMS and Joshi classifications together. We believe that our study will contribute, to the clinician in the investigation of the etiology of clinical findings in the region; the surgeon who aims to create safe areas in the region; radiologists and other researchers who try to standardize the complex features of the anatomy of the sinonasal region.
Anterior ethmoidal artery; one of the orbital branches of the ophthalmic artery and leaves the orbita from the anterior ethmoidal foramen on the medial wall of the orbit. Then, it goes through the ethmoidal labyrinth and enters the anterior cranial fossa over the cribriform plate. The artery is in close relationship with important structures during its course in these three cavities. It is closely related to variations or diseases in the orbita, paranasal sinuses and nasal cavity. Our aim in this study is to investigate the relationship between the anterior ethmoidal artery and the important anatomical structures during its course from the beginning to the end branch. For this purpose; the course of the artery was shown in six head halves and two cranial base, determined from the cadaver material archive of Ege University Faculty of Medicine, Department of Anatomy; the relationship between the structures and the artery was investigated using the CT images of 200 cases (400 sides) obtained from the image archive of the Department of Radiology. In our study, the mean diameter of the anterior ethmoidal artery was 0.82 mm on cadavers and 0.89 mm on CT images. This artery mostly branches from the ophthalmic artery and leaves the orbit through the anterior ethmoidal foramen; placed 19.5 mm anterior to the optic canal and 21 mm behind the anterior lacrimal crista. Within the ethmoidal labyrinth, the artery was located between the ethmoidal bulla and the middle nasal concha at a rate of 71% and extends approximately 5.6 mm in length. During this course, the distance from the base of the skull was 3.7 mm. During its course in the ethmoidal labyrinth, the distance of the artery to the upper bone point of the lower nasal turbinate was approximately 29 mm, and the distance to the hard palate was 49 mm. There is a significant relationship between Keros and TMS classification and the distance of the anterior ethmoidal artery from the skull base. Although there is a relationship between the Yenigun classification and the place of the anterior ethmoidal foramen in the orbit, it is not statistically significant. In cases with crista galli pneumatization, we can say that the depth of this foramen decreases from the anterior bone structures. In order to determine the risk of injury to the anterior ethmoidal artery during surgical interventions into the orbit, Yenigün classification and rule ‘21-12-7’ will guide the surgeon. For the procedures to be performed in the nasal cavity, it will be useful to evaluate Keros, TMS and Joshi classifications together. We believe that our study will contribute, to the clinician in the investigation of the etiology of clinical findings in the region; the surgeon who aims to create safe areas in the region; radiologists and other researchers who try to standardize the complex features of the anatomy of the sinonasal region.
Açıklama
Anahtar Kelimeler
Arteria Ethmoidalis Anterior, Endoskopik Sinüs Cerrahisi, Lamina Cribrosa, Morfometri, Sinus Paranasales, Anterior Ethmoidal Artery, Endoscopic Sinus Surgery, Cribriform Plate, Morphometry, Paranasal Sinuses
