The relationship between anterior etmoidal artery course and supraorbital etmoid cell and keros classification in computerized tomography

The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. It is among the important anatomical structures that need to be identified and preserved in order to avoid complications. Our aim is to evaluate the course of AEA according to the skull base, according to the Keros classification and the presence of supraorbital ethmoid cells (SOEH), and to prevent possible related complications by demonstrating the importance of imaging with pre-operative paranasal CT. Thus, the efficiency and patient safety of endoscopic sinus surgery will be increased. MATERIAL AND METHOD In our study all the patients admitted to the emergency department of Dicle University Medical Faculty Hospital between March 2012 and August 2019 with trauma and acute abdominal pain is evaluated retrospectively using with and without contrast according to number,size,location ort he distribution of the patients.Total of 280 patients with 200 trauma and 80 acutte abdomen is included in the study.The cases consist of 184 male and 96 female patients.In the control group trauma patients who had following diagnosis is presented with acute abdomen,acute appendicitis,acute enterocolitis,ovarian torsion,ovarian cyst,ileus,acute cholecystitis,invagination,epiploic appendigitis,duodenum perforation,acute pancreatitis,ureteral stone,pyelonephritis,mesenteric torsion.Patients with diagnosed lymphproliferative disease is not included in the study because they may lead to misinterpretation of the results. FINDINGS Paranasal CT images of patients over the age of 18 who underwent non-contrast paranasal CT scan on 16 and 64 Detector Computed Tomography devices due to various complaints between October 2020 and November 2021 in the Department of Radiology of Dicle University were retrospectively analyzed. Paranasal CT images without contrast of the patients were evaluated primarily in the coronal plane, and the variations of AEA according to the skull base and its relationship with the Keros classification and SOEH were evaluated by using the sagittal and axial planes. A total of 1000 cases (2000 samples on the right and left) between the ages of 18-80 were included in the study. In our study, patients under the age of 18 who had paranasal anomalies, a space-occupying mass and sinusitis, who had sinus surgery, who applied for facial trauma, who had artifacts, images where any AEA on the right or left could not be evaluated, and who were under the age of 18 were excluded from the study. RESULT In accordance with the literature, the probability of having Grade 3 AEA in patients with high Keros classification and SOEH was also significantly higher in our study. Therefore, we think that pre-op imaging can predict the course of AEA and guide the surgeon according to the keros classification and the presence of SOEH.