Abstract
(1) Background: For good surgical performance, sound knowledge of anatomy is required. Although the ethmoid air cells and sphenoid sinuses are subject to a high degree of variation, their possible extensions above the nasal fossa at the posterior end of the cribriform plate of the ethmoid bone (CPEB) were seemingly overlooked. (2) Methods: We retrospectively studied 162 case files from 55 male and 107 female cases, with ages varying from 42 to 80, which were scanned using Cone Beam Computed Tomography. (3) Results: In 56.17% of cases, an unpneumatized CPEB (type I) was found. Nasal roof recesses of ethmoidal origin (type II) were found at the posterior end of the CPEB in 20.37% of cases. Different types of sphenoidal pneumatizations of the posterior end of the CPEB (type III) were found in 22.83% of the cases. Onodi cells projected nasal roof recesses (type IV) in only 10 cases. In all types, nasal roof recesses were found either above the CPEB or within/underneath it. Moreover, such nasal roof recesses were found to be either unilateral, extended contralaterally, or bilateral. (4) Conclusions: As such recesses of the posterior CPEB, previously overlooked, belong to the posterior rhinobase, they should be carefully documented preoperatively to avoid unwanted surgical damage to the olfactory bulb or CSF fistula.
Highlights
The preoperative diagnostic tools currently available allow for a great therapeutic effect and minor iatrogenic injuries [1]
The CPEB is located at the junction of the frontal sinuses, anterior cranial fossa (ACF), and nasal fossae and is relevant for ENT surgeons and neurosurgeons [2]
As the CPEB is a thin portion of the skull base, it is susceptible to lesions [7,8]
Summary
The preoperative diagnostic tools currently available allow for a great therapeutic effect and minor iatrogenic injuries [1]. The floor of the anterior cranial fossa (ACF) is mainly formed in its median region by the cribriform plate (sieve plate) of the ethmoid bone (CPEB) fitted into the ethmoidal notch of the frontal bone [1]. The CPEB is located at the junction of the frontal sinuses, ACF, and nasal fossae and is relevant for ENT surgeons and neurosurgeons [2]. Anatomic variations of the ethmoid air cells and nasal fossae are common and of clinical relevance to endoscopic surgical management in this area [5]. Occurring arterial variants above the CPEB, such as the nasal branch of the persisting primitive olfactory artery [11], indicate that the common anatomical details on that plate are not exclusive
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