Lise-Marie Roussel1, Vincent Patron1, Eric Maubert2, Clément Escalard3, Didier Goux4, Vincent Beaudouin5, Emmanuèle Lechapt6, Sylvain Moreau1,7, Martin Hitier1,7,8. 1. Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier Universitaire (CHU) de Caen, Caen, France. 2. Institut National de la Santé et de la Recherche Médicale (INSERM) U 919 Sérine Protéases et Physiopathologie de l'Unité neurovasculaire, Cycéron Université de Caen (UNICAEN), Caen, France. 3. Department of Radiology, Centre Hospitalier Universitaire (CHU) de Caen, Caen, France. 4. Centre de Microscopie Appliquée à la Biologie, Université de Caen (UNICAEN), Caen, France. 5. Unite Mixte de Recherche (UMR) U 6301 Imagerie et Stratégies Thérapeutiques des pathologies Cérébrales et Tumorales, Cycéron, Université de Caen (UNICAEN), Caen, France. 6. Department of Anatomopathology, Centre Hospitalier Universitaire (CHU) de Caen, Caen, France. 7. Department of Anatomy, Université de Caen (UNICAEN), Caen, France. 8. INSERM U 1075 COMETE, Caen, France.
Abstract
BACKGROUND: Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. METHODS: Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. RESULTS: The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." CONCLUSION: The clinical applications of this new anatomic description concern both cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.
BACKGROUND: Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. METHODS: Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. RESULTS: The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." CONCLUSION: The clinical applications of this new anatomic description concern both cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.