Cadaveric and Computed Tomography Analysis of the Anterior Ethmoidal Artery Flap

Background The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flap's axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width. Methods Ten fresh latex‐injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally. Results From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1–1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm. Conclusions Based on the non‐vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0–2.3 cm. Level of Evidence NA Laryngoscope, 134:2100–2104, 2024 The anterior ethmoidal artery (AEA) flap was first described in 2011 and has been highly successful for repairing nasal septal perforations. The AEA branches are often published in a vertical orientation, however our study demonstrates a consistent non‐vertical orientation. Based on cadaver and CT analysis, the AEA flap is a random transposition flap with a mean flap length of 6–7 cm.