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Anterior Fossa, Orbit, and Perinasal Sinuses

Surgical Correlation

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E, Enlarged view. The superior oblique muscle has been retracted medially to expose the anterior and posterior ethmoidal branches of the ophthalmic artery and nasociliary nerve entering the anterior and posterior ethmoidal canal. The trochlea of the superior oblique muscle is attached to the superomedial margin of the orbit just behind the orbital rim. The frontal nerve divides into supraorbital and supratrochlear branches. F, The levator and superior rectus muscle have been retracted posteriorly to expose the nasociliary nerve, ophthalmic artery, and superior ophthalmic vein passing above the optic nerve. G, Superior view of the anterior fossa in another specimen. The nasal cavity, sphenoid sinus, and orbit have been unroofed. The dura has been removed from the roof and lateral wall of the cavernous sinus. The medial strip below the anterior cranial base is formed, from anterior to posterior, by the frontal, ethmoidal, and sphenoid sinuses. The orbital fat has been removed to expose the intraorbital structures. The frontal nerve courses above the levator muscle. The trochlear nerve passes above the annular tendon to reach the superior oblique muscle. The trochlea of the superior oblique muscle is attached in the superomedial part of the anterior orbit. The lacrimal nerve courses above the lateral rectus muscle. The ophthalmic artery and superior ophthalmic vein are seen in the interval between the levator and superior oblique muscle. The anterior and posterior ethmoidal branches of the ophthalmic artery course through the anterior and posterior ethmoidal canals. H, Enlarged view of cavernous sinus, superior orbital fissure, and orbital apex. The superior oblique, levator, and superior rectus muscles have been removed. The ophthalmic artery and nasociliary nerve enter the orbital apex on the lateral side of the optic nerve and cross between the optic nerve and superior rectus muscle to reach the medial part of the orbit. The optic nerve has been elevated to expose the ophthalmic artery, which courses through the optic canal on the lower side of the optic nerve and enters the orbital apex on the lateral side of the optic nerve. The ophthalmic artery then crosses medially between the optic nerve and superior rectus muscle, as does the nasociliary nerve. The maxillary nerve exits the foramen rotundum to enter the pterygopalatine fossa, and the mandibular nerve exits the foramen ovale to enter the infratemporal fossa. (Images courtesy of AL Rhoton, Jr.)

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