This article reviews the anatomy and clinical significance of the anterior and posterior ethmoid arteries in sinus and skull base surgery. It details their origins, anatomical variations, and vascular territories, emphasizing the anterior ethmoid artery’s role as a key surgical landmark. The discussion includes preoperative imaging considerations, implications for functional endoscopic sinus surgery, and management strategies for epistaxis. The article also compares endoscopic and external approaches for controlling these arteries, highlighting their relevance in complex skull base procedures and surgical planning.