By Marcos V. Goycoolea, Michael M. Paparella, Rick L. Nissen
Ebook via Goycoolea, Marcos V., Paparella, Michael M., Nissen, Rick L.
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Additional info for Atlas of Otologic Surgery
I he brain is then removed, care being taken to section cranial nerves Vll and VIII sharplv at the surface of the internal auditorv meatus (I ig. 4 - M ) . Thus the nerve trunks remain with the temporal bom- specimen. 1 he two most c o m m o n methods of removal arc (1) the block method and (2) the bone plug method Block Method (Fig. 4 - 1 B ) A motor-driven saw or, preferably, a Strvker saw* (rocker-type oscillating saw) is used. Four saw cuts are made. The first (1) is made at a right angle, as close to the apex of the petrous bone as the regional anatomy will allow.
2. Large meatoplasty is crucial for the success of the procedure. Pitfalls 1. Incomplete removal of the posterior meatal wall.. 2. Poor meatoplasty. Surgical 67 Intact Bridge M a s t o i d e c t o m y The "bridge" is the most medial portion of the posterosuperior meatal wall; it is literally the bridge that crosses the attic toward the tegmental area. It has both anterior and posterior buttresses. The anterior buttress is the superior portion where the posterior bony canal meets the tegmen. The posterior buttress is the inferior portion where the posterior bony canal meets the floor of the external auditory canal, lateral to the facial nerve.
5 - 2 4 B ) . Palpate the ossicles, J a c o b s o n ' s nerve, the round window niche area, and the opening of the eustachian tube, and identify the tensor tympani. Cochlear Implant (Mastoidotomy-Tympanotomy Approach) R e m o v e the skin, leaving the a n n u l u s intact. Identify t h e t y m p a n o s q u a m o u s s u t u r e s u p e r i o r l y a n d t h e t y m p a n o m a s t o i d suture posteriorly. B e t w e e n the su- Aim tures is the vascular strip. Identify the anterior wall a n d carefullv drill the anterior b o n v overhang with- out temporomandibular entering the joint space.
Atlas of Otologic Surgery by Marcos V. Goycoolea, Michael M. Paparella, Rick L. Nissen