temporal bone resection
TRANSCRIPT
Temporal bone resection 3-10-20161.36 pm
Great teachers – All this is their work . I am just the reader of their books .
Prof. Paolo castelnuovo
Prof. Aldo Stamm Prof. Mario Sanna
Prof. Magnan
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Lateral temporal bone resection cadaver video click
https://www.youtube.com/watch?v=mjRGsEidrL8
Piece meal resection (STBR + ITFA - A + superficial parotidectomy) for TBSCC. Here the facial nerve is
spared and rerouted.
Superficial parotidectomy must be done in temporal bone malignancy because first level of draining lymph nodes present in the parotid – Dr.Satish jain
Sampath Chandra Prasad Section of the EAC taking care to achieve good margins. Blind sac closure of the remaining skin of
EAC. Frozen section of margins
STBR can be married into a variety of procedures depending upon the disease extension. Here sub total petrosectomy (drilling out all the mastoid-middle ear air cells) is carried out along with Infratemporal fossa type B approach wherein FN is
completely isolated and transposed. Note that superficial parotidectomy is being done which also helps release the facial nerve.
Facial nerve completely exposed from mastoid to parotid segment. SP completed.
Facial nerve completely tansposed anteriorly for which the nerve is drilled upto the geniculate ganglion. The GSPN is sectioned to obtain the release of the nerve. The nerve along with the
parotid is sutured anteriorly to the flap
This is done to obtain exposure of the infratemporal fossa. Here the tumor was involving the hypotympanum. Hence the entire tympanic bone was removed. Note the exposure of the middle
fossa dura, carotid and the jugular bulb.
Sampath Chandra Prasad Facial nerve transposed posteriorly. Carotid canal can be clearly seen. Jugular foramen completely exposed after excision of the
IJV along with the jugular bulb.
While removing the temporal bone malignancy at Parisier’s triangle ( dangerous triangle ) we have to very careful , higher chances of injuring the labyrinthine part of facial nerve if we are not careful in clearing the tumor at parisier’s triangle.
PARISIER'S TRIANGLE (DANGEROUS TRIANGLE)
Perisier's triangle is very important triangle in endoscopic ear surgery1) Superior limb is formed by inferior part of HFN 2) The apex is formed by the geniculate ganglion
3) The base is formed by the anterior commissure (end) of oval window 4) Inferior limb is formed by tunning point of jocobson's nerve to the the
geniculate ganglion.
• The surgical implications are
1) This triangle contains labyrinthine part of FN. 2) During transotic or transcochlear approaches surgeon should respect this triangle and drill carefully to avoid injury to FN. 3) Clinically labyrinthine part consists of two segments a meatal segment of nerve, labyrinthine part of nerve. total length of this nerve is 3 to 5 mm. Anteriorly we can see these parts clearly through this triangle. 4) 1st part of FN passes close to lower border of precochlear HFN towards anterior end of oval window in this triangle. 5) Irregular drilling of cochlea in this triangle damages FN That is why it is called DANGERS TRIANGLE. 6) During trans meatal endoscopic dissection of IAC, this triangle important for identification of nerves7) Translabyrinthine approach visualises posterior surface of 1st part of FN, in transcochlear approaches the anterior surface of the nerve is exposed. In transottic approaches 270 to 320 degrees of 1 st part of FN is exposed. 8)Observe closely the labyrinthine part of FN there is a constriction of labyrinthine segment and meatal segment. Facial nerve key points1) Facial nerve changes direction 5 times during its course from brain stem to styloid foramen. 2) No other nerve in body covers such a long distance in bony canal3) facial nerve contains 10000 axons that are responsible for the innervation of the face musculature and also for the communications with other nerves human body4) work with injured facial nerve requires lot of patience.
Sampath Chandra Prasad cavity obliterated with fat
Sampath chandra prasad did this case
• https://www.facebook.com/groups/learningent/permalink/731085130262697/
Steps in subtemporal resection with neck dissection and total parotidectomy (my dad's style of en-block resection). At Gruppo Otologico, we do a piece meal
resection. – click
https://www.facebook.com/groups/learningent/permalink/731072510263959
/
Lot of material to update – stay tuned
For Other powerpoint presentatioins of “ Skull base 360° ”
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