By Vittorio, M.D. Colletti, James E. Benecke

Modern microsurgical concepts have unfolded a brand new horizon for the otoneurosurgeon. This quantity is a crucial contribu­ tion to the coed who's studying those surgical techniques. Surgical otoneurology has now handed the infancy degree, yet remains to be a teen. As extra otologists and neurosurgeons turn into expert during this form of surgical procedure, new and higher methods will evolve. definitely there has to be far better administration of the carotid artery because it passes throughout the temporal bone. greater concepts to maintain the IX, X, and XI nerves within the jugular bulb zone will be built, and extra soft strategies for administration of lesions contained in the cochlea and vestibular labyrinth will be constructed. As our diagnostic options have more advantageous, really via imaging, surgical strategies to check the enhanced diagnostic suggestions will emerge. For destiny otoneurologists who're pre­ pared, many difficulties related to the temporal bone which are now thought of untreatable may be effectively controlled for terribly thankful sufferers. the aim of this article is to familiarize the otoneurosur­ geon with the anatomy of the temporal bone, cranium base, infratem­ poral fossa, and cerebellopontine attitude. This anatomy can be taught by way of demonstrating surgeries. This atlas that is an instance of cooperation among the universities of la and Verona will let the reader to rehearse otoneurosurgical tactics within the laboratory, and, whilst the innovations were mastered, practice a number of the ways within the remedy of internal ear and cranium base lesions. William F. condominium MD.

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A routine facial recess approach is accomplished 2. The retrofacial air tract is opened exposing the endolymphatic sac. 53 3. A labyrinthectomy is performed. 4. The incus and malleus head are removed. 5. The facial nerve is skeletonized from stylomastoid foramen to geniculate. The hook is transecting the greater superficial petrosal nerve. 54 6. The facial nerve is mobilized from the fallopian canal. 7. The facial nerve is now rerouted posteriorly. 8. With the facial rerouted, drilling proceeds deep to the nerve to expose the cochlea.

B. The plane between the temporalis fascia and the overlying soft tissues is developed and the skin flaps are widely undermined. A large self-retaining retractor is inserted. C. Management of the temporalis muscle de- pends upon the underlying condition for which the surgery is being performed. If a vestibular nerve section is to be performed, or if the surgeon is draining a lesion of the petrous apex, situations where facial nerve injury is unlikely, then the traditional vertical muscle splitting incision may be employed.

MIDDLE FOSSA SURGERY Surgery through the middle fossa has many applications for the oto-neurological surgeon. Vestibular neurectomy can be accomplished by this route, though the authors prefer the retrolabyrinthine approach. Total facial nerve decompression and exploration can be achieved through the middle fossa. This approach also provides access to the petrous apex for the treatment of cholesterol granuloma or apicitis. And finally, small acoustic tumors can be removed via the middle fossa where preservation of hearing is desired.

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