Endoscope assisted middle ear surgery
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This document discusses endoscope-assisted middle ear surgery. Some key points: 1) Endoscopes allow wide field visualization with minimal exposure and can see behind obstructions or into recesses with less surgical exposure than conventional techniques. 2) Endoscopes are useful for visualizing the epitympanic recess, facial recess, sinus tympani, Eustachian tube, and hypotympanum. 3) Potential indications for middle ear endoscopy include unexplained conductive hearing loss, trauma, cholesteatoma, perilymph fistula, and follow-up for cholesteatoma.
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2) Ossiculoplasty surgically repairs the ossicular chain to restore conduction. Materials used include autografts, allografts, and synthetic grafts.
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Mastoidectomy is a surgical procedure to access and treat infections of the mastoid air cells behind the ear. Over time, the procedure has evolved from simple cortical mastoidectomies described in the 17th century to more advanced techniques using an operating microscope and drill. Modern mastoidectomies are typically classified as canal wall up or canal wall down depending on whether the bony ear canal wall is preserved. Indications include treatment of cholesteatoma, refractory ear infections, and approaches for other inner ear procedures. The surgery involves an incision behind the ear to access and clean out the infected mastoid air cells.
Anatomy of External Ear and Middle Ear
Anatomy of Ear, Anatomy of External Ear, Anatomy of Middle Ear
Hope it will be helpful for you.
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Dr Diptiman Baliarsingh
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Anatomy of middle ear
The document summarizes the anatomy of the middle ear, including its walls, contents, spaces, blood supply, and related structures like the ossicles, muscles, nerves and mucosa. It describes the embryology, locations, and relationships between the malleus, incus, stapes, tensor tympani muscle, stapedius muscle, chorda tympani nerve, and tympanic plexus. It also discusses the spaces within the middle ear like the epitympanum, mesotympanum, and hypotympanum.
Clinical anatomy of the middle ear
anatomy of the middle ear, cochlear implantation, posterior tympanotomy, stapedotomi, facial nerve, internal carotid artery,
Anatomy of external n middle ear
This document provides an overview of the anatomy of the external ear, middle ear, and related structures. It describes the embryology, structures, blood supply, nerve supply, and anomalies of the pinna, external auditory meatus, tympanic membrane, middle ear cavities, ossicles, muscles, and Eustachian tube. Key areas covered include the compartments of the middle ear, walls of the tympanic cavity, course of nerves like the chorda tympani and facial nerve, and mastoid air cell system.
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Anatomy & embryology ext ear & middle ear
The document provides an overview of the anatomy and embryology of the external and middle ear. It describes how the external ear develops from the first and second pharyngeal arches. It then details the anatomy of the auricle, external acoustic canal, and tympanic membrane. For the middle ear, it discusses the embryological development and describes the structures of the middle ear cleft, tympanic cavity, ossicles, muscles, nerves and blood supply.
ANATOMY OF MIDDLE EAR CLEFT
The tympanic cavity, which is part of the middle ear cleft, contains the ossicles, muscles and other structures. It is divided into three compartments - the epitympanum, mesotympanum, and hypotympanum. The lateral wall is formed by the tympanic membrane and bony walls above and below. The medial wall separates the cavity from the inner ear and contains prominent features like the oval window and round window niche. The anterior, posterior and medial walls each have distinct anatomical structures and landmarks that are important for middle ear surgery.
Anatomy of the middle ear
The document summarizes the anatomy of the middle ear, which consists of the tympanic cavity, Eustachian tube, and mastoid air cell system. The tympanic cavity contains the three ossicles (malleus, incus, stapes), two muscles (tensor tympani and stapedius), the chorda tympani nerve, and tympanic plexus. It is further divided into compartments and its walls, contents, and structures like the ossicles, nerves, muscles are described in detail.
Mastoidectomy Epitympanum
1. The facial recess is a collection of air cells located lateral to the facial nerve at the external genu. It can provide a route for middle ear disease to spread to the mastoid area.
2. Opening the facial recess during surgery for chronic ear disease provides additional drainage pathways and better visualization of the middle ear cavity and facial nerve.
3. The landmarks used to expose the facial recess include the external genu of the facial nerve, fossa incudis, chorda tympani nerve, and tympanic membrane. The facial recess is dissected by identifying these landmarks with microscopes and thin-burring the bone between them.
The history of Cochlear implantation - Dr. Dr. h.c. Monika Lehnhardt
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Endoscope assisted middle ear surgery
- 2. •“ endoscopy is an adjunct to microscope but never a substitute”
- 3. Endoscopes offer the surgeon the : • capability of wide field visualization with minimal exposure, • looking behind the obstructions or overhangs and • peering into recesses with much less requirement for surgical exposure than demanded by conventional techniques.
- 4. • endoscopes help in angled vision at tip allowing off line-of-site visualization Off Line-of-Sight Structures: • Middle ear Epitympanic recess • Facial recess • Sinus tympani • Eustachian tube • Hypotympanum
- 5. MIDDLE EAR ENDOSCOPY – POTENTIAL INDICATIONS: • Unexplained conductive hearing loss • Trauma • Cholesteatoma • Perilymph fistula • Follow-up (second look) cholesteatoma
- 6. FACIAL RECESS: • Shallow depression on the posterior wall of tympanic cavity Relations: Medial wall : PE, vertical segment of FN Lateral wall : bony annulus
- 7. SINUS TYMPANI: • Relations: Sup- ponticulus Inf- subiculum Lat – mastoid segment of facial nerve
- 9. ST CLASSIFICATION WITH ENDOSCOPY: • Classical shape: medial to the facial nerve and to the pyramidal process • Confluent shape: absent ponticulus • Partitioned shape: when a ridge of bone extending from the third portion of the facial nerve to the promontory area is present, separating the sinus tympani into two portions (superior and inferior) • Restricted shape: when a high jugular bulb is present thus reducing the size of ST
- 10. TRANSTYMPANIC ENDOSCOPY • Endoscopy through perforation /myringotomy for a limited middle ear exploration. TECHNIQUE: • Position- supine • Local anaesthetic- phenol solution • Myringotomy incision : at site of pathology (PLF-half way b/w RWN shadow and distal end of long process of incus
- 11. ENDOSCOPY IN CHRONIC EAR SURGERY • As a adjuvant for removal of cholesteatoma • For cholesteatoma in deep recesses • For ds limited to aditus ,antrum ,ST,FR (mastoidectomy avoided) • Perform intact canal wall mastoidectomy +endoscopy(avoids canal wall down technique) • Used if firm adhesions of cholesteatoma sac to recesses , blind elevation results in tearing the matrix and residual ds, • Lessen the need for second look procedure
- 12. • Thomassin et .al: Only canal wall up procedure: 47.7% has residual procedure and planned for second stage procedure Canal wall up+endoscopic removal: only 5.5% required second stage procedure , results are on par with canal wall down procedure
- 13. DISADVANTAGES: • One handed surgery • Bleeding hard to manage • Passing instruments past endoscope • Fogging • Cannot be very helpful if disease involves mastoid antrum
- 14. ENDOSCOPIC TYMPANOPLASTY MOSTLY DONE IN • Anterior perforation / anterior bony overhang • Marginal perforation
- 15. ENDOSCOPIC ASSISTANCE IN STAPEDOTOMY: • Anterior crus and anterior part of foot plate better visualised using endoscope than microscope
- 16. PERILYMPH FISTULA EXPLORATION: • ME endoscopy proably improve the ability to identify true peri-lymph fistula and reduce the number of false positive examination whereas open surgical exploration cannot eliminate the artefactual pooling of infilitrated anaesthetics and surgery induced transudates
- 17. ENDOSCOPY OF EAC AND T.M • Photo documentation • T.M and medial E.A.C (canal stenosis/obstruction) • Bony canal defects • Recesses • To determine depth and presence of cholesteatoma in retraction pockets