Abstract
IntroductionMicrosurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. ObjectiveThe aim of this study is to determine anatomic variations of the middle ear in an autopsy series. MethodsAll evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. ResultsOne hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. ConclusionThe pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.
Highlights
Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy
The other two sinuses are in the middle of the Fallopian canal: posterior tympanic sinus, which is in the superior, and sinus tympani, which is in the inferior, and they are separated from each other by the ponticulus.[2,3]
It should be kept in mind that the anterior part of the eardrum cannot be seen when viewed with the surgical microscope during operation if the anterior wall prominence (AWP) of the external ear canal is present
Summary
Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Modern otologic microsurgery requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy, because this region contains many irregular spaces, creating a suitable environment for hiding of cholesteatoma.[1,2] The posterior tympanic cavity contains four sinuses that surround the facial nerve and the Fallopian canal. The other two sinuses are in the middle of the Fallopian canal: posterior tympanic sinus, which is in the superior, and sinus tympani, which is in the inferior, and they are separated from each other by the ponticulus.[2,3] The sinus tympani is the posterior extension of the mesotympanic space towards to the tympanic annulus. The superior border is constituted by ponticulus while inferior border is formed by subiculum.[4]
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