Abstract
Abstract Posterior tympanotomy is a well-known otologic procedure that allows surgeons access to the middle ear cavity. During posterior tympanotomy the surgeon can approach the round window niche and promontory, where a cochleostomy is carried out for cochlear implant electrode array insertion. The mastoid segment of the facial nerve and the chorda tympani nerve could be injured in cases of narrow facial recess or inadequate posterior tympanotomy. With the image reconstruction in an oblique sagittal plane and curve reconstructions, the whole tympanic and mastoid segments of the facial nerve can be visualized in just one image. It is necessary to preoperatively estimate both the facial nerve status and the anatomical relationships between the facial recess and the round window, this may reduce the risk of facial nerve injury and influence the decision on which side to implant, which approach to use and whether to enter the cochlea via cochleostomy or round window membrane route. The aim of our study is to evaluate the facial nerve (course and anomalies), visibility of the round window membrane and the width of posterior tympanotomy before cochlear implantation by using oblique sagittal cuts CT scan temporal bone. A prospective study; done on 18 consecutive patients with severe to profound sensorineural hearing loss who are candidates for cochlear implantation in Ain Shams University Hospitals during years 2011 & 2012. We focused on oblique sagittal cut CT scan & its role to evaluate the course of facial nerve, posterior tympanotomy width and visibility of the round window. We tried to make a statistical correlation between CT scan and intraoperative findings. Statistically significant positive correlation between posterior tympanotomy width and 2nd genu angle, distance from facial bony canal to round window and distance from facial nerve to round window. The mean distance from facial bony canal to round window was longer in operatively viewed round window than non-viewed window (4.7 and 4.4 mm respectively) (P < 0.05). The mean distance from facial nerve to round window was longer in operatively viewed round window membrane than non-viewed window (5.9 and 5.5 mm respectively) (P < 0.05). The mean width of posterior tympanotomy was wider in operatively viewed round window niche than non-viewed window niche (3.1 and 3.0 mm respectively) (P < 0.01). Oblique sagittal cuts CT scan temporal bone is very helpful preoperative radiological tool for evaluation of the facial nerve course and anatomical factors that may determine the field of view or the accessibility of the posterior tympanotomy for either cochleostomy or round window membrane approach. Other approaches can be used with more safety when the position of the facial nerve prevents an adequate posterior tympanotomy.
Highlights
Posterior tympanotomy is a well-known otologic procedure that allows surgeons access to the middle ear cavity
The mastoid segment of the facial nerve and the chorda tympani nerve could be injured in cases of narrow facial recess or inadequate posterior tympanotomy [3]. This complication generally occurs because of a limited understanding of the anatomy of the facial recess and different mastoid segment anomalies [4]; radiological evaluation of the anatomy, anomalies of the facial nerve course, and anatomical factors that may determine the field of view or the accessibility of the posterior tympanotomy are very important to minimize the risk for nerve injury
We focused on oblique sagittal cut computed tomography (CT) scan and its role to evaluate the course of facial nerve, posterior tympanotomy width, and visibility of round window; the following measures were taken (Figs. 1–4): (1) Length of tympanic segment of the facial nerve in millimeters
Summary
Posterior tympanotomy is a well-known otologic procedure that allows surgeons access to the middle ear cavity This technique was first described by Jansen in 1958 and is achieved by opening of the facial recess, which is a triangular space defined medially by the mastoid segment of the facial nerve, laterally by the chorda tympani nerve and superiorly by the incudal fossa [1]. The mastoid segment of the facial nerve and the chorda tympani nerve could be injured in cases of narrow facial recess or inadequate posterior tympanotomy. It is necessary to preoperatively estimate both the facial nerve status and the anatomical relationships between the facial recess and the round window, this may reduce the risk of facial nerve injury and inƀuence the decision on which side to implant, which approach to use and whether to enter the cochlea via cochleostomy or round window membrane route
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