The feasibility of the retrofacial approach to the pediatric group’s sinus tympani

Abstract

Problem: Sinus tympani (ST) are often invaded by cholesteatoma and are difficult to visualize. The retrofacial approach is suggested as a possible solution in case of residue or recurrent cholesteatoma involving ST. The feasibility in the pediatric group remains unknown. The aim of this study was to investigate the feasibility of the retrofacial approach to ST in pediatric specimens. Methods: Eight pediatric (age below 5) patients were compared with 24 adults using high-resolution CT measurements and temporal bone dissections. CT measurements included the depth (d) and the width (w) of ST, the distance (F-PSC) from the medial aspect of the facial nerve canal to the lateral aspect of the posterior semicircular canal, and the distance (P-ST) from the posterior aspect of ST to F-PSC. Results: The depth of ST was 2.81 ± 0.92 mm in pediatric and 2.24 ± 0.91 mm in adult specimens. The width of ST was 1.66 ± 0.50 mm in pediatric and 1.98 ± 0.71 mm in adult patients. F-PSC was 3.96 ± 0.97 mm in pediatric and 3.73 ± 0.63 mm in adult patients. F-PSC greater than 3 mm was found in 6 of 8 (75%) pediatric patients and in 21 of 24 (87.5%) adults. P-ST was 1.90 ± 1.20 mm in pediatric patients and 2.34 ± 0.82 mm in adults. A distance of less than 2 mm was found in 5 of 8 (62.5%) pediatric patients and 9 of 24 (37.5%) adults. Conclusion: There were no significant differences for any measurements between the pediatric and adult specimens ( P > 0.05). The retrofacial approach performing in the pediatric group was no more complex than in adult specimens. The study suggested that F-PSC greater than 3.0 mm and P-ST less than 2.0 mm provided an accessible approach to ST in pediatric specimens. Significance: This study indicates that the retrofacial approach can also be used in selected pediatric cases. Although it only applies necessarily in a minority of cases, it still provides the surgeon with a technique that enriches his or her surgical strategies for diseased tissue in difficult-to-reach ST. Support: None reported.