Middle Ear and Mastoid Microsurgery

by Sanna, Mario, M.D.; Sunose, Hiroshi; Mancini, Fernando; Russo, Alessandra; Taibah, Abdelkader

• ISBN13: 9781588901637
• ISBN10: 1588901637
• Edition: 1st
• Format: Hardcover
• Copyright: 2003-08-01
• Publisher: Thieme Medical Pub

Summary

Thirty years of experiencein one comprehensive guidebook! Middle Ear and Mastoid Microsurgery Produced by leading experts in otosurgery, Middle Ear and Mastoid Microsurgery is the result of thirty years' experience in the field and 12,000 clinical cases. This groundbreaking, up-to-the-minute atlas is the very first book to comprehensively cover middle ear and mastoid microsurgery. Beginning with a discussion on the anatomy of the temporal bone, Middle Ear and Mastoid Microsurgery next discusses the most efficient operating room layout, anesthesia and technical considerations, staging, ventilation-tube insertion, general surgical procedures, and pre- and post-operative care. In the bulk of the book, the authors providethrough careful description, elaborate photographs, and schematic computer illustrationsan exhaustive, step-by-step account of each type of middle-ear and mastoid microsurgery. Key features of this landmark text include: 855 lavish computer illustrations and photographsnearly three per page quick-reference summaries at the end of each chapter that provide rules, hints, pitfalls, problems, and evaluations for each surgical procedure meticulous, step-by-step descriptions of state-of-the-art techniques in middle-ear and mastoid surgery All otologic surgeons, residents, and medical students will benefit from this essential atlas, which is sure to become the fundamental guide for beginners and a treasured standby for established surgeons.

Author Biography

Mario Sanna, M.D.: Professor of Otolaryngology University of Chieti Italy; Gruppo Otologico, Piacenza and Rome, Italy Hiroshi Sunose, M.D.: Department of Otolaryngology, Tohoku University School of Medicine, Sendai, Japan Fernando Mancini, M.D. Gruppo Otologico, Piacenza and Rome, Italy; Ospedale Koelleker Turin, Italy Alessandra Russo, M.D.: Gruppo Otologico, Piacenza and Rome, Italy Abdelkader Taibah, M.D.: Gruppo Otologico, Piacenza and Rome, Italy Mario Sanna, M.D., is professor of otolaryngology at the University of Chieti in Chieti, and director of Gruppo Otologico in Piacenza and Rome, Italy. Hiroshi Sunose, M.D., is in the department of otolaryngology at the Tohoku University School of Medicine in Sendai, Japan. Fernando Mancini, M.D., is a physician with the Gruppo Otologico in Piacenza and Rome, Italy, and the Ospedale Koelleker in Turin, Italy. Alessandra Russo, M.D., and Abdelkader Taibah, M.D., are physicians with the Gruppo Otologico in Piacenza and Rome, Italy.

Table of Contents

Anatomy of the Temporal Bone	p. 1
The External Auditory Canal	p. 1
The Tympanic Membrane	p. 1
The Ossicular Chain	p. 1
The Tympanic Cavity	p. 1
Medial Wall	p. 2
Posterior Wall	p. 2
The Attic	p. 2
The Antrum	p. 2
The Labyrinth	p. 3
The Jugular Bulb	p. 3
The Carotid Artery	p. 3
The Facial Nerve	p. 3
Surgical Anatomy of the Canal Wall Down (Open) Tympanoplasty	p. 13
Surgical Anatomy of the Canal Wall Up (Closed) Tympanoplasty	p. 15
Operating Room Setup	p. 19
Arrangement of the Room	p. 19
Position of the Patient	p. 20
Special Considerations in Stapes Surgery	p. 21
Preparation of the Operative Site	p. 21
Position of the Surgeon	p. 21
Position of the Surgeon's Hands	p. 21
Suction and Irrigation	p. 23
Bipolar and Monopolar Coagulation	p. 23
Microscope	p. 23
Facial Nerve Monitoring	p. 23
Instruments	p. 23
Hints and Pitfalls for Operating Room Setup	p. 33
Anesthesia	p. 34
Local Anesthesia	p. 34
General Anesthesia	p. 34
Hints and Pitfalls for Anesthesia	p. 37
Stapes Surgery and Transcanal Approaches	p. 37
Surgeries via Retroauricular Incision	p. 37
General Technical Considerations	p. 38
Rules and Hints	p. 38
Drilling	p. 38
Suction and Irrigation	p. 40
Hemostasis	p. 40
Dissection	p. 40
Decision-Making in Middle Ear Surgery	p. 41
How Should We Choose Our Patients?	p. 41
Canalplasty	p. 41
Myringoplasty	p. 41
Ossiculoplasty	p. 41
Tympanoplasty	p. 41
Stapes Surgery	p. 41
Strategy in the Only Hearing Ear	p. 41
Tympanostomy Tube	p. 41
Non-cholesteatomatous Chronic Otitis Media	p. 41
Cholesteatoma	p. 41
Ossiculoplasty	p. 42
Neoplasm	p. 42
Stapes Surgery	p. 42
Staging Strategy	p. 42
Non-cholesteatomatous Chronic Otitis Media	p. 42
Cholesteatoma	p. 42
Stapes Surgery	p. 42
Strategy for Revision Surgery	p. 42
Canal Stenosis	p. 43
Myringoplasty	p. 43
Ossiculoplasty	p. 43
Tympanoplasty in Cholesteatoma	p. 43
Stapes Surgery	p. 43
Ventilation Tube Insertion	p. 44
Indications	p. 44
Contraindications	p. 44
General Oto-surgical Procedures	p. 47
Retroauricular Skin Incision	p. 47
Harvesting Grafting Material	p. 49
Temporalis Fascia (Retroauricular Scar Tissue)	p. 49
Tragal Cartilage and Perichondrium	p. 51
Split-thickness Skin Graft	p. 55
Incision of the External Auditory Canal	p. 57
Canalplasty (Calibration of the Bony Canal Walls)	p. 65
Skin Closure	p. 77
Pre- and Postoperative Care	p. 79
Preoperative Care	p. 79
Postoperative Care	p. 79
Dressing	p. 79
Postoperative Management	p. 79
External Auditory Canal	p. 80
Exostosis and Osteoma	p. 80
Hints and Pitfalls for Exostosis	p. 97
Hints for Beginners	p. 97
Stenosis of the External Auditory Canal	p. 97
Postinflammatory and Postoperative Stenoses	p. 97
Hints and Pitfalls for Canal Stenosis	p. 103
Cholesteatoma of the External Auditory Canal	p. 103
Myringoplasty	p. 106
Retroauricular Myringoplasty	p. 108
Surgical Steps	p. 108
Transcanal Myringoplasty	p. 153
Problems and Solutions in Myringoplasty	p. 154
Pathological Status of the Anterior Part of the Tympanomeatal Flap	p. 154
Thickened Tympanomeatal Flap	p. 154
Everted Mucosa	p. 154
Atelectasis	p. 155
Epithelialization in the Medial Aspect of the Tympanic Membrane	p. 156
Limited Epithelialization in the Middle Ear	p. 156
Extensive Epithelialization in the Middle Ear	p. 156
Tympanosclerosis	p. 157
Extensive Defects of the Middle Ear Mucosa	p. 157
Revision Myringoplasty	p. 158
Hints and Pitfalls for Myringoplasty	p. 164
Ossiculoplasty	p. 166
Indications	p. 166
Contraindications	p. 166
Approaches	p. 166
Considerations Regarding Atelectasis and Adhesive Otitis Media	p. 167
Considerations Regarding Tympanosclerosis	p. 169
Tympanosclerosis with Intact Tympanic Membrane	p. 169
Tympanosclerosis with Tympanic Membrane Perforation	p. 170
Management of the Stapes in Tympanosclerosis	p. 170
Ossiculoplasty in Various Situations	p. 176
Closure	p. 183
Hints and Pitfalls for Ossiculoplasty	p. 212
Revision Ossiculoplasty	p. 212
Simple Mastoidectomy	p. 218
Indications	p. 218
Landmarks	p. 218
Canal Wall Up (Closed) Tympanoplasty	p. 221
Indications	p. 221
Second Stage and Revision Surgery after Canal Wall Up Technique	p. 260
Hints and Pitfalls	p. 272
Canal Wall Down (Open) Tympanoplasty	p. 274
Indications	p. 274
Canal Wall Down (Open) Tympanoplasty	p. 274
Meatoplasty	p. 279
Packing and Closure	p. 280
Hints and Pitfalls	p. 289
Modified Bondy Technique	p. 289
Indications	p. 289
Hints and Pitfalls of the Modified Bondy Technique	p. 323
Radical Mastoidectomy	p. 323
Indications	p. 323
Second Stage Surgery in Open Technique	p. 324
Revision Surgery after Open Technique	p. 324
Hints and Pitfalls of Revision Surgery	p. 330
Special Considerations Regarding Glomus Tumor (Class A and B)	p. 331
Problems and Solutions in Mastoid Surgery	p. 344
Labyrinthine Fistula	p. 344
Bone Erosion in the Tegmen	p. 348
Facial Nerve Paralysis	p. 348
New Bone Formation	p. 348
Meningoencephalic and Dural Herniation	p. 348
Stapes Surgery	p. 355
Indications	p. 355
Contraindications	p. 355
Approach	p. 355
Anesthesia	p. 355
Problems and Solutions	p. 389
Disease States	p. 389
Anatomical Variations	p. 393
Surgical Trauma	p. 397
Hints and Pitfalls for Stapes Surgery	p. 400
Revision Stapes Surgery	p. 400
Ossicular Chain Problems	p. 401
Prosthetic Failure	p. 402
Medial Problems after Stapedectomy	p. 404
Hints and Pitfalls for Revision Stapes Surgery	p. 416
Obliteration of the Middle Ear	p. 417
Cochlear Implant	p. 420
Management of Iatrogenic Injuries	p. 423
Bleeding from the Dura	p. 423
Bleeding from the Sigmoid and Other Sinuses	p. 423
Bleeding from the Jugular Bulb	p. 423
CSF Leak	p. 423
Labyrinthine Fistula	p. 424
Disarticulation of the Incus	p. 424
Fracture of the Stapes	p. 424
Tear in the Tympanic Membrane	p. 424
Tear in the Meatal Skin	p. 424
Facial Nerve Injury	p. 424
References	p. 429
Index	p. 431
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