Temporal bone resection

1. Temporal bone resection
3-10-2016
1.36 pm

2. Great teachers – All this is their work .
I am just the reader of their books .
Prof. Paolo castelnuovo
Prof. Aldo Stamm Prof. Mario Sanna
Prof. Magnan

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4. Lateral temporal bone resection
cadaver video click
https://www.youtube.com/watch?v
=mjRGsEidrL8

5. Piece meal resection (STBR + ITFA - A
+ superficial parotidectomy) for
TBSCC. Here the facial nerve is
spared and rerouted.

6. Superficial parotidectomy must be
done in temporal bone malignancy
because first level of draining lymph
nodes present in the parotid –
Dr.Satish jain

7. Sampath Chandra Prasad Section of the EAC taking care to
achieve good margins. Blind sac closure of the remaining skin of
EAC. Frozen section of margins

8. STBR can be married into a variety of procedures depending upon the disease
extension. Here sub total petrosectomy (drilling out all the mastoid-middle ear air
cells) is carried out along with Infratemporal fossa type B approach wherein FN is
completely isolated and transposed. Note that superficial parotidectomy is being done
which also helps release the facial nerve.

9. Facial nerve completely exposed from mastoid to
parotid segment. SP completed.

10. Facial nerve completely tansposed anteriorly for which the nerve is drilled upto the geniculate
ganglion. The GSPN is sectioned to obtain the release of the nerve. The nerve along with the
parotid is sutured anteriorly to the flap
This is done to obtain exposure of the infratemporal fossa. Here the tumor was involving the
hypotympanum. Hence the entire tympanic bone was removed. Note the exposure of the middle
fossa dura, carotid and the jugular bulb.

11. Sampath Chandra Prasad Facial nerve transposed posteriorly. Carotid canal
can be clearly seen. Jugular foramen completely exposed after excision of the
IJV along with the jugular bulb.

12. While removing the temporal bone
malignancy at Parisier’s triangle (
dangerous triangle ) we have to very
careful , higher chances of injuring the
labyrinthine part of facial nerve if we are
not careful in clearing the tumor at
parisier’s triangle.

13. PARISIER'S TRIANGLE
(DANGEROUS TRIANGLE)
Perisier's triangle is very important triangle in endoscopic ear surgery
1) Superior limb is formed by inferior part of HFN
2) The apex is formed by the geniculate ganglion
3) The base is formed by the anterior commissure (end) of oval window
4) Inferior limb is formed by tunning point of jocobson's nerve to the the
geniculate ganglion.

14. • The surgical implications are
1) This triangle contains labyrinthine part of FN.
2) During transotic or transcochlear approaches surgeon should respect this triangle and drill carefully
to avoid injury to FN.
3) Clinically labyrinthine part consists of two segments a meatal segment of nerve, labyrinthine part of
nerve. total length of this nerve is 3 to 5 mm. Anteriorly we can see these parts clearly through this
triangle.
4) 1st part of FN passes close to lower border of precochlear HFN towards anterior end of oval window
in this triangle.
5) Irregular drilling of cochlea in this triangle damages FN That is why it is called DANGERS TRIANGLE.
6) During trans meatal endoscopic dissection of IAC, this triangle important for identification of nerves
7) Translabyrinthine approach visualises posterior surface of 1st part of FN, in transcochlear approaches
the anterior surface of the nerve is exposed. In transottic approaches 270 to 320 degrees of 1 st part of
FN is exposed.
8)Observe closely the labyrinthine part of FN there is a constriction of labyrinthine segment and meatal
segment.
Facial nerve key points
1) Facial nerve changes direction 5 times during its course from brain stem to styloid foramen.
2) No other nerve in body covers such a long distance in bony canal
3) facial nerve contains 10000 axons that are responsible for the innervation of the face musculature
and also for the communications with other nerves human body
4) work with injured facial nerve requires lot of patience.

20. Sampath Chandra Prasad cavity
obliterated with fat

21. Sampath Chandra Prasad blind sac
closure

22. Sampath chandra prasad did this case
• https://www.facebook.com/groups/learninge
nt/permalink/731085130262697/

23. Steps in subtemporal resection with neck dissection
and total parotidectomy (my dad's style of en-block
resection). At Gruppo Otologico, we do a piece meal
resection. – click
https://www.facebook.com/groups/l
earningent/permalink/73107251026
3959/

24. Lot of material to update – stay
tuned

25. For Other powerpoint presentatioins
of
“ Skull base 360° ”
I will update continuosly with date tag at the end as I am
getting more & more information
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- you have to login to slideshare.net with Facebook
account for downloading.