Surgical Anatomy of Anterior and Retrofacial Approaches to Sinus Tympani

Abreu, Carlos Eduardo Cesário de; Cruz, Oswaldo Laércio Mendonça

doi:10.1097/mao.0b013e318068b298

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…The limited surgical corridor increases the risk of FN injury in the retrofacial approach and therefore is less feasible. This conclusion is similar to CI surgery [26,38], where the degree of prominence of the sigmoid sinus appeared to be a crucial factor for the feasibility of the retrofacial approach. The level of anterior displacement of the SM in relation to the course of the FN (expressed by the metrics Depth SM behind FN) was shown to be a further valid predictor for the surgical approach.…”

Section: Plos Onesupporting

confidence: 78%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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Human stapedius muscle (SM) can be directly and safely accessed via retrofacial approach, opening new approaches to directly measure the electrically evoked stapedius reflex threshold (eSRT). The measurement of the SM activity via direct surgical access represents a potential tool for objective eSRT fitting of cochlear implants (CI), increasing the benefit experienced by the CI users and leading to new perspectives in the development of smart implantable neurostimulators. 3D middle-ear reconstructions created after manual segmentation and related SM accessibility metrics were evaluated before the CI surgery for 16 candidates with assessed stapedius reflex. Retrofacial approach to access the SM was performed after facial recess exposure. In cases of poor exposition of SM, the access was performed anteriorly to the FN via drilling of the pyramidal eminence (PE). The total access rate of the SM via both the retrofacial and anterior approach of the FN was 100%. In 81.2% of cases (13/16), the retrofacial approach allowed to access the SM on previously categorized well exposed (8/8), partially exposed (4/5), and wholly concealed (1/3) SM with respect to FN. Following intraoperative evaluation in the remaining 18.8% (3/16), the SM was accessed anteriorly via drilling of the PE. Exposure of SM with respect to the FN and the sigmoid sinus’s prominence was a predictor for the suitable surgical approach. The retrofacial approach offers feasible and reproducible access to the SM belly, opening direct access to electromyographic sensing of the eSRT. Surgical planner tools can quantitatively assist pre-surgical assessment.

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Section: Plos Onesupporting

confidence: 78%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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“…It can be visualised by intra tympanic mirrors, Oto-endoscopes, or with techniques like, removal of the lateral lip of bone and tilting the patient's head and/or microscope. Removal of the disease from sinus tympani is also inXuenced by surgical approaches, which include the anterior to posterior and the retro facial approach [3].…”

mentioning

confidence: 99%

A technique for defogging intra tympanic mirrors

Manikavasagam

Ranganathan

Dugar

2009

Eur Arch Otorhinolaryngol

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“…The dimensions of the sinus tympani have been shown to vary considerably, with depths ranging from 0.2 to 9.9 mm and widths ranging from 0.49 to 4.5 mm 3 . As a result, adequate visualisation is not always possible and several studies have attempted to demonstrate a superior approach to prevent residual and recurrent disease 1–4 . This includes the anterior to posterior and the retrofacial approach, and the use of intratympanic mirrors or intra‐operative oto‐endscopes.…”

mentioning

confidence: 99%