Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4453_Библиотеки_им_академика_М_И_Перельмана
.pdf
220
https://t.me/medicina_free
X. Gao et al.
A. Vertical segment of the
internal carotid artery
B. Internal jugular vein
C. Jugular bulb
D. Sigmoid sinus
Fig. 8.26 Internal jugular vein and vertical segment of the internal
carotid artery (right)
The bone is removed down along the jugular bulb, the jugular foramen
is opened, and the internal jugular vein is revealed. The bone anteromedial to the jugular bulb and along the direction of the vertical segment
of the internal carotid artery is drilled away from superior to inferior
layer by layer, exposing the vertical segment of the internal carotid
artery. Hints: Because of the close relationship between the carotid
sheath and the skull base, it is difcult to separate. Dissection can be
conducted along the long axes of the internal jugular vein and internal
carotid artery, or the internal jugular vein and internal carotid artery
can be separated in the neck (below the skull base) and traced
superiorly
Instruments: medium-sized diamond burs, ophthalmic scissors, ophthalmic forceps
A.
B. Posterior semicircular canal
C.
D. Internal carotid artery
E.
F.
G.
A.
B. Common crus
C.
D.
E.
8 Infratemporal Fossa Approach
https://t.me/medicina_free
Lateral semicircular canal
Superior semicircular canal
Jugular bulb
Sigmoid sinus
Sinodural angle
221
Fig. 8.27 Open the three semicircular canals (right)
A smaller diamond bur is used to drill the three semicircular canals until
the “blue line” of semicircular canals can be seen. A right-angle hook is
used to open the semicircular canals
Ampulla of the lateral
semicircular canal
Stapes footplate and oval
window
Round window membrane
Posterior semicircular canal
Instruments: small-sized diamond burs, right- angle hook
Fig. 8.28 Open the vestibule, exposing the common crus (right)
The lateral wall of the vestibule, and the superior and lateral semicircular canals are drilled out. The vestibule is opened, and the stapes are
kept intact. The stapes footplate and the annular ligament in the oval
window can be seen. The common crus can be traced along the superior
and posterior semicircular canals. The opening where the common crus
enters the vestibule can be seen. Hints: (1) In the infratemporal fossa
approach type A, only the superstructure of the stapes is removed so as
not to cause injury to the inner ear. (2) To display the anatomy of the
temporal bone comprehensively, dissection of the jugular foramen area
and the trans labyrinthine approach is carried out simultaneously
Instruments: small- and medium-sized diamond burs
222
https://t.me/medicina_free
X. Gao et al.
A. Scala tympani
B. Ve stibule
C. Ampulla of the lateral
semicircular canal
D. Ampulla of the superior
semicircular canal
E. Common crus
F. Posterior semicircular canal
Fig. 8.29 Open the basal turn of the cochlea (right)
The vestibule receives the perilymph in the scala vestibuli, and the ductus reuniens connects the saccule and the membranous cochlear canal.
The scala vestibuli, the scala tympani, and the bony spiral lamina can be
seen after opening the lateral wall of the vestibule and the round window membrane
Instruments: small-sized diamond burs, right- angle hook
A. Spherical recess
B. Elliptical recess
C. Scala vestibuli
D. Scala tympani
E. Bony spiral lamina and
basilar membrane
F. Posterior semicircular canal
Fig. 8.30 Medial wall of the vestibule and the basal turn of the cochlea
(right)
There are two recesses in the medial wall of the vestibule: the anteroinferior spherical recess and the posterosuperior elliptical recess. Between
them is the crest of the vestibule. The cochlea is located anteroinferior
to the vestibule and the basal turn of the cochlea projects into the tympanic cavity, forming the bulge of the promontory
Instruments: small-sized diamond burs, right- angle hook
A.
B. Apical and middle turn of
C. Medial wall of the vestibule
A. Labyrinthine segment of
the facial nerve
B.
C.
D. Horizontal segment of the
internal carotid artery
E.
8 Infratemporal Fossa Approach
https://t.me/medicina_free
Basal turn of the cochlea
the cochlea
223
Fig. 8.31 Resection of the vestibule, opening the cochlea (right)
The lateral wall of the cochlea is drilled out along its direction of rotation. The right-sided cochlea is shown in the picture above; the direction of its rotation is the same as the index nger direction of a st made
End of the cochlear nerve
IAC
Internal jugular vein
with the right hand. The internal auditory canal (IAC) is located medial
to the vestibule, and the medial wall of the vestibule is part of the lateral
wall of the IAC
Instruments: medium- and small-sized diamond burs
Fig. 8.32 Skeletonized IAC and the internal carotid artery (right)
Once the cochlea has been drilled out, the labyrinthine segment of the
facial nerve can be seen. The bone posterior to the horizontal segment
of the internal carotid artery is drilled away to expose that part of the
artery. The IAC is skeletonized after bone medial to the vestibule has
been removed. The labyrinthine segment of the facial nerve runs above
the upper borders of the cochlea and the vestibule. The internal carotid
artery is located anteroinferior to the basal turn of the cochlea, separated from it by a thin plate of bone
Instruments: medium-sized diamond burs
224
https://t.me/medicina_free
X. Gao et al.
A. Transverse sinus
B. Sigmoid sinus
C. Jugular bulb
D. Superior petrosal sinus
E. Mastoid emissary vein
Fig. 8.33 Transverse sinus, sigmoid sinus, and jugular bulb (right)
The sigmoid sinus is located between the inner and outer layers of the
dura. It starts at the end of the transverse sinus and expands at its lower
end to form the jugular bulb. The sigmoid sinus receives the superior
petrosal sinus at its origin and the mastoid emissary vein in its mid por-
tion; the inferior petrosal sinus opens into the jugular bulb and/or internal
jugular vein. A view of the vascular cavity containing blue material (a
mixture of self-curing denture material and oil paint) after removal of the
bone covering the sigmoid sinus and transverse sinus and the vessel wall
Instruments: large-sized cutting burs, medium- sized diamond burs
A. Medial wall of the sigmoid
sinus
B. Cerebellum
C. Occipital bone
D. Medial wall of the jugular
bulb
E. Opening of the inferior
petrosal sinus
F. Internal carotid artery
Fig. 8.34 Medial wall of the sigmoid sinus and the jugular bulb (right)
The jugular bulb and the lling in the lower end of the sigmoid sinus are
removed to show the inner wall of the blood vessel. The jugular bulb
can be seen receiving the inferior petrosal sinus
Instruments: medium-sized cutting burs
A. Internal carotid artery
B.
C.
A. Glossopharyngeal nerve
B.
C.
D. Inferior petrosal sinus
E.
F.
G. Occipital bone
H. Petrous apex
8 Infratemporal Fossa Approach
https://t.me/medicina_free
Inferior petrosal sinus
Glossopharyngeal nerve
225
Fig. 8.35 Glossopharyngeal nerve (right)
The glossopharyngeal nerve is a mixed nerve, exiting the brainstem
from the posterior olivary sulcus and accompanying the vagus nerve to
enter the jugular foramen. The glossopharyngeal nerve exits the skull
via the jugular foramen medial to the jugular bulb and anterior to the
Vagus nerve
Accessory nerve
Internal carotid artery
Cerebellum
inferior petrosal sinus. The tympanic nerve, the carotid sinus branch,
and the tonsillar branches are the main branches of the glossopharyngeal nerve. The vagus nerve also exits the skull via the jugular foramen,
along with the accessory nerve, posterior to the inferior petrosal sinus
Instruments: ophthalmic scissors, septal raspatory, straight micro-needle
Fig. 8.36 Lower cranial nerves (right)
The lower cranial nerves are visible after removal of the posterior fossa
dura and the medial wall of the jugular bulb. The vagus nerve together
with the accessory nerve can be seen exiting the skull via the jugular
foramen, posterior to the inferior petrosal sinus, and medial to the jugular bulb. The glossopharyngeal nerve exits the skull anterior to the inferior petrosal sinus
226
https://t.me/medicina_free
X. Gao et al.
Suggested Reading
Dai P, Han D-y, Cousins VC, etal. Stereo operative atlas of micro ear
surgery. Singapore: Springer; 2017.
Sanna M, Saleh E, Khrais T, etal. Atlas of microsurgery of the lateral
skull base. 2nd ed. NewYork: Thieme; 2008.
Sharma R, Sirohi D.Proximal and distal facial nerve exploration during
supercial parotidectomy. J Maxillofac Oral Surg. 2010;9(2):150–4.
Stereoscopic Virtual Anatomy
https://t.me/medicina_free
ofTemporal Bone
Sha-shaHuang, Yi-chenWan, De-junZhang,
Xiao-
hongLi, ChangGuo, andYue-shuaiSong
9
The original data used in this chapter comes from 3-D Viewer
of the Human Temporal Bone Mode (Haobing Wang et al.,
Eaton-Peabody Lab, Massachusetts Eye & Ear Inrmary),
and permission for the secondary development has been
obtained from Dr. Haobing Wang.
Virtual Anatomy: Transcanal Approach
Yi-chenWan and Sha-shaHuang
S.-s. Huang (*) · C. Guo
College of Otolaryngology Head and Neck Surgery, Chinese PLA
General Hospital, Beijing, China
Y.-c. Wan
Department of Otolaryngology Head and Neck Surgery, Peking
University International Hospital, Beijing, China
D.-j. Zhang
Department of Otolaryngology Head and Neck Surgery,
The Second Hospital of Jilin University, Changchun, China
X.-h. Li
Department of Otolaryngology Head and Neck Surgery, Beijing
Children’s Hospital, Capital Medical University, Beijing, China
Y.-s. Song
Department of Otolaryngology Head and Neck Surgery, Beijing
Friendship Hospital, Capital Medical University, Beijing, China
© People’s Medical Publishing House, PR of China 2021
P. Dai et al. (eds.), Stereoscopic Anatomical Atlas of Ear Surgery, https://doi.org/10.1007/978-981-16-0927-5_9
227
228
https://t.me/medicina_free
A. Temporal bone (semi transparent)
B. Tympanic membrane
C. Lateral semicircular canal
D. Mastoid segment of the
facial nerve
S.-s. Huang et al.
Fig. 9.1 Scenography of temporal bone (right, lateral)
Simulating a postauricular approach; observe the spatial relationships between the different structures of the temporal bone
A. Bony part of the EAC
B. Tympanic membrane
C. Incus
D. Mastoid segment of the
facial nerve
E. Lateral semicircular canal
F. Chorda tympani
Fig. 9.2 Part of temporal bone removed (right)
Remove part of the temporal bone with the inner structures preserved,
so the bony part of the external auditory canal (EAC), tympanic membrane, chorda tympani, and ossicles can be revealed. The posterior tympanotomy opening into the facial recess is a triangular space bounded
anteriorly by the chorda tympani, and posteriorly by the mastoid segment of the facial nerve. Due to the proximity of the chorda tympani
and the posterior wall of the EAC, the latter needs to be drilled down to
a thin layer to give a better exposure of the facial recess
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
229
A. Bony segment of the
Eustachian tube
B. Malleus
C. Incus
D. Stapes
E. Chorda tympani
F. Prussak’s space
Fig. 9.3 Tympanic membrane and bony part of the EAC removed
(right)
Remove the tympanic membrane and bony part of the EAC to reveal the
three ossicles. The bony segment of the Eustachian tube (lateral 1/3) is
located superiorly in the anterior wall of the tympanic cavity, while the
semicanal for the tensor tympani muscle is superior to it and the internal
carotid artery (ICA) is inferior to it. Prussak’s space, also known as the
superior recess of the tympanic membrane, is a space between the lateral process of the malleus, neck of the malleus, lateral ligament of the
malleus, and pars accida of the tympanic membrane, and is a site predisposed to the formation of cholesteatoma
A. Tensor tympani muscle
B. Cochleariform process
C. Chorda tympani
D. Stapedius muscle
Fig. 9.4 Tympanic membrane and bony part of the EAC removed
(right)
The tensor tympani muscle resides in its own semicanal. The tensor tympani tendon passes through the cochleariform process, at approximately
90° and attaches to the upper part of the handle of the malleus. The stapedius muscle, which is innervated by the stapedius branch of the facial nerve,
is located deep in the bony canal medial to the facial nerve. The tendon of
the stapedius muscle enters the tympanic cavity through the pyramidal eminence and attaches to the neck of the stapes. The cochleariform process,
pyramidal eminence, and the facial nerve are closely related; the former
two structures are almost always located in the same position and are thus
important landmarks for locating the facial nerve during surgery
Соседние файлы в папке Библиотека им академика М.И. Перельмана