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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4501_Библиотеки_им_академика_М_И_Перельмана
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240 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 32
Radical mastoidectomy cavity. A surgical procedure including right modified radical mastoidectomy was performed for squamous cell
carcinoma at age 71 yr. The mastoid bowl contains desquamated keratin on a lining of squamous epithelium. The patient died of unrelated
causes 9 yr after surgery (male, age 80 yr).
Figure 33
Purulent otitis media, meningitis, and labyrinthitis. This infant had repeated bouts of pneumonia
and succumbed to acute pneumococcal meningitis at the age of 17 mo. The precipitate in the middle ear is purulent fluid (otitis media). The cloudy
fluid in all three turns of the perilymphatic scalae
as well as in the vestibule and canals is characteristic of bacterial labyrinthitis; the precipitate
around the nerve trunks in the internal auditory
canal is the purulent cerebrospinal fluid of
meningitis (male, age 17 mo).
CHAPTER 8: STEREOSCOPIC VIEWS OF THE TEMPORAL BONE ■ 241
Figure 34
Stapedectomy for otosclerosis. At the age of 45
this woman underwent right total stapedectomy
followed by the implantation of a “fat-wire”
prosthesis. She had an excellent hearing gain
which persisted to the time of death 13 yr later.
There is a large vascular otosclerotic focus
anterior to the oval window. The hook of the
prosthesis is well attached to the long process of
the incus. Its medial end extends to the posterior
margin of the oval window instead of to the
ideal central location (female, age 58 yr).
Figure 35
Exostoses. These bony excrescences of the
external auditory canal (EAC) are usually caused
by refrigeration periostitis associated with swimming in cold water (male, age 80 yr).
242 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 36
This photograph shows the operative field during a simple mastoidectomy on the right ear. In
this procedure the mastoid is exenterated but
the external auditory canal and middle ear are
not entered (male, age 7 yr).
OPERATIVE VIEWS
Surgery epitomizes applied anatomy. These operative views (Figs. 36–49)
accompany disease entities encountered at various stages of surgery. All
photographs are taken from the surgeon’s view, thus the anterior aspect of
the ear is located superiorly in the photographs.
CHAPTER 8: STEREOSCOPIC VIEWS OF THE TEMPORAL BONE ■ 243
Figure 38
Same case as Figure 44. A cholesteatoma is seen
in the middle ear and mastoid of this right ear.
The incus and crural arch are absent and the
malleus is enveloped by the cholesteatoma. As
the operation proceeds, the posterior wall of the
external auditory canal will be completely
removed to gain access to the middle ear. The
epitympanum has yet to be fully exteriorized
(male, age 16 yr).
Figure 37
This photograph was taken during the course of
a tympanomastoidectomy on the right ear for
chronic otitis media and cholesteatoma. The
incus has been resorbed and the head of the
malleus is surrounded by cholesteatoma. There
is a perforation of the posterior half of the tympanic membrane (male, age 29 yr).
244 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 40
Same ear as Figure 39. A temporalis fascia graft
has been introduced to bridge the tympanic
space. The graft is placed in contact with
the head of the stapes (female, age 55 yr). This
operation is a type III tympanoplasty.
Figure 39
The photograph shows the tympanomastoid
compartment of the left ear after surgical exenteration and removal of diseased tissues prior to
reconstructive procedures (female, age 55 yr).
TM–tympanic membrane. (See Fig. 40.)
CHAPTER 8: STEREOSCOPIC VIEWS OF THE TEMPORAL BONE ■ 245
Figure 42
This photograph was taken during an intactcanal-wall tympanoplasty on the left ear. The
skin of the posterior wall of the external auditory canal (EAC) has been elevated from the
bony canal wall and displaced anteriorly along
with the tympanic membrane to provide access
to the middle ear (male, age 24 yr).
Figure 41
This photograph was taken during tympanomastoidectomy on the right ear. The mastoid
has been exenterated of diseased tissue and the
posterior wall of the external auditory canal has
been partially removed. Thick granular mucous
membrane can be seen in the epitympanum
surrounding the ossicles. An aural polyp
protrudes from a hidden perforation in the tympanic membrane (male, age 39 yr).
246 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 44
Same case as Figure 38. Here we see the tympanomastoid compartment of the right ear after diseased
tissues (cholesteatoma and granulations) have been
removed preparatory to reconstructive procedures
(male, age 16 yr).
Figure 43
This view shows an extensive surgical exenteration of the tympanomastoid compartment of the
left ear for removal of an acquired cholesteatoma.
The cholesteatoma had extended through the
supralabyrinthine tract to the petrous apex
(female, age 12 yr).
CHAPTER 8: STEREOSCOPIC VIEWS OF THE TEMPORAL BONE ■ 247
Figure 45
This photograph taken during a surgical procedure
shows a congenital cholesteatoma of the petrous apex
of the left ear. The apex has been reached by drilling
away the cochlear part of the bony labyrinth. The
cholesteatoma cavity was permanently exteriorized to
the external auditory canal (male, age 49 yr).
Figure 46
The tympanomastoid compartment of the left ear
has been thoroughly exenterated for the
management of chronic otitis media and mastoiditis with cholesteatoma. In this case, since the
ear was profoundly deaf, the entire compartment
was obliterated with pedicled and free autogenous tissue grafts (female, age 52 yr).
248 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 47
This view shows a late stage of a tympanomastoidectomy on the right ear. A packing, consisting
of silk cloth strips and cotton, holds in place the
tissue grafts used in reconstruction. Dual pedicled grafts composed of muscle, fascia, and
periosteum are used to obliterate the mastoid
cavity (female, age 58 yr).
Figure 48
This photograph taken during a surgical procedure on a right ear shows a glomus jugulare
tumor occupying the mesotympanum and
hypotympanum (female, age 63 yr).
CHAPTER 8: STEREOSCOPIC VIEWS OF THE TEMPORAL BONE ■ 249
Figure 49
This surgical view of the right ear shows the
opened endolymphatic sac. A plastic tube was
placed in the opening to drain the sac into the
mastoid cavity for the alleviation of vertigo
caused by
Méni`ere’s disease (male, age 32 yr).
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