Surgical Atlas of Transcanal Endoscopic Ear Surgery: A Step by Step Guide Arindam Das, Sandipta Mitra, Sayan Hazra
INDEX
ABCDEFGHIJLMNOPRSTVWX
Page numbers followed by f refer to figure.
A
Acoustic meatus, internal 71, 72, 76, 82, 313
Aditus 222–225, 228, 228f, 229
Adrenaline 211, 212, 263
soaked cotton pledgets 268f, 269f
Alligator forceps 58f, 95f, 107f, 133f, 142, 149f, 215f, 223f, 231f, 247f, 335f, 337, 338f
Aluminum oxide 140
Anesthesia 63, 101, 211, 263, 317
general 211
hypotensive 63
local 63, 211
workstation 54
Angled curettes 12
Angled endoscope 7
placement of 179f
Annular ligament 255
Annular ring 90, 92f, 93, 95, 98, 99
Annulus 106, 108, 125, 271, 359
elevator 114, 259, 259f
inferior 185
palpation of 265f
Anterior canal
skin 124, 125f
wall 103f
Anterior malleal
fold 249
ligament 246, 249f
Anterior malleolar
fold 31
ligament 29, 38, 244, 248
Antifog solution 66
Antrum 228f
Apical turn 10, 40, 73
Arc of exposure 169f
Attic bone drilling 195
Attic cholesteatoma 86f, 87f
Atticotomy 101, 184, 255f, 328f
microscopic 184
window, dimensions of 326f
Attico-tympanic diaphragm 27
Auditory canal
external 9, 11, 70, 73, 76, 77f, 83f, 84f, 167, 211, 269f, 316f–318f, 350
internal 70
packing of external 105f
part of external 105
skin, protection of external 196f
superior aspect of external 67f
Aural speculum 264f
Austin classification 140
Austin-Kartush classification 140
Axon 343
B
Basal turn 10, 40, 73
Basilar membrane 42, 43
Bend test 302, 303f
Bill's elevator 337
double-curved 59f, 224
Bone
annulus 115f, 125f, 135f
egg-shell of 193
malformation 80
Bone drilling 193, 217
amount of 184
anatomical site of 184
drilling, steps of 218f, 219f
Bone removal 7, 278
amount of 209
extent of 219f
Bony annulus 113, 114, 115, 126, 190
anterior 124f–126f, 135f
Bony-cartilaginous junction 65f, 105, 211
Bucket handle 71
Burr, cutting 262f
Bypass technique 251
C
Camera sensors, types of 47
Canal bone, posterosuperior 174f, 175f
Canal hair
external 105
removal 105
Canal incision, step of 185f, 186f, 211f, 212f
Canal of Huguier 37
Canal wall 90, 92f, 93, 98
curettage of posterosuperior 173f, 279f
defect, reconstruction of posterosuperior 182f
down mastoidectomy 209
posterior 103f, 112
posterosuperior 173, 219, 259, 278, 325f
superior 103f
Caroticocochlear recess 35
Caroticotympanic vessels 32
Carotid artery 10, 23, 33–36, 73, 75, 78f
internal 70
Carotid dehiscence 80
Cartilage cap
over prosthesis 157f
placement of 205f
placement of 156f, 159f
Cartilage perichondrium 132
preparation of 130
Cartilage pieces 229
Cartilage shoe 158, 232
over footplate, placement of 158f
preparation of 157
Cartilage slicer, use of 60f, 61f
Cartilage tip 130
Catrilage cap 159
Cavity obliteration 229, 230f
Cephalosporin, third-generation 68
Cerebellopontine 364
angle 2
Cerebrospinal fluid leak 35
Chalk type plaques 251
Charge-coupled device 47
Cholesteatoma 2, 3, 20, 24, 31, 35, 80, 85, 198, 209, 210, 226, 227
recurrence 80
types of 210f
Cholesteatoma sac 8, 85, 214, 214f, 215, 215f, 216, 217, 221, 222f–224f, 226, 229, 229f
dissection of 224, 355
over facial nerve, dissection of 226
separation of 214
steps of
dissection of 224f–226f
separation of 214f–216f
Cholesteatoma surgery 17, 363
principle of 209
Cholesterol granuloma 88
Chorda tympani 17, 18, 21, 28, 31, 38, 82, 125, 143, 149, 150, 164, 169, 170, 172, 174f, 176, 176f, 177f, 178–180, 190, 195, 198, 199, 214, 216–218, 223, 228, 250, 274, 280f, 281, 291, 322f, 327, 329, 346, 358
anatomy of 38f
course of 37, 38f
damage of 37
dissection 171f, 198f, 217f, 271
method of 271f, 272f
endoscopic view of 38f
manipulation of 272
nerve 114, 114f, 115, 116, 118–120, 158, 170, 213f, 214, 216, 226, 271, 304, 305
management 216
reflection, direction of 172f
separation of 172f, 173f
steps of dissection of 170f, 171f
surgical anatomy of 37
Chordal eminence 18
Chordal ridge, separated by 18
Cilia 35
Cochlea 22, 72, 72f, 75
anatomical disposition of 39f
anatomy of 40f
appearance of 71
basal turn of 41f, 73f
endoscopic anatomy of 39
internal anatomy of 43f
Cochlear duct 40, 43
Cochlear implant insertion, site of 41f
Cochlear nerve 10
Cochlear otospongiosis site 86f
Cochleariform process 150, 291
Cochleariformis 25
Cochleo-carotid recess 33
Cochleostomy 43
Common ear pathology 9
Conchamerata 42, 43
Cone-beam computed tomography scan 84
Correct placement, tests for 302
Corticosteroid 93
Cosmetic deformity 130
Cranial fossa
approach, middle 313
posterior 80
Cranial nerve 70
Crista 42
fenestra 42, 43
surgical importance of 43
Crocodile forceps 239, 239f, 242f
Crura
anterior 281
posterior 274, 281, 285
Crurotomy 285, 286f–288f
alternate technique of 289f, 290f
intraoperative view of 287f, 288f
Crus
anterior 21, 22, 336
posterior 21, 22
Cup forceps 142
D
Dexamethasone 93
Diagnostic otoendoscopy, preoperative 259
Diamond burr 12, 262f
Diathermy 54, 63
Diazepam 63
Digital contrast enhancement 47
Digital visual interface 51
Direct mechanical injury 10
Discomalleolar ligament 38
Drape sheet 63
Duckbill elevator 59f, 239
Dysplasia 358
malformation and 84
E
Ear
canal 353
drops, steroid-containing 10
packing 104
preparation 63
right 66
surgery, microscopic 6, 46
Echo-planar imaging 80
Ectosylvian sulcus
anterior 70
posterior 70
Electrophysiological tests 317
Endolymph 39
Endolymphatic sac 72
Endoneurium 342, 343
Endoscope 7, 9, 10, 12, 12f, 46, 65, 122f, 274, 290
advantages of 90
console 54
holder, role of 12
role of 233
zero-degree 7
Endoscopic atticotomy 184f, 185, 206, 209, 249, 255, 325f, 326f
Endoscopic bone drilling 12
Endoscopic ear surgery 2, 2f, 3, 6–10, 10f, 11f, 12, 13, 46, 46f, 54f, 69, 70, 355, 363
functional 141
history of 1
laser probe in 356
microscopic to 6
principles of 5, 105
revolution of 47
set 57f
spectrum of 6
types of 6f
Endoscopic epitympanic exploration 6, 26, 101, 161, 162, 185
indications of 162
surgical technique 162f, 163f
Endoscopic facial nerve decompression 313
surgery 185
Endoscopic mastoid
exploration 209
surgery 141
Endoscopic mastoidectomy 8, 185, 209
principle of 209
Endoscopic myringoplasty 100
Endoscopic myringotomy 89
Endoscopic ossiculoplasty 139, 140
anatomical configuration 140
confirmation of diagnosis 141
physiological principles 141
placement of prosthesis 141
principles of 140
steps of 141
visualization 141
Endoscopic procedure 51
Endoscopic sinus surgery, functional 8
Endoscopic stapedectomy 304
Endoscopic stapedotomy 256, 262
working window of 263f, 264f
Endoscopic stapes surgery 6, 258
special instruments for 259
Endoscopic surgery, principles of 7
Endoscopic technique 233
Endoscopic transcanal atticotomy 183, 184, 325
contraindications of 185
indications of 185
principle of 184
Endoscopic transcanal facial nerve decompression 312
contraindications of 315
indications of 315
rationale of 315
Endoscopic tympanoplasty, indications of 101
Endoscopy
application of 2
system 51
Epidermoid cyst 88
Epineurium 342, 343, 343f, 346
permanent 108f
separation of 344f
Epitympanic cholesteatoma 210f, 219
Epitympanic diaphragm 27, 28, 28f, 29f, 116, 172, 198, 249, 327
Epitympanic dysventilation syndrome 162
Epitympanic exploration 101
Epitympanic recess, anterior 46
Epitympanic space 72f
anterior 24–27, 27f, 122, 150, 150f, 181, 181f, 200, 202, 203f, 204, 221, 224, 229, 236, 237, 249
inspection of 150f
anterior 202
posterior 24, 24f, 25, 149, 150, 200–202, 221, 223, 228, 229, 236, 237
Epitympanum 24f, 30f, 75, 80, 162, 184, 200, 202f, 331f
anatomy of 24f
sclerotic plaque in 251f
surgical anatomy of 24
vertical folds of 29f
Eustachian tube 9, 10, 24, 32, 33, 33f, 34, 34f, 35, 46, 70, 84, 91, 91f, 126, 180, 185, 187f, 211, 223, 243, 247, 323
opening 246, 249
orifice 121
visualization of 101
F
Facial nerve 10, 18, 19f, 20, 20f, 23, 30, 37, 70, 75, 76f, 80f, 82, 149, 164, 198–204, 221, 229, 233, 243, 246, 247, 250, 256, 274, 281, 291, 304, 307f, 313, 333, 334f, 335f, 336, 337f, 340, 341f, 342, 343, 351, 357f, 365
decompression 59f, 313f
surgery 359, 361f, 362f, 365
types of segmental 314f
disease clearance over 226f, 227f
dissection of 337
exposure of 337
horizontal 358, 359
portion of 249
segment of 178f
injury, iatrogenic 226
integrity 365f
labyrinthine segment of 82f
layers of 343f
location of 365
mastoid segment of 76f
monitor system 365
sheath 343
incision over 342
tympanic segment of 71f, 226
vertical segment of 78f
Facial recess 18f, 19f, 46, 342, 360
Fallopian canal 253f
bone, egg shelling of 341
drill 339, 340f
over tympanic segment of 340f
rules of drilling over 339
Fenestra
creation of 291, 292f, 293f
subsequent enlargement of 293f
Fibers, types of 37
Fibrous annulus 113, 114, 114f, 115, 124, 187, 188, 190, 241f
elevation 124f–126f
Fibrous bands 324f
Fibrous tissue 88
Finiculus 17, 18, 22, 35, 36, 40, 43, 121
Flap elevation 111, 187, 212, 268, 320, 320f
steps of 168f, 169f, 213f, 214f
superior 117f
Flap fibres, anterosuperior part of 270f
Flap tear 270f
Footplate 21, 22, 80, 150, 201, 203, 255, 257f, 274, 281, 304, 305
fenestra 358f
inspection 290
mobilization 292f
posterior third of 291, 292f
Fracture 81f
Fustis 22, 23, 40, 42, 43, 121
G
Gelfoam 136, 232, 311, 350
dissection around ossicles 256f
dry 172
pieces 153
placement 207f, 350f
Geniculate ganglion 313, 336
Glossopharyngeal nerve 39
tympanic branch of 32
Goblet cells 35
Graft
advancement of 133f
bed, preparation of 124
method of placement of 307
Graft placement 132
needle for 132
over vestibule 307f, 308f
single-handed 132
Granular myringitis 360f
Granulation tissue 88
Great vessels 78f
Grommet
insertion 95
placement of 97f
used, types of 90
H
Hand burrs 259
Handheld laser probes 356f
Healthy flap 214
Helicotrema 39
Hematoma 323, 359
Hemorrhage
severe 13
soiling scope, severe 13
Hemosiderin 325f
Hemostasis 10
Holding piston, method of 299f
House-Brackmann grading system 315
Human body 70
complex region of 16
Hydroxyapatite 140
Hypertrophied mucosa 172
folds 162
clearance of 201f, 202f
Hypotympanum 18, 23, 40, 75, 80, 116, 121, 191, 243
bony landmarks of 36f
landmarks of 37f
surgical anatomy of 36
I
Ice cream cone 71
Incudostapedial joint 143f
Inadvertent injury 10
Incision 108, 265, 319f, 320f
inferior limb of 111f, 267f
placement of 108
site of 108
superior 267
Incudal ligament, posterior 29
Incudomalleal chain 249
Incudomalleolar fold, lateral 28
Incudomalleolar joint 221, 223, 226, 228, 250, 329f
disarticulation of 199f, 328f, 329, 327
Incudostapedial complex 21f, 121, 274, 274f, 275f
Incudostapedial joint 11, 38, 106, 115, 116, 118–121, 123, 125, 126, 136, 164, 165f, 190, 198, 216, 217, 218, 221, 223, 228, 243, 246, 247, 251, 254, 255, 257f, 274, 282f, 324, 327
complex 279f
disarticulation 281, 281f–283f
discontinuity 198
Incus 10, 17, 21, 24, 28, 38, 143, 164, 176, 178, 179, 180, 190, 217, 218, 221, 223, 228, 250, 274, 281, 291, 304, 305, 307, 308, 358, 359
body 144, 249
buttress 18, 329
long process of 78f
Infection, active local 10
Infiltration, sites of 101
Inflammation 88
Inner ear 50, 80
lesions 364
Instrument
integrated suction 56f
trolley 54
Intensity projection, maximum 81, 81f
Intraneural bleeding 359
Intraneural hematoma 333
Intratympanic tympanosclerosis 236f
Intravenous tranexamic acid 105
Ipsilateral tragal cartilage 257
Iris scissors 56f, 59f, 226, 337
Isthmus
anterior 29, 30f
anticus 29, 29f, 30, 30f, 162
clearance
pass technique of 177f, 178f
technique of 177
posterior 29, 30f
posticus 29, 30, 30f
J
Jacobson's nerve 39, 104, 305
Joint knife 198, 281
Jugular bulb 10, 22, 33, 36, 37, 70, 78f, 91f
L
Labyrinthine segment 313
Laser 355
specifications 357
surgery, microscopic 356
Lateral attic
bone removal, methods of 194f, 195f
wall 184
wall bone 197f
curettage of 194f
Lateral malleolar
fold 28, 31
ligament 29, 38
Lateral semicircular canal 18, 24, 28, 29, 70, 72, 82, 201, 202, 221, 223–225, 227, 229, 253, 253f, 342, 351
Left ear endoscopic epitympanic exploration 164f
Length of piston, calculation of 297f, 298f
Lidocaine 211, 263
Lift test 302, 302f
Ligaments 28
Light sources, types of 50
Limb
horizontal 108, 185, 267
inferior 108, 185, 267, 320f
of incision
horizontal 319f
superior 109f
superior 185, 267, 319f
Local anesthesia 263f
infiltration, sites of 103f, 104f
M
Malleolar fold
posterior 17
superior 29
Malleolar ligament, posterior 31, 143, 170, 248
Malleus 10, 28, 277
fixation 246
handle 1, 17, 24–28, 38, 78f, 84, 94, 106, 112, 116, 119, 125, 134f, 136, 144, 145f, 149, 150, 164, 169, 172, 176, 178–181, 192, 195, 200, 204, 217, 218, 221–226, 233, 241, 243, 246–251, 256, 305, 324, 336, 359, 365
lateral process of 24, 26, 84, 90, 92f, 93, 94, 98, 99, 116f, 118, 120, 126, 145f, 169, 170, 176, 178–180, 210, 226, 227, 265, 327, 329
Malleus head 145f, 199, 200, 217, 222, 223, 249, 329, 331
nipping of 145f, 199f, 331, 331f
Malleus nipper 59f, 146f, 198
position of 222f
Mastoid antrum 210f, 221
obliteration of 230f
Mastoid exploration 209
Mastoid pneumatization 70, 77f
Mastoidectomy 101
cortical 162
Mechanical trauma 66
Medial tip cell area 76
Medical grade monitor 51f
Medication, preoperative 63
Medtronic indigo drill system 62f
Ménière's disease 90
Meniett device 90
Mesotympanic cholesteatoma 210f
Mesotympanum 17, 24, 75
Metal-oxide-semiconductor 47
Micro alligator forceps 58
left-turned 58
right-turned 58
Micro scissors 58, 267
Micro-cup forceps, upturned 58
Microdrill 61
Micro-forceps set 58f
Microinstruments, angled 8
Micromotor drill 353
Microneedle holder 59f
Microscope 54
Microscopic stapedotomy, working window of 264f
Microscopic technique 233
Microtrephine 157
Middle ear 16, 50, 80, 153
anatomy of 16
cavity 236, 243f, 353
inspection of 243f
cleft 244
compartments of right 16f, 17f
cross section 120f
endoscopic anatomy of 15
fluid aspiration 93
gauge 58f
inspection 101, 121, 121f, 323
landmarks 84f
mucosa 104
opacity 85
packing of 350
role of 10
part of 17
pathology 360
photography 2
space 230
division of 75f
structure 359
visibility index 13, 13f
surgery 2, 360
endoscopic 2
temperature 9
transformer mechanism 141
ventilation pathways
anatomy of 30f
of left 30f
walls 85
Minimally invasive endoscopic mastoid surgery 208
contraindications of 209
indications of 209
rationale of 209
Modiolus 39, 40
Molar tooth 71
appearance 78f, 81f
Mucosa 28
dissection of 337
folds, disposition of 180f
variety 140
Multiplanar reconstructions 86f, 87f
Myringoplasty 80, 101
Myringosclerosis 237
Myringotomy 90, 91, 91f
N
Nausea, severe postoperative 68
Needle otoscope 2
Neotympanum 244
Nerve
fibers 313
holding forceps 59f
monitoring systems, intraoperative 365f
segment, loss of 313
sheath incision 344f, 345f
concept of 343f
stimulator probe 365
transection, complete 313
Neurolysis 342
Neuronavigation system 364f
Neuroplasticity 37
Neurosurgical procedures 363
New endoscopic surgical approaches, development of 364
Niche, oval window 236
Nipped malleus head 148f
Nipping malleus 251f
Nonacoustic tumors 4
Notch of Rivinus 32
O
Obliterative tympanosclerosis 256
Operating microscope 54, 353
Operation theatre
instruments 45
setup 45, 46, 54
table 54
Organized tissue, dissection of 333, 333f, 334f
Osseous fallopian canal 85
Osseous labyrinthine wall, thin 85
Osseous spiral lamina 43
Ossicles 73f, 74f, 78f, 81f, 83
palpation of 277f
Ossicular chain 81, 85, 91, 141, 175
defects 140
classification of 140
discontinuity 140
erosion 222f, 223f
management 198, 221
necrosis 229f
palpation of 123
reconstruction 141, 185, 204, 232, 232f, 233f, 347f, 348f
status of 70, 172, 323
unit 91f
Ossicular erosion 9
Ossicular palpation, method of 277f, 278f
Ossicular reconstruction 347
assembly, protecting nerve from 346
Ossicular replacement prosthesis 142
Ossicular status 189
Ossiculoplasty 141, 152, 254f
general principles of 140
materials used for 140
prognostication in 140
second stage 80
Otic capsule-sparing fractures 313
Otic neuralgia 35
Otitis media
chronic 6
surgical management of chronic 6
Otoendoscopy 85f, 86f, 106f
role of preoperative 9
Otologic surgery 6, 101
tools for 13
Otology 84
Otosclerosis 259
treatment of 259
P
Panetti set-suction dissector 224
Panetti suction instruments set 55f
Pars flaccida 31, 90, 143, 164, 170, 179, 180
Pars tensa 31, 90
Partial nerve transection 313
Partial ossicular
reconstruction prosthesis 347f
replacement prosthesis 204f, 232, 237, 347f, 348f
Patient preparation 63
analgesics 63
antibiotics 63
antiemetics 63
Pentazocine 63
Perforation margin, anterior 135f
Perichondrium 132, 204, 230f
Perilymph 39
fistula 257
Perineurium 342, 343
Petrosal nerve, greater superficial 18, 313, 351
Petrous apex 36, 71
Pick scissors 337
Piezoelectric device 233
Piezoelectric handpiece 363
Piezoelectric surgery device 363
Piezoelectric ultrasonic handpiece 363f
Piezosurgery 363
Pig's bladder 101
Piston
measurement of 310
method of insertion of 300f
over graft, placement of 309f
placement of 298f, 300, 301f, 302f
preparation of 297
trimming 299f
Plester's side knife 221
Pneumatized temporal bones 70
Pocket of von Tröltsch 31
posterior 31, 118
Polytetrafluoroethylene 140
Pöschl projection 79
Posterior pillar 23, 39, 42
Povidone-iodine 64f
Prestapedial otospongiosis site 85f
Presynaptic parasympathetic fibers 37
Processus cochleariformis 18, 23–27, 30, 31, 35, 121, 122, 145, 164, 180, 201–203, 224, 225, 227, 229, 230, 251, 252, 336, 342, 346, 351, 358, 359
Processus pyramidalis 17, 18, 25, 27, 30, 115, 120, 121, 143, 164, 253, 324, 332f, 336, 342, 346, 351, 365
Promontory 11, 17, 28, 33, 35, 40, 84, 106, 112–114, 126, 136, 144, 169, 170, 178–180, 192, 198, 199, 210, 218, 222, 227, 230, 232, 243, 246, 247, 249, 250, 256, 257, 305, 308, 324, 336, 340, 359
Prosthesis
length of 152f
placement of 141, 153, 154
preparation of 150, 157
pressure over 156f
Prosthesis in situ
length of 151f
method of placement of 154f, 155f
Prosthesis placement 159
method of 153f, 154f
over cartilage shoe 158f
Protiniculum 17, 33–36, 243
Protympanic spine 33–35
Protympanic tympanosclerotic plaques 246f, 247f
Protympanum 24, 32, 35, 35f, 80, 91, 246, 247f
anatomy of 33f
boundaries of 32
endoscopic anatomy of 33f, 34f
morphological significance of 35
part of 24
plaque 244
surgical
anatomy of 32
importance of 35
tube, visualization of 101
Prussak's space 11, 31, 31f, 32f, 118, 169
boundaries of 31f
Pseudostratified ciliated columnar 35
Puncture wound, postaural 303
Pyramidal eminence 21, 23
Pyramidalis process 358, 359
R
Recording device 53f
Recurrent disease 209
Regular otologic procedures 46
Residual air-bone gap 85
Residual disease 209
Retraction pocket 187, 188, 190, 192, 195, 200
dissection of 189, 190f, 200f
exposure of 9, 188f, 189f
posterosuperior 210f
Retrotympanum 9, 17, 18f, 23, 80, 123f
inferior 17,
superior 17, 18, 19f
surgical anatomy of 17, 18f
Rhinologist's set 8
Round window 39, 73
anatomy 23f
membrane 23f, 39, 40, 41
surgical importance of 40
niche 10, 11, 17, 39, 43, 84, 106, 108, 115, 116, 118, 120, 123, 126, 136, 142, 158, 170, 178, 190, 201, 224, 225, 230, 232, 236, 242, 247, 256, 274, 308, 324, 336, 351
reflex 155, 237
Round-round window protection 140
S
Safety protocol 357
Scala media 39
Scala tympani 39, 40, 42, 252
direction of 41f
Scala vestibuli 39, 40, 43
Scalp incision, posterosuperior 231
Scar 88
Scarless 101
Schwann cell 343
Sclerosed mastoid 209
Sclerosis 251
Sclerotic plaque 244f
Scrub nurse 54
Scutum 75, 84, 143, 144, 180
Segmental decompression, concept of 313
Semicircular canal
integrity 80
superior 71, 76, 79f
Sensorineural deficit 251
Sensory fibers, special 37
Sharp sickle 343
Sickle knife 57, 114
Simple traction injury 313
Sinus
sigmoid 71–73
subpyramidalis 21
subtympanicus 22
anatomy of 22f
tympani 2, 18, 19, 18f–20f, 23f, 74, 324, 324f, 360
depth of 20f
Skeeter drill 259, 262f, 295f, 296f
Skin
incision of 127f
preparation 63
Slow intravenous tranexamic acid bolus 10
Small residual disease 359
Small retraction pockets 9
Soft tissue 128, 141
augment 82
dissection of 128f
removal 7
seal 303
Spiral ligament's basilar crest 43
Spring scissors 267
Squamosal disease 209
Squamosal variety 140
Squamous epithelium 228
lateral 241f, 244
Stack of coin 71
appearance 73f
Standard mastoid bandage 68
Stapedectomy 6
Stapedial tendon 21, 22, 28, 29, 164, 169, 216–218, 223, 246, 253
Stapediovestibular otospongiosis site 85f
Stapedius 221
muscle 257f
tendon 115, 120, 121, 123, 142, 151, 191, 201, 202, 274, 281, 284f, 324
division of 283, 284f, 285f
Stapedotomy 6
microscopic 259, 262
Stapes 10, 21, 27, 30, 80, 143, 144, 251, 333, 336, 340, 342, 351
crura 255
prosthesis, fit of 302
Stapes footplate 291
inspection of 290f, 291f
Stapes superstructure
absent 157
complete fracture of 287f
present 142
Stay suture 65, 105
Storz endoscopic ear surgery instrument set 55f
Straight endoscopic approach 20
Styloid eminence 18, 22, 114–116, 118, 120, 121
Stylomastoid foramen 76
Subcutaneous soft tissues
dissection of 127f
incision of 127f
Subiculum 18
Subpyramidal space 21
anatomy of 21f
Subtensor recess 33
type B 33
type C 33
Suction cannula 67f
Suction instruments 8
Suction machine 54
Suction set with adapter 56f
Supratubal recess 17, 23, 24, 30, 33, 35, 122, 181, 202, 243, 244, 248
Surgeons wearing polarization glasses 354f, 355f
Surgery, steps of 101, 165, 185, 211, 317
Surgical proprioception 13
Surgical spirit 63
Surgical steps 237, 244, 249, 255
anesthesia 90
Sustentaculum promontorii 22
T
Tactile feedback 13
Taste constancy 37
Teflon 140
piston 303
quality 300
Tegmen 223–225, 228
plate 336
tympani 203, 204, 218f, 249
Temporal artery, superficial 126f
Temporal bone 316f, 317f
dissection 25f
dry left 23f
specimen, wet 43f
drilling 363
fractures 313
traumatic 313
types of 313
specimen, dry 35f
Temporal vessels, superficial 126
Temporalis fascia 124, 128, 129f, 132–134, 136, 232, 244f, 346
graft 128f, 159f, 231f, 349, 349f
harvest 102f
over scalp 102f
steps of 126f–129f
preparation of 126
strip of 346f
Temporomandibular joint
capsule of 38
disk of 38
Tenotome 343
Tensor fold 24, 26–28, 30, 122, 164, 180, 204, 223, 244
anatomy of 26f
complete 178f
incomplete 26, 27f
Tensor tympani 10, 28, 29, 145, 246, 249, 252
canal 17, 18, 23, 24, 30, 33, 34, 122, 164, 176, 180, 181, 192, 203, 227, 248, 336
muscle 72, 75
tendon 24, 25, 27, 201, 202, 305
sectioning of 227f
Therapeutic decision 70
Thermal injury 9, 50
Three D endoscope 354f
Tic capsule-sparing fractures 313
Tissue preservation, maximum 8
Titanium instruments 55f
Total ossicular
reconstruction prosthesis, reconstruction with 157
replacement prosthesis 158, 232, 233
Tragal cartilage 154, 156f, 182f, 204, 206f, 230, 231, 231f, 233
harvest site 104f
Tragus, medial aspect of 130
Tranexamic acid 10, 11f
injection 63
protocol 10, 105, 317
Transcanal endoscopic
ear surgery 352, 353, 356f
facial nerve decompression 313
tympanotomy 2
Transcanal incision 319f
Transcanal technique 264f
Translabyrinthine approach 313
Transverse fractures 313
Trauma 85
Tympanosclerosis 257f
Turbo spin-echo 88
Tympanic artery, inferior 22
Tympanic isthmus 24, 26, 29, 121
Tympanic membrane 91f–93f, 98f, 156, 192f, 210, 235f, 237, 244, 274, 359f
defect 257
graft 156
normal 187
perforation 107f, 162, 165f
margin of 165
reconstruction 101, 231, 231f, 232f
remnant of 108f, 191f
secondary 39
Tympanic neurectomy 35
Tympanic plexus 104
Tympanic segment 76f, 313
Tympanic sinus 46
lateral 18f, 19f
posterior 18, 18f, 20f, 114, 116, 118, 169, 272
Tympanic spine, anterior 32
Tympanomeatal flap 11, 111, 112, 112f, 113, 116, 118, 133, 134, 143f, 157f, 168, 187f, 188f, 204, 213f, 214, 217, 257, 268, 268f, 271, 304f, 311
elevation 111f, 142f, 143f, 255
graft position after placement of 135f
over prosthesis 160f
replacement of 136f, 349f
Tympanoplasty 100
Tympanosclerosis 80, 185, 235f, 236, 253f, 257f
endoscopic management of 234
Tympanosclerotic plaque 240f, 241, 241f, 242, 244, 246, 248
Tympanotomy 273, 355f
V
Vein graft 307, 308
placed over vestibule 308f
Ventilation
pathway of 29, 35
anterior 164f
posterior 164f
tube 99, 99f
placement of 99f
Vertical limb, posterior aspect of 151
Vestibular schwannomas 4
Vestibular sedatives 68
Vestibule visible beneath vein graft 310f
Vomiting, severe postoperative 68
W
Warm caloric stimulation 9
Water molecules, Brownian motion of 88
Wilson bone punch 197f, 198f, 217
use of 196, 197f
Wilson's down-biting bone punch 59f
X
Xenon light source 9, 51f
×
Chapter Notes

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