Manual of Temporal Bone Dissection by M. Barbara

By M. Barbara

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30). When the lowering of the posterior EAC wall has been completed, it will be possible to make a note of what portion of the posterior mesotympanum it is possible to visualise with an open technique. Remembering (or better still, recording) what it was possible to visualise 28 Fig. 30. The ‘open’ technique implies lowering of the posterior canal wall (PW). TM= Tympanic membrane. through the posterior tympanotomy, it can be concluded that the ‘open’ technique: a. does not permit to see more than a ‘closed’ technique, but perhaps allows a more comfortable use of the instruments; b.

35a. 8 mm) diamond Fig. 35b. The arrow shows the direction burr, cochleostomy is performed. of the basal turn of the cochlea. late its insertion, ending with the application, before starting with the anatomical dissection of the cochlea. This step is carried out by using a diamond burr, and removal of the superficial part of the cochlear wall is continued anteriorly up to the projecting area of the ICA, and then superiorly in the region which is medial to the pathway between the CP and the semicanal of the tensor tympani muscle.

The dissection continues with an extension of a closed TPL, a conservative approach to the middle ear. Opening of the anterior epitympanum is generally needed when a pathological process has invaded it, as in the case of a cholesteatoma which may already have induced local damage, such as tegmen or incus erosion, as well as COG demolition. Removal of the incus and head of the malleus and demolition 23 Fig. 27a-b. After removal of the ossicles from the posterior epitympanum, COG becomes visualised.

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