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Education:■ M.D. Ear, Nose and Throat Surgery.

May 1992, Faculty of medicine,Cairo University Kasr Al-Ainy Medical School

■ M.S. Ear, Nose and Throat Surgery. May 1985 (very good degree), faculty of medicine,Cairo University Kasr Al-Ainy Medical School

■ M B & Bch Nov. 1981 (very good degree), faculty ofmedicine, Cairo University Kasr Al-Ainy MedicalSchool

Posts:■ Senior Consultant at ENT department, Sabah and MTC

hospitals, Ministry of Health (MOH), Kuwait ■ Lecturer of otorhinolaryngology, department of

surgery, faculty of medicine, Kuwait university 1996,ongoing. (Mandated from MOH).

■ X-Chairman of ENT medical council in Kuwait.December 1999 – April 2006.

■ X-Chairman of ENT department, Al-Sabah Hospital,Kuwait, July 1999 – April 2006.

■ Resident at Cairo University Medical School, ENTdepartment, Kasr Al-Ainy Hospital, Egypt,from 2nd March 1983 until 28 Feb. 1986.

■ House officer at Cairo university hospitals, Egypt,from 1st march 1982 – 28 Feb. 1983.

Licensures and activities:■ Licensed as ENT Consultant in Kuwait, Egypt and

Sudan.■ Referee of the Kuwait Medical Journal.■ Member of the Faculty of Surgery, Kuwait Institute for

Medical Specialization (KIMS) since October 1998,ongoing.

■ X-chairman of the inspection board for private hospitals,MOH, Kuwait.

■ X-Member of the operational policy follow-up teamMOH, Kuwait.

■ X-Member of the accreditation standards setup com-mittee for hospitals and primary health care centers,MOH, Kuwait.

■ Visiting professor, Khartoum university, faculty ofmedicine.

■ Director of the first temporal bone course, Kuwait,November 2005.

Publications:19 publications in national, regional and internationaljournals, 12 presentations, 8 posters and booklets.

Awards and certificates of honor:1. From KMA on the occasion of obtaining the M.D.

degree.2. From the Egyptian medical syndicate on the occasion

of obtaining the M.D. degree.3. The first prize of the 11th course in otology and oto-

neurosurgery, 5–7 Dec. 2000, hôpital Purpan,Toulouse, France.

4. From the 3rd International Conference of the GulfCooperation Council (GCC) Otorhinological, Head &Neck Societies & Associations. March 98.

5. From the Sudanese ENT association. 6. From the minister of health of Kuwait for editing the

operational policy of the ENT departments in Kuwait,May 2000.

7. From the minister of health, Kuwait, for the 3rd editionof the operational policy of the ENT departments inKuwait, Febr. 2002.

8. Support for research from the “Kuwait Foundation forAdvancement of Science” (KFAS).

9. From the faculty of surgery, Kuwait Institute for Medic alSpecialization (KIMS)

10. From the director of Sabah medical area.

Khairy Alhag Abu Shara, M.D.Senior consultant ENT, Head and NeckSurgeon, Sabah and MTC Hospitals, Kuwait

DISSECTION MANUAL FOR THETEMPORAL BONE LABORATORY

KHAIRY ALHAG ABU SHARA, M.D.Senior Consultant ENT, Head and Neck Surgeon

Sabah and MTC Hospitals, KuwaitX-Chairman of ENT Medical Council – MOH 99-06

To my mother,from whom I have learned how

sincere hard work can bean endless source of enjoyment.

To my Family,for their unlimited support

and understanding of the medical professionas well as its obligations and commitments.

Dissection Manual for the Temporal Bone Laboratory4

Acknowledgement

The growth of medico-legal problems related to surgical practicesnecessitates greater emphasis on clinical training. Lab practice oncadavers and various models is becoming increasingly popular for bothresearch and training.

The challenges of ear surgery are unique because the density ofanatomical structures in a relatively small space is unlike any otherorgan in the human body. This consequently calls for extensive lab train-ing before starting to operate in the theater—a step that should only betaken once both the trainer and trainee are satisfied with the level ofskills achieved.

For those reasons, the establishment of a temporal bone lab within theotology center is an inevitable option.

Considering the short time frame given during a temporal bone dissec-tion course – in which the participants are concerned mainly with hands-on training rather than going into further theoretical details – this manualnevertheless provides practical and concise orientation to the topic. Theauthor’s aim was not to write a textbook, but to address the actualneeds in a temporal bone lab, which is why this manual should be sup-ported by more detailed training instructions and further readings.

I hope, this booklet will be of great help to our junior candidates and tothe seniors who are planning to establish a temporal bone lab.

A special word of gratitude goes to KARL STORZ company for their kindsupport and valuable assistance in the preparation of this booklet.

Khairy Alhag Abu Shara, M.D.Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitEmail: [email protected]: 00965 9784104

Dissection Manual for the Temporal Bone Laboratory 5

Foreword

Middle ear surgery involves procedures that are among the most chal-lenging in the field of ORL, demanding a high degree of technical skill,expertise and precision. To become a proficient otologist requires goodorientation skills and thorough knowledge of numerous anatomicalstructures confined to a space amounting to less than one cubic inch.Furthermore, the introduction of the surgical micro scope, dental drill andfine instruments requires the development of precise operative tech-niques.

The introduction of high-resolution CT scanners, 1 mm cuts and MRIenables surgeons to gain a more detailed knowledge of fine anatomicalstructures, e.g., the thickness of the stapes foot plate in stapes surgery,the facial nerve anatomy, and the possibility of any associated congenit -al anomalies in cochlear implantation.

Full anatomical orientation regarding both normal and abnormal variantsis the first step to be taught in temporal bone labs. Otherwise avoidablecomplications could occur.

It has been suggested by many authors that prior to performing in-vivosurgery in an operating theater, a trainee surgeon should acquire goodknowledge of temporal bone anatomy and develop proper navigationalskills to such a degree comparable to the uncanny sense of directionthat allows us to find our way through our own bedroom in completedarkness. It takes a long time to become an ear surgeon and even moretime to gain the required level of proficiency to successfully manage dif-ficult and complicated cases. The temporal bone dissection lab pro-vides an entry point, where candidates can devote their efforts to work -ing toward this goal.

In this manual, information is given about the anatomy of the temporalbone, the various surgical procedures, that can be practiced on cadaverspecimen in the lab (including photos, adressing procedures, and con-cepts), imaging procedures, and a suggested temporal bone laboratorysetup.


Dissection Manual for the Temporal Bone LaboratoryKhairy Alhag Abu Shara, M.D.

Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitX-Chairman of ENT Medical Council – MOH 99-06

Address for correspondence:Khairy Alhag Abu Shara, M.D.Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitEmail: [email protected]: 00965 9784104

© 2007 Endo-PressTM, Tuttlingen, GermanyISBN 978-3-89756-151-9, Printed in GermanyPostfach, D-78503 TuttlingenPhone: +49 74 61 145 90Fax: +49 74 61 708 529E-mail: [email protected]

Editions in languages other than English and German are in prepara-tion. For up-to-date information, please contact Endo-PressTM

Tuttlingen, Germany, at the address mentioned above.

Printed by:Endo-PressTM Tuttlingen, GermanyBraun Druck+Medien, D-78532 Tuttlingenj, Germany

11.07-2

Anatomical schematic drawings:Mr. Andreas MückeKarl-Frank-Str. 3212587 Berlin, Germany

Most of the photographs shown inthis manual were taken by the authorduring dissection sessions in the temporal bone laboratory.

All rights reserved. No part of this publication may be translated, reprinted orreproduced, transmitted in any form or by any means, electronic or mechanical,now known or hereafter invented, including photocopying and recording, or uti-lized in any information storage or retrieval system without the prior written per-mission of the copyright holder.

Please note:Medical knowledge is constantly changing. As new researchand clinical experience broaden our knowledge, changes intreatment and drug therapy may be required. The authorsand editors of the material herein have consulted sourcesbelieved to be reliable in their efforts to provide informationthat is complete and in accordance with the standardsaccepted at the time of publication. However, in view of thepossibility of human error by the authors, editors, or pub-lisher of the work herein, or changes in medical knowledge,neither the authors, editors, publisher, nor any other partywho has been involved in the preparation of this work, canguarantee that the information contained herein is in everyrespect accurate or complete, and they cannot be heldresponsible for any errors or omissions or for the resultsobtained from use of such information. The information con-tained within this brochure is intended for use by doctorsand other health care professionals. This material is notintended for use as a basis for treatment decisions, and isnot a substitute for professional consultation and/or peer-reviewed medical literature.Some of the product names, patents, and registereddesigns referred to in this booklet are in fact registeredtrademarks or proprietary names even though specific refer-ence to this fact is not always made in the text. Therefore,the appearance of a name without designation as propri-etary is not to be construed as a representation by the pub-lisher that it is in the public domain.All rights reserved. No part of this publication may be trans-lated, reprinted or reproduced, transmitted in any form or byany means, electronic or mechanical, now known or here-after invented, includ ing photocopying and recording, or uti-lized in any informa tion storage or retrieval system withoutthe prior written permission of the copyright holder.


Table of Contents

Acknowledgement ................................................................................................................... 4

Forword...................................................................................................................................... 5

1.0 Introduction ........................................................................................................................ 8

2.0 Training Procedures............................................................................................................ 13

3.0 Endoscopic Views of the Temporal Bone ......................................................................... 24

4.0 Temporal Bone CT Images4.1 Axial CT Scans ............................................................................................................. 284.2 Coronal CT Scans ....................................................................................................... 35

5.0 Exposure of the Temporal Bone: Genuine Dissections ................................................... 39

Remember ......................................................................................................................... 42


1.0 Introduction

Fig. 1Left temporal bone, lateral view with the squama sculptured asan auricle. There are two temporal bones. Each is composed offive parts: mastoid, petrous, squamous, tympanic plate andstyloid process.

Squamous portion

Petrous portion

Mandibular fossa

Zygomatic processTympanic portion

Mastoid portion

Styloid portion

Fig. 2Right temporal bone attached to the occipital bone. View of theposterior cranial fossa. The internal auditory meatus (IAM),jugular foramen and notch, sigmoid sinus, superior and inferiorpetrosal sinuses, petrous apex, clivus, and hypoglossal canalcan be seen.

Internal auditory meatus

Basisphenoid

Occipital condyle

Nerves of the jugular foramen

Sigmoid sinus

Vessels of the jugular foramen

Occipitomastoid suture

Squamous part of theoccipital bone

Basiocciput

Jugular tubercle

Hypoglossal canal


Fig. 3Right temporal bone attached to sphenoid and occipital bones.View of the middle cranial fossa. The foramina (rotundum, ovale,spinosum, and lacerum), the superior orbital fissure, internalcarotid artery, anterior clinoid process, clivus, petrous apex,cavum trigeminale, greater wing of the sphenoid, petro-sphenoid and petro-occipital suture lines are visible.

Foramen rotundum

Superior orbital fissure

Sella turcica

Foramen spinosum

Foramen ovale

Superior petrosal sulcus

Foramen lacerum

Clivus

Anterior clinoid process

Internal carotid artery

Occipital condyle

Fig. 4External view of the skull base. The jugular foramen, carotidcanal, greater wing of the sphenoid, the foramina (ovale,spinosum, lacerum), zygomatic root, mandibular fossa, styloidprocess, squamo-sphenoid suture, occipital condyle, digastricfossa, stylo-mastoid foramen, and mastoid tip are visible.

Zygomatic root

Squamo-sphenoid suture

Jugular bulb

Mandibular fossa

Tympanic plate

Mastoid tip

Stylo-mastoid foramen

Digastric fossa

Styloid process

Occipital condyle

Foramen spinosum

Carotid canal

Foramen ovale

Jugular tubercle


Fig. 5Right inner ear. The three semicircular canals (SCC) are open,the lateral, the posterior and the superior with crus communeare visible. The cochlea and oval window are also exposed.

Superior SCC

Cochlea

Oval window

Lateral SCC

Common crus

Posterior SCC

Fig. 6Left inner ear. The superior and lateral SCC, facial nerve,oval and round windows, cochlea, modulus, and promontory.

Oval window

Superior SCC

Lateral SCC

Facial nerve

Remnant of promontory

Cochlea: basal turn

Modulus

Round window


Fig. 7Anatomy of the left middle ear: The incudo-stapedial joint, thestapes head and the crura, facial nerve, stapedial tendon,promontory, and tympanomeatal flap are visible.

Malleus handle andtympanomeatal flap Long incus process

Stapes head

Stapedial tendon

Lenticular incus process

Incudo-stapedial joint

Promontory

Fig. 8The auditory ossicles.1 The malleus, head, neck, lateral process, and handle.2 The incus: body, short, long, and lenticular processes. 3 The stapes: head, neck, anterior and posterior crura,

and footplate.

HeadNeck

1 Malleus

2 Incus

3 Stapes

Short process

BodyLenticular process

Long process

Head

Neck

Posterior crus

Anterior crus

Footplate

Lateral process

Handle

1

2

3


Fig. 9Right side dissection. Notice the jugular bulb, carotid canal,both vertical and horizontal parts, carotico-jugular septum,and foramen for the IX cranial nerve, cochlea, oval window,facial nerve, cochleariform process, semi-canal of the tensortympani muscle, and lateral SCC.

Facial nerve(transverse segment)

Cochleariform process

Transverse partof the carotid canal

Vertical partof the carotid canal

Semi-canal of thetensor tympani muscle

Carotico-jugular foramen

Middle ear

Jugular bulb


Identify important landmarks related to different anatomic views of the temporal bone, for example:

• Zygomatic root • Petrous part of temporal bone and its apex• Mastoid tip • Cavum trigeminale • Digastric notch • Arcuate eminence• External auditory meatus • Internal auditory meatus• Squamous part of temporal bone • Cranial nerves VII, VIII, IX and X

(spaghetti-like structure)

2.0 Training Procedures

The bones should be removed from therefridgerator at least one hour before dissection.First, determine whether the bone is right or left,and secure it with a temporal bone holder in a

surgical position, as if in the operating theater.The zygomatic root is anterior, and the mastoidtip is inferior (Fig. 10a)

Fig. 10aLeft temporal bone with soft tissues.

External auditory meatus

Squama

Zygomatic root

Mastoid tip

Digastric notch

General rules• Specimen should be taken out of the

refridgerator one hour before dissection.• All needed instruments should be available.• Temporal bone should be in surgical

position.• Rapid review of the gross anatomy.• Verify operational integrity of the drill and

perform an initial function test .• Leave your bones in a labeled plastic bag.

Sanitary rules• Anti-hepatitis vaccination.• Wear gowns, gloves, overshoes, safety

glasses and face mask to prevent bone dustinhalation and entry of a bone splinter into theeye.

• Avoid injuries by using proper instruments.• Remaining bones and dust should be

handled as medical wastes.• Leave the working area clean and tidy for

the next group.


Attempt soft tissue procedures, such as:• Periosteal incision and dissection• Dissection of the posterior meatal skin

down to the annulus.

1.

Drill a code number on the squama to prac-tice control of the drill handpiece, whichshould be held and used like a pencil. Neverapply undue force to avoid losing controland causing subsequent, potentially cata-strophic injury.

2.

Fig. 10bDifferent periosteal incisions and flaps.

U- shaped incision

Vertical andtransverse incisions

Transmeatal transverse andvertical skin incisions

Craniotomy flap

T- shaped incision

Obliteration flap

Sometimes the candidate cannot practice thesoft tissue work properly if formalinized speci-mens or macerated bones are used.The candidate should be familiar with the anatomyof macerated bones (Figs. 10d and 10e).

The Golden Rules of Drilling:• Hold the drill securely with a steady hand• Never perform blind drilling!• Proper burr type, size and shape.• Parallel direction• Excavate, but never penetrate.• Use suction-irrigation and prevent overheating.


Fig. 10cThe art of drilling.

Antrum External auditory meatus

Cells of the mastoid tip

Posterior meatal wall

Dural plate

Lateral SCC

Posterior tympanotomy

Sinus plate

Digastric ridge

Drill

Fig. 10dAnatomy of macerated bones. Lateral surface.

Squama

Zygomatic root

External auditory meatusMastoid

Tympanic plate

Digastric notchCarotid canal

Petrous bone

Fig. 10eAnatomy of macerated bones: Medial surface.

Arcuate eminence

Squama

Mastoid

Petrous bone



Fig. 10fLeft myringotomy and grommet insertion.

Malleus handle andtympanomeatal flap Long incus process

Stapes head

Stapedial tendon

Lenticular incus process


Promontory

Fig. 11Left anterior tympanotomy.


Practice myringotomy and grommetinsertion (Fig. 10f).

3.

Practice anterior tympanotomy: a tympano -meatal flap is created by removal of theposterior meatal wall and exploration of themiddle ear (Figs. 11, 12a). Practice stape -dectomy and teflon piston insertion (Fig.12b)In-vitro fixation can be achieved by injectingadhesive glue around the footplate or intothe labyrinth through a “decapitated” super iorSCC at the arcuate eminence.

Check the annulus, incudo-stapedial joint, stapessuprastructures, stapedial tendon, pyramidalprocess, facial nerve, chorda tympani, malleushandle, tympanic membrane, promontory, andround window.

4.

Fig. 12aLeft anterior tympanotomy (schematic drawing).

Annulus fibrosus

Long process of incus


Posterior crus of stapes

Incudostapedial joint

Tympanomeatal flap

Malleus handle

Chorda tympani

Promontory

Fig. 12bLeft stapedectomy and teflon piston insertion.

Teflon piston

Long process of incus

Lenticular process of incus

Promontory

Pyramidal process

Shaft

Perform myringoplasty, in which a piece ofperiosteum is harvested and used as a graftwhich is positioned with the underlay tech-nique to repair a previously created tympanicmembrane perforation.


5.

6.

Zygomatic root



Tip cells

Sinus plate

Antrum

Squama

Lateral SCC

Dural plate

Sinodural angle

Practice a cortical mastoidectomy (Figs.13, 14). Identify the spine of Henle, thenstart with the largest cutting burr in theMacEwen’s triangle between the inferiortemporal line, tangent to the posterior meatalwall and the spine of Henle. This triangle

serves as a landmark for localizing the mastoidantrum. Drilling should be accompanied by con-tinuous irrigation and performed parallel to theanticipated border without leaving behind anyoverhangs. Never work blindly. The antrum, whichis the largest mastoid air cell, has the lateral SCCon its floor. Cells over the dural and sinus platesare drilled, the sinodural angle is identified, andcells behind the sinus are cleared. Identify thedigastric ridge and clear the peri-facial and deepmastoid air cells. Keep the posterior bonymeatal wall intact.

Fig. 13Right cortical mastoidectomy.

Fig. 14Right cortical mastoidectomy (schematic drawing).

Lateral semicircular canal

Dural plate



Digastric ridge

Facial nerve

Sinus plate

Antrum

Sinodural angle


tympani, and facial nerve down to the middleear. The incudostapedial joint, promontory andround window niche should be visible.

Note: You can fill the external auditory meatuswith a colored fluid. This fluid should not leakinto the mastoid. If leakage occurs, it is anearly alarm that the annulus, tympanic mem-brane or posterior meatal wall was injured.

Incus body

Antrum

Short process of incus

Lateral SCC

Posterior meatal wal


Window of the posteriortympanotomy

Facial nerve

Fig. 16Left posterior tympanotomy (schematic drawing).

7. Perform posterior tympanotomy (Figs. 15, 16)by initially gaining access to the middle earfrom the mastoid cavity while ensuring thatthe tympanic membrane and annulusremain intact. A cortical mastoidectomy isperformed to deepen the sinodural angleand thin the posterior meatal wall. The incusbody and its short process are identified.Drilling begins with the 2 mm-diamond burrbetween the incus short process, chorda

Fig. 15Left posterior tympanotomy.

Chorda tympani


Promontory

Body of incus process


Dural plate


Facial nerve

Round window

Sinus plate


8.

Fig. 18Right saccus decompression (schematic drawing).

Fig. 17Right saccus decompression.

Perifacial cells

Endolymphatic sacopened with a sickle knife

Sigmoid sinus

Lateral SCC (de-roofed)

Antrum

Posterior SCC (de-roofed)

Identify the endolymphatic sac (Figs. 17, 18).Both lateral and posterior SCCs are exposedbut not opened. The peri-sinus cells aredrilled, and an imaginary line is passed alongthe lateral SCC, perpendicular to the poste-

rior SCC. The bone inferior to this line is thenthinned out and removed with a needle. The lateral wall of the sac is identified and incisedusing a sickle knife.

Dural plate



Sinus plate

Sinodural angle

Digastric ridge

Endolymphatic sac

Axis of lateralsemicircular canal

Axis of posteriorsemicircular canal


Fig. 20Right double cochleostomy.

Posteriormeatal wall

Cochleostomy

Secondcochleostomy

Window of the posterior

tympanotomy

Fig. 19Cochlear implant bed.

Corticalmastoid

Nose of theimplantdummy inthe recesscreated forelectrodes

Dummyinsertedinto theimplant site

Fig. 21Electrode hugging the modulus of the rightcochlea (counter-clockwise).

9. A cochleostomy is performed (Fig.20) afterpreparation of the cochlear implant bed(Fig. 19) and cortical mastoidectomy withposterior tympanotomy. An attempt can bemade under visual control with the cochleaopened from posterior so the electrode isconstantly under direct vision during inser-tion (Fig. 21).

Note: This step needs to be perform ed undersupervision of a trainer.


10. Perform a radical mastoidectomy (Figs. 22,23) by drilling through the posterior meatalbony wall down to a level just above a linefrom the lateral SCC to the digastric ridge,removing the bridge over the attic area, as

well as the anterior and posterior buttresses. Theanterior attic is also cleared. Identify the facialnerve, semicanal of the tensor tympani muscleand the cochleariform process tendon. Try to com-plete an ossiculoplasty procedure.

Fig. 23Right radical mastoidectomy (schematic drawing).

Semi-canal of thetensor tympani muscle

Promontory

Round window

Stapes

Facial nerve

Sinus plate

Tendon of the tensortympani muscle


Dural plate

Dural plate


Fig. 22Right radical mastoidectomy.

Middle ear

Lateral SCC

Zygomatic root

Stapes

Dural plate

Sinodural angleTip cells

Sinus plate


Superior SCC

Facial nerve

Lateral SCC

Posterior SCC

11. Perform a labyrinthectomy (Fig. 24, 25) byfirst identifying the domes of the three SCC.Open the canals and follow with a small dia-

mond burr to the vestibule. Preserve the anteriorpart of the lateral SCC to avoid injury to the facialnerve.

Fig. 24Left labyrinthectomy.

Fig. 25Left labyrinthectomy (schematical drawing).

Facial nerve

Posterior semicircular canalLateral semicircular canal

Superior semicircular canal

Dural plate

Stapes

Sinus plate


3.0 Endoscopic Views of the Temporal Bone

Fig. 26Right tympanic membrane.

Malleus handle

Lateral malleus process

Cone of lightUmbo

Pars flaccida

Pars tensa

Fig. 27Oto-endoscopic view of the right middle ear through theEustachian tube.

Long incus process

Semicanal of thetensor tympani muscle

Middle ear

Incudo-stapedial jointTympanic membrane

Umbo

Eustachian tube


Malleus handle


Fig. 28Left middle ear.

Facial nerve

Attic

Oval window

PyramidPonticulus promontorii

Sinus tympani

Subiculum promontorii

Round window

Mesotympanum

Promontory

Hypotympanic cells

Semicanal of thetensor tympani muscle

Eustachian tube

Fig. 29Right internal auditory meatus.

Superior vestibular area

Fallopian canal

Inferior vestibular area

Singular nerve

Cochlear area

Bill’s bar

Transverse crest


Fig. 30Left internal auditory meatus.

Bill’s bar

Fallopian canal

Cochlear areaInferior vestibular area

Singular nerve

Superior vestibular area

Transverse crest

Fig. 31a, ba Right internal auditory meatus (de-roofed) and cochlea

opened with modiolous and spiral lamina visible.b MRI insert image provides orientation about the position of

the cochlea in (a).

Right internal auditory meatus(de-roofed)

Modiolus

Cochlea (opened)

Spiral lamina

a b


Fig. 32Endoscopic view of the right internal auditory meatus (IAM).The vestibular, cochlear and facial nerves are contained withinthe sheath of the dura mater.

Facial nerve

Vestibular nerve

Dural sleeve

Cochlear nerve


Jugular bulband inferiorpetrosal sinus


4.0 Temporal Bone CT Images

4.1 Axial CT Scans

Axial CT sections that include 1 mm cuts withoverlap are appropriate for temporal bone visu-alization. The cuts start from the level of themastoid tip and continue up to the level of thesuperior SCC.

Some authors link the anatomical structureswith mnemonic cartoon symbols that aid inmemorizing the major structures and their char-acteristics, such as:

Mnemonicsymbols

Anatomicalstructure

Cochlearaqueduct

Basal turn ofthe cochlea

Cochlea

Common crus

Lateral SCC

Duck bill

Horn

Smile

Horns

Spot

Bucket handle

Internalauditorymeatus(IAM)

Mnemonicsymbols

Anatomicalstructure

Incus andmalleus

Attic, aditus,and antrum

Carotid artery

Vestibularaqueduct

Superior SCC

Funnel

Ice cream cone

Hour glass

Inverted L

Slit

Snake eyes

The following CT images very effectively illustratethe osteological details needed for this course


Fig. 33

Sphenoid sinus

Great wing of the sphenoid

Foramen ovale

Carotid artery (transverse)

Carotid artery (vertical)

Inferior petrosal sinus

Sphenoid body

Jugular vein

Posterior cranial fossa

Mandibular condyle


Sinus plate

Mastoid cortex

Occipito-mastoid suture

Squamo-sphenoid suture

Anterior cranial fossa

Foramen spinosum

Fig. 34

Sphenoid sinus


Foramen spinosum


Sphenoid body

Jugular vein

Petrous apex


Mandibular condyle


Facial nerve

Mastoid cortex

Sigmoid sinus

Foramen ovale

Anterior cranial fossa

Try to refresh your knowledgewith the axial sections listed below.


Fig. 35

Sphenoid sinus


Foramen ovale

Sphenoid body

Eustachian tube

Cochlea



Middle ear


Facial nerve

Sigmoid sinus

Mandibular condyle

Foramen spinosum

Fig. 36Notice the basal turn of the cochlea, middle ear and thecochlear aqueduct.


Foramen ovale


Sphenoid body

Cochlea


Petrous apex

Tympanic membraneand malleus


Facial nerve

Sigmoid sinus

Mandibular condyle

Middle ear


Fig. 37Notice the cochlea, posterior SCC, sinus tympani, semi-canalof the tensor tympani muscle, round window, facial nerve,chorda tympani, tympanic membrane, and malleus handle.


Round window

Cochlea

Ampullary end of theposterior semi-circular canal


Cochlear aqueduct

Tympanic membraneand malleus

Facial nerve

Sinus tympani

Posterior semi-circular canal

Middle ear

Foramen rotundum

Fig. 38

Foramen rotundum

Semicanal of the tensortympani muscle



CochleaFacial nerve

Common crus

Middle ear andauditory ossicles

Sinus tympani


Fig. 39Notice the long incus process.

Carotid artery

Petrous apex

Cochlea

Semicanal of the tensortympani muscle


Vestibule

Malleus

Sinus tympani

Facial nerve

Anterior and posterior crura of the stapes

Middle ear and ossicles

Long incus process

Fig. 40Notice the stapes, vestibule, common crus, and facial nerve.

Petrous apex


Vestibule

Cochlea


Incudomallear complex

Vestibular aqueduct

Common crus

Facial nerve



Fig. 41Notice the “ice cream cone” (incus and malleus) ossicular complex, vestibule, lateral SCC, facial nerve, IAM, and attic.

Greater superficialpetrosal nerve

Geniculate ganglion


Petrous apex


Malleus head

Posterior semicircular canal


Mid-cranial fossa

Incus body

Fig. 42Notice the posterior and superior semicircular canals.

Mid-cranial fossa

Petrous apex


Greater superficialpetrosal nerve


Attic


Antrum


Aditus ad antrum


Fig. 43Notice the superior SCC extending to the dome, which isequivalent to the arcuate eminence at the mid-cranial fossa.

Superior SCC


4.2 Coronal CT Scans

A series of 1 mm cuts with overlap are appropri-ate for temporal bone coronal CT imaging. Thecuts start from anterior to posterior from thelevel of the cochlea back to the level of the pos-terior SCC.

Some authors link the anatomical structureswith mnemonic cartoon symbols that aid inmemorizing the major structures and their char-acteristics, such as:

Superior SCC,lateral SCC,basal turn ofcochlean

Mnemonicsymbols

Anatomicalstructure

Transverse crest IAM

Vestibule andround window

Cochlea

Three fingers

Inverted tear drop

Snail shell

Scutum

Mnemonicsymbols

Anatomicalstructure

Malleus

Labyrinth andtympanic facialnerve seg-ments

Eustachiantube

Pyramid

Hammer

Snail eyes

Inverted triangle


Fig. 44Notice the cochlea, carotid artery, Eustachian tube, middle ear,attic, digastric notch, tympanomastoid suture, and mandibularcondyle.

Petrous apex

Petro-occipital joint

Facial nerve, labyrinth portion

Attic

Cochlea

Carotid artery

Middle earDigastric notch

Eustachian tube

Mandibular condyle

Facial nerve, tympanic portion

Tegmen tympani

Annulus

Fig. 45Notice the attic, malleus head and neck, tendon of tensor tym-pani muscle, tympanic membrane, middle and external ear,Eustachian tube, petro-occipital suture, cochlea, mandibularcondyle, petrous apex, annulus, scutum, tegmen and cochleari-form process.

Petro-occipital fissure

Middle ear

Cochlea


Attic

Petrous apex

Eustachian tube

Tegmen

External ear

Tympanic membrane

Annulus

Mandibular condyle

Scutum

Malleus


Mastoid air cells

Fig. 46Notice the internal auditory meatus and transverse crest, attic,malleus, scutum, tegmen, mastoid air cells, external auditorymeatus, tympanic membrane, mandibular condyle, annulus,petro-occipital suture, petrous apex and middle ear.

Petrous apex

Petro-occipital


Transverse crest

Attic

Middle ear

Annulus

Mastoid air cells

Tympanic membrane

Mandibular condyle

External ear

Tegmen

Malleus

Scutum

Try to refresh your knowledgewith the coronal sections listed below.


Fig. 48Notice the vestibule, round window, petromastoid suture,hypoglossal canal, and jugular bulb.

Vestibule

Petrous apex

Middle ear

Round window

Tympanic membrane

Antrum

Mastoid air cells

Tegmen tympani

External ear

Fig. 49Notice the jugular bulb, hypoglossal canal, mastoid cells, andSCC.



Arcuate eminence

Jugular vein

Antrum

Mastoid air cells

Tegmen tympani

Facial nerve (vertical part)

Fig. 47Notice the internal auditory meatus, basal turn of the cochlea,superior (arcuate eminence) and lateral SCC, tympanic mem-brane, incus, stapes footplate, tegmen tympani, lateral semicir-cular canal, mastoid air cells, body of incus, scutum, externalear, incudo-stapedial joint, vestibule, petrous apex, petro-occipital fissure and middle ear.

Stapes footplate

Petrous apex

Vestibule

Superior semicircular canalArcuate eminence


Petro-occipital fissure

Basal turn of the cochlea

Middle ear

Body of incus

Tympanic membrane


External ear

Mastoid air cells

Tegmen tympani


Scutum


Fig. 50Notice the posterior SCC, mastoid air cells, jugular bulb,tegmen tympani, mastoid tip, lateral and superior SSCs andhypoglossal canal.


Jugular vein



Hypoglossal canal

Mastoid air cells

Tegmen tympani

Mastoid tip


Fig. 51

Eustachian tube

Facial nerve

Cochleostomy

Digastric ridge

Lateral SCC

Superior SCC

Solid angle

Posterior SCC

5.0 Exposure of the Temporal Bone: Genuine Dissections

Fig. 52



Superior incudal ligament

Body of incus

Attic

Lateral SCC

Fossa incudis

Posterior tympanotomy


Fig. 53



Incus

Fossa incudis

Attic

Tympanic plate

Antrum

Superior SCC

Annulus

Umbo

Facial nerve

Lateral SCC

Posterior SCC

Fig. 54

Semicanal of tensor tympani


Facial nerveTendon of the tensor

tympani muscle

Malleus handle

Tympanic membrane

Chorda tympani

Head of malleus

Body of incus


Superior SCC

Lateral SCC


Fig. 55

Malleus

Incus

Tympanic membrane


Malleus handle

Anterior wall of externalauditory meatus

Promontory

Attic

Lateral SCC

Pyramidal process


Fig. 56

Körner’s septum is an internalextension of the petrosqua-

mous suture. May misleadinto a false antrum

Antrum

Fig. 57

Oval window

Promontory

Lateral SCC

Posterior SCC

Superior SCC

Facial nerve

Tegmen tympani

Sinus plate

Round window

Facial nerve

Jugular bulb


☞ When is the right time to begin withtraining in the operating room?

● When both the trainer and trainee are equally satisfied about the outcome.

● When the trainee is able to identify earstructures as if within one’s own bedroomin the dark.

● After watching various live surgeries.

☞ When back to the operating room,never forget

● Morbid anatomy.● Congenital anomalies.● Continuous polishing of your skills.

Remember

Remember, that ear surgery is not foramateurs; it can end with unpleasantcomplications like facial nerve palsy, peri-lymph fistula and vertigo, fatal intracranialcomplications or hearing loss.


Dissection Manual for the Temporal Bone LaboratoryInstruments, Units, Video Systems and Accessories


Please note: The temporal bone dissection laboratory should be located away from all clinical and surgical activities with sanitaryarrangements managed by the infection control officer of the hospital. The number of stations is subject to the number of participants.The main station should be equipped with a video camera and monitor for demonstration purposes. The lab should be equipped with alarge double level refrigerator for storage of the temporal bone specimens.

Checklist: Instruments for the Temporal Bone Dissection LaboratoryEach participant and main station:❑ 123207 HOLMGREEN Endaural Ear Speculum, self-retaining, outer diameter 7 mm❑ 223803 Seeker, with ball end, angled 45°, size 3, length 15.5 cm❑ 224001 HOUSE Curette, large, spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm, length 15 cm❑ 225205 Pick, 90º, length 16 cm, 0.5 mm❑ 152301 Ear Hook, without ball end, size 1, length 15.5 cm❑ 212803 LEMPERT Elevator, width 3 mm, length 19 cm❑ 213008 PLESTER Elevator, width 8 mm, length 18 cm❑ 208000 Surgical Handle, Fig. 3, length 12.5 cm, for blades 208010 – 19, 208210 – 19❑ 208015 Blades, Fig. 15, non-sterile, package of 100❑ 203710 Suction Tube, cylindrical, LUER, outer diameter 1 mm, working length 9 cm❑ 203730 Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm❑ 206500 FISCH Suction and Irrigation Tube, cylindrical, outer diameter of suction tube 3 mm,

irrigation tube 2 mm, working length 9.5 cm❑ 161000 HARTMANN Ear Forceps, alligator type, serrated, working length 8 cm❑ 223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm❑ 280120 Temporal Bone Holder, bowl-shaped, with 3 fixation screws for tensioning the

petrosal bone and with evacuation tube for irrigation liquid

Checklist: Powered Instrumentation – UNIDRIVE® ENTEach participant and main station:❑ 40 7116 01-1 UNIDRIVE® ENT

consisting of:20 7116 20-1 UNIDRIVE® ENT with KARL STORZ-SCB®,power supply 100 – 120, 230 – 240 VAC, 50/60 Hz400 A Mains Cord20 0126 30 Two-Pedal Footswitch, two stage, with proportional function20 7116 40 Silicone Tubing Set, for irrigation, sterilizable20 7116 21 Clip Set, for use with Tubing Set 20 7116 4020 0901 70 SCB Connecting Cable, length 100 cm031131-01* Single Use Tubing Set, sterile, package of 3

❑ 20 7110 32 High Performance EC Micro Motor❑ 20 7110 72 Connecting Cable, to connect EC micro motor 20 7110 32 to control unit❑ 252475 INTRA Drill Handpiece, angled, length 12.5 cm, for use with straight shaft burrs,

transmission 1:1 (40,000 rpm)❑ 260000 Standard Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15❑ 262000 Diamond Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

Checklist : General Equipment for ParticipantsEach participant:❑ Zeiss Operating Microscope with side tube

Main station:Main station operating microscope with:❑ Camera control unit 20 2130 11❑ Camera head 20 2120 34❑ TV-Adaptor for ZEISS operating microscope 301677❑ Optical Beamsplitter 50/50, for use with Zeiss operating microscope 301513❑ C-Mount Microscope Adapter 20220040 and monitor 9415 N

Each participant and main station:❑ Suction and irrigation unit❑ Gowns❑ Gloves❑ Overshoes❑ Head caps❑ Fluid soap❑ Tissues❑ Disposable syringe


Instruments for the Temporal Bone Dissection Laboratory

123207 HOLMGREEN Endaural Ear Speculum,self-retaining, outer diameter 7 mm

212803 LEMPERT Elevator, width 3 mm,length 19 cm

213008 PLESTER Elevator, width 8 mm,length 18 cm

208000 Surgical Handle, Fig. 3, length 12.5 cm,for Blades 208010 – 19, 208210 – 19

208015 Blades, Fig. 15, non-sterile, package of 100223803 Seeker, with ball end, angled 45°, size 3,

length 15.5 cm224001 HOUSE Curette, large,

spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm,length 15 cm

225205 Pick, 90º, length 16 cm, 0.5 mm

123207 212803 213008 208000

208015

223803

223803

224001

224001

225205

225205


152301

152301

Instruments for the Temporal Bone Dissection Laboratory

152301 Ear Hook, without ball end, size 1,length 15.5 cm

223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm

161000 HARTMANN Ear Forceps, alligator type,serrated, working length 8 cm

203710 Suction Tube, cylindrical, LUER,outer diameter 1 mm, working length 9 cm

203730 Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm

206500 FISCH Suction and Irrigation Tube, cylindrical, outer diameter suction tube 3 mm,gelieferti irrigation tube 2 mm,working length 9.5 cm

280120 Temporal Bone Holder, bowl-shaped,with 3 fixation screws for tensioning thepetrosal bone and with evacuation tube forirrigation liquid

223500

223500

8 cm

161000

161000

203710

203710

9 cm 203730

203730

11 cm

206500

206500

9,5 cm

280120


UNIDRIVE® ENTThe high-end multifunction system for excellenthandling and convenience in the OR

One unit – six functions

• Shaver S7ystem for surgery of the paranasal sinuses and anterior skull base

• Sinus Burr• Drill• STAMMBERGER-SACHSE Intranasal Drill• Micro Saw• Dermatome

Special features:

• With touch screen• Color display• Choice between several display languages• Functions displayed in words• Clearly defined operating elements• Set values of the last session are stored• Automatic error message via text display


UNIDRIVE® ENT

Special features and benefits

Constant motor speed• Microprocessor-controlled motor speed• Preselected parameters are maintained during drilling• Continuously adjustable speed of rotation• Maximum speed of rotation can be preset

Integrated irrigation pump• Microprocessor-controlled flow rate• Quick and easy connection of the tubing set• Flow rate can be controlled from the sterile area via footswitch• Flow rate adjustable from 6–125 ml/min

2 motor outputs• Simultaneous connection of 2 motors• Active output can be selected from the sterile area via footswitch

Saves time

• 2 motors can be connected simultaneously � no plugging or unplugging during the operation

• Automatic display of error messages� no time-consuming error tracing in the operating room

• Exact reading and adjustment of motor speed• Preselected parameters can be stored

� set-point values for motor speed and flow rate do not need to be readjusted with each new procedure• Quick and easy connection of the tubing set to the pump

Relieves OR personnel

• The time for preparation prior to surgery is considerably reduced by standardization• Irrigation flow rate and motor speed adjustable via footswitch• Easy to use due to clearly structured design and optimized function selection• Personnel can use the time saved for other tasks• User can control multiple functions from the sterile area via footswitch

Saves money

• Only one unit required to perform six functions• Most of the available shaver blades, burrs and drills are reuseable

� enables perfect hygienic reprocessing• EC micro motor is compatible with various INTRA drill handpieces


Mode Handpiece No. Motorspeed(max.) rpm

Touch Screen: 6.4" / 300 cd/m2

Weight: 6.1 kg

Certified to: IEC 60-1 CE acc. to MDD

Selectabledisplay English, French, German, Spanish,languages: Italian, Portuguese, Greek, Turkish

UNIDRIVE® ENT

Shaver modeOperation mode: oscillatingMax. rev. (rpm): in conjunction with Micro Shaver Handpiece 40 7110 35 3,000*

in conjunction with Paranasal Sinus Shaver Handpiece 40 711039 7,000*in conjunction with DrillCut-X Shaver Handpiece 40 711040 7,000*

Sinus Burr modeOperation mode: rotatingMax. rev. (rpm): in conjunction with DrillCut-X Shaver Handpiece 407110 40 12,000

Drilling modeOperation mode: counter-clockwise or clockwiseMax. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 40,000

and Connecting Cable 207110 72

Micro Saw modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 711032 20,000


Intranasal Drill modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 711032 60,000


Dermatome modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 8,000


* Approx. 3000 rpm is recommended as this is the most efficient suction/performance ratio.

Power supply: 100-120, 230-240 VAC, 50/60 Hz

Dimensions: 304 x 164 x 263 mm(w x h x d)

Two outputs for parallel connection of two motors

Integrated irrigation pumpFlow rate: 6-125 ml/min, adjustable in 8 steps

Technical specifications:


UNIDRIVE® ENT

20 7116 20-1

40 7116 01-1 UNIDRIVE® ENTconsisting of:20 7116 20-1 UNIDRIVE® ENT with KARL STORZ

Communication Bus System ®,power supply: 100 – 240 VAC, 50/60 Hz

400 A Mains Cord20 0126 30 Two-Pedal Footswitch, two-stage,

with proportional function20 7116 40 Silicone Tubing Set, for irrigation, sterilizable20 7116 21 Clip-Set, for use with tubing set 20 7116 4020 0901 70 SCB Connecting Cable, length 100 cm031131-01* Disposable tubing set, sterile

* mtp medical technical promotion gmbh, Take-Off Gewerbepark 46, D-78579 Neuhausen ob Eck, Germany


Two-Pedal Footswitch

20 0126 30 20 7116 40

U N I T S I D E

P A T I E N T S I D E

UNIDRIVE® ENT

Silicone Tubing Set

Shaver Blade, straight

41305 DN

Shaver Blade, curved

41201 KN

41202 KN

Sinus Burr

253000 - 253300

Dermatome

254000 - 254300

Micro Saw

Shaver Blade, straight

Shaver Blade, curved

40201 KN

40302 KN

252475 - 252495

660000

INTRA Drill Handle

Intranasal Drill

EC Motorwith Connecting Cable

20 7110 3220 7110 72

STAMMBERGER-CASTELNUOVODrillCut-X Shaver Handpiecewith integrat ed suction / irrigationchannel and longer shaver blade,with connecting cable

40 7110 40

Micro Shaver Handpiecestraight, with integrated EC-MicroMotor and Connecting Cable

40 7110 35

STAMMBERGER, Paranasal SinusShaver Handpiece90° angle, with connecting cable

40 7110 3920 7110 70

UNIDRIVE® ENTSystem Components


252475 INTRA Drill Handpiece, angled,length 12.5 cm,for use with straight shaft burrs,transmission 1:1 (40,000 rpm)252475

INTRA Drill Handpieces

BurrsStraight Shaft Burrs, length 7 cm

260000 Standard Straight Shaft Burr, stainless,sizes 006 – 070, length 7 cm, set of 15

262000 Diamond Straight Shaft Burr, stainless,sizes 006 – 070, length 7 cm, set of 15

SizeDetail Dia. mm

Standard

for singleuse, sterile,

set of 5sterilizable

for singleuse, sterile,

set of 5sterilizable

TungstenCarbide

TransverseTungstenCarbide

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

–

–

260023 D

–

260031 D

–

260040 D

–

260050 D

260060 D

261014

261018

261023

261027

261031

261035

261040

261045

261050

261060

261123

–

261131

–

261140

–

261150

261160

DiamondDiamond,

coarse

–

007 0.7 – – – – –

008 0.8 – 261008 – – –

010 1 – 261010 –

261114

–

– –

–

–

006 0.6 – 261006 – – –

–

262023 D

–

262031 D

–

262040 D

–

262050 D

262060 D

262223

262227

262231

262235

262240

262245

262250

262260

070 7 –

260014

260018

260023

260027

260031

260035

260040

260045

260050

260060

260007

260008

260010

260006

260070 261070 – –

262014

262007

262008

262010

262006

262018

262023

262027

262031

262035

262040

262045

262050

262060

262070 262270

7 cm


20 2120 30 / 20 2121 30

TELECAM® One-Chip Camera Head

20 2120 34 / 20 2121 34

TELECAM® C-MOUNT One-Chip Camera Head

TELECAM®

One-Chip Camera Head20 2120 30 PAL

20 2121 30 NTSC

color systems PAL/NTSC, with integrated Parfocal ZoomLens, f = 25 – 50 mm (2x), 2 freely programmable camerahead buttons

20 2120 34 PAL

20 2121 34 NTSC

color systems PAL/NTSC, 2 freely programmable camerahead buttons

TELECAM® C-MOUNTOne-Chip Camera Head

For use with TELECAM® SL II Camera Control Unit 20 2130 11U

TELECAM® SL IICamera Heads

TELECAM® SL IICamera Control Unit

n

20 2130 20

20 2130 11U TELECAM® SL II Camera Control Unitcolor systems PAL/NTSC, with integrated digitalImage Processing Moduleconsisting of:20 2130 20 TELECAM® SL II Camera

Control Unit400 A Mains Cord20 2001 30U Keyboard, with US-english

character set2x 20 2210 70 Connecting Cable,

for controlling peripheral devices,length 180 cm

536 MK BNC/BNC Video Cable,length 180 cm

547 S S-Video (Y/C) Connecting Cable,length 180 cm

20 0400 82 DV Cable, 6 pin to 4 pin,length 500 cm

Specifications:

- Composite signal atBNC socket

- S-Video signal to 4 pinMini DIN socket (2x)

- DV signal to 6 pin DV socket

Video Output

Keyboard input for titlegenerator and camerafunctions to 5 pin DINsocket

Input

3.5 mm stereo jack plug(ACC 1, ACC 2)

Control Output

- Dimensions:305 x 88 x 254 mm (w x h x d)

- Weight:2.7 kg

Control Unit (CCU)

100-240 VAC, 50/60 Hz

Power Supply

IEC 601-1, 601-2-18,CSA 22.2 No. 601,UL 2601, and CE accor-ding to MDD, protectionclass 1/BF

Certified to:


Video Accessories for Operating Microscopes

Example for direct C-MOUNT adaption:KARL STORZ Endovision® TELECAM® MicroscopeCamera Head

In addition to using the KARL STORZ Endovision®

camera systems with endoscopes, all KARL STORZ cameras can be connected to other systems, such asmicroscopes, colposcopes, and slit lamps. The adap -tation requires a standardized C-MOUNT connectionon the specific optical system.

This connection can be made both directly via the standardized C-MOUNT connection or indirectly via special quick-adaptors.

Both alternatives have specific advantages:

Direct Adaptation

A direct connection between camera and microscopehas the advantage that no special adaptor systems arenecessary any longer. The direct C-MOUNT connec-tion is safe, stable, and does not reduce quality. Such acon nec tion can be made, for example, with the TELE-CAM® C-MOUNT Camera Head 20 2120 34/20 2121 34or the TRICAM® C-MOUNT Camera Head 20 2210 34/20 2211 34 in conjunction with a C-MOUNT micro-scope adaptor.

Indirect Adaptation

An indirect adaptation between the KARL STORZ Endovision® camera systems and other optical sys-tems, for example, a microscope or colposcope with C-MOUNT connection, may be accomplished with specialquick-adaptors. These quick-adaptors ensure the con-nection between the standardized endoscope couplingand the C-MOUNT of the optical system. The advan-tage of this solution is that the camera can be pluggeddirectly into the optical system with the endoscopecoupling, without time-consuming threading action.Such a quick- adaptation is possible with allKARL STORZ Endovision® cameras.


Video Accessories for Operating MicroscopesAdaptor for Direct and Indirect C-MOUNT Adaptation

Camera Heads for quick coupling of Endovision®

camera with C-MOUNT Adaptor 2010 Z:Indirect C-MOUNT Adaptation

Camera Heads for use with TV Adaptor 301677:Direct C-MOUNT Adaptation

20 2120 3020 2121 30

20 2120 3420 2121 34

20 2200 40C-MOUNT

Microscope Adaptor

2010 Z

301677 TV-Adaptor, for ZEISS operating microscopeor colposcope, f = 85 mm, for use withOptical Beamsplitter 301513 and C-MOUNTAdaptor 2010 Z or TELECAM® C-MOUNTOne-Chip Camera Head20 2120 34/20 2121 34

20 2200 40 C-Mount Microscope Adaptor for use withKARL STORZ Endovision TRICAM® C CameraHead 20221034/20221134

2010 Z C-MOUNT Adaptor, allows quickcoupling of Endovision® camera e. g.with operating microscopes (the camera’s coupling device is mountedon the 2010 Z adaptor which fits to anoperating microscope’s C-MOUNT ring)

301513 Optical Beamsplitter 50/50,for use with ZEISS operating micro -scope or colposcope

301513

301677


KARL STORZ AIDA™ compact II combines all the required functions for integrated and precisedocumentation of endoscopic procedures and open surgeries in a single system.

Data Acquisition

AIDA compact II records still images, video sequences and spokencomments of findings and intraoperative procedures directly from thesterile area. Recordings are activated via touch screen, voice control,footswitch or camera head buttons.

Live display of camera images on the touch screen enables immediatemonitoring and selection of the recorded data.

Flexible Review

Before final archiving, the saved data can be viewed or listened to onthe review screen. Data no longer required can be simply deleted.

Individual images, video and audio sequences can be renamed andgiven more meaningful names. A pre-defined selection list with key-words simplifies and speeds up data entry. Furthermore, a commentfield is available for entering relevant details of an intervention.

A voice entry of the case report can yet be recorded while viewing video and image files.

Automated Data Archiving

Once a treatment is completed, AIDA compact II automatically stores thedata on a DVD or CD-ROM, creates a standard report and prints it as anoverview if required.

Multisession and Multipatient

Efficient data archiving is assured as several treatments can be savedon one DVD, CD-ROM or on an USB stick.

AIDA compact II: Automatic creation of standard reports

AIDA compact II: Review screen

AIDA compact II:Efficient archiving

The Compact Documentation Solution

AIDA compact II: Voice control


Special Features:● Digital storage of still images, video sequences and audio files● Digital alternative to video printer, video recorder and dictating machine● Sterile, ergonomic operation via touch screen, voice control, camera head buttons

and/or footswitch● Efficient archiving on DVD, CD-ROM or USB stick, multisession and multipatient● Network storage is possible● Optional connection to PACS, RIS and HIS● Automatic creation of standard reports● Computers and monitors for use in the OR area certified according to EN 60601-1● Compatible with KARL STORZ Communication Bus (SCB) and OR1™ connect series

● PAL ● NTSC

● S-Video (Y/C)● Composite

● JPG● BMP

● MJPEG● MPEG1● MPEG2

● WAV ● DVD+R● DVD+RW● DVD-R● DVD-RW● CD-R● CD-RW● USB Stick

Video Systems Signal Inputs Image Formats Video Formats Audio Formats Storage Media

Specifications:

consisting of:20 0960 20 KARL STORZ AIDA™ control,

with integrated DVD/CD writer20 040377 Frame Grabber Board,

with digital I/Os20 0403 78 Slot Bracket, for digital I/Os20 0902 34U PS/2 Compact Keyboard,

US version, with cover20 0404 02-12 KARL STORZ AIDATM compact II

Software, with voice control andsoftware protection

20 0402 75 KARL STORZ USB Stick, 512 MB2 x 20 2210 70 Connecting Cable20 0901 38 Headset20 0903 76 Headset Extension Cable,

length 10 m547 S S-Video (Y/C) Connecting Cable,

length 180 cm400 A Mains Cord400 B Mains Cord, US version

20 0406 01U KARL STORZ AIDA™ compact II SystemDocumentation system for digital archiving of image,video and audio files in the OR,power supply: 100/240 VAC, 50/60 Hz


20200032 KARL STORZ Special Beamsplitter, for use with IMAGE1™, TRICAM® and TELECAM® camera heads, for simultaneousviewing by endoscope and monitor screen. The camera headconnector is 120º deflected and can instantly be swiveled tothe desired position.

KARL STORZ ENDOVISION TRICAM® SL II with ® – autoclavableDigital Three-Chip Video Camera – Color Systems PAL, NTSC

20 2210 40 KARL STORZ Endovision TRICAM®, three-chip camera,color system PAL, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT.

20 2211 40 KARL STORZ Endovision TRICAM®, three-chip camera,color system NTSC, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT.

20 223011U1 TRICAM® SL II Camera Control Unit color system PAL/NTSC, with integrated KARL STORZ Communication Bus System ® and integrated ImageProcessing Module; power supply: 100–240 VAC, 50/60 Hz;set, ready for use; without camera head

20 2120 40 KARL STORZ Endovision TELECAM®, one-chip camera,color system PAL, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT

20 2121 40 KARL STORZ Endovision TELECAM®, one-chip camera,color system NTSC, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT

20 2130 11U TELECAM® SL II Camera Control Unit, color system PAL/NTSC, with integrated Image ProcessingModule; power supply: 100–240 VAC, 50/60 Hz;set, ready for use; without camera head

KARL STORZ ENDOVISION TELECAM® SL II – autoclavableDigital 1-Chip Video Camera – Color Systems PAL, NTSC

Camera Control Unit

Camera Control Unit


KARL STORZ TM DVD-M with SmartscreenTM

Advanced Image and Data Archieving System

Special Features:● Digital storage of still images,

video sequenc es and audio files● Digital alternative to video printers,

video recorders and dictaphone● Easy and intuitive handling via touch screen,

camera head buttons or footswitch● Compact design● Efficient archiving on DVD-R, DVD+R,

CD-R, USB Stick, multisession andmultipatient

● SDI, S-video (Y/C) and compositevideo inputs

● Network storage is possible● All video signals are through-patchable to

the video monitor● Print-out of still images via ink jet printer

possible● Compatible with KARL STORZ Communication

Bus (SCB) and OR1™ connect series

20 2045 01-140 KARL STORZ AIDA™ DVD-M with SmartscreenTM,color system: PAL, NTSCpower supply: 100–240 VAC, 50/60 Hz

consisting of:20 2045 20-140 KARL STORZ AIDA™ DVD-M, with integrated

DVD/CD writer and integrated touch screen400 A Mains Cord400 B Mains Cord, US version536 MK BNC/BNC Video Cable, length 180 cm547 S S-Video (Y/C) Connecting Cable, length 180 cm2 x 20 0400 83 Adaptor, BNC–Cinch20 0400 84 Serial Connecting Cable, length 20 cm20 0400 85 DVI Connecting Cable, length 20 cm20 0400 88 USB-Extension Cable, length 7.5 cm


Cold Light Fountains and Accessories

Cold Light Fountain HALOGEN 250 twin

20 1133 01 Cold Light Fountain HALOGEN 250 twin,power supply:100/120/230/240 VAC, 50/60 Hz,consisting of:400 A Mains Cord

495 NL Fiber Optic Light Cable, diameter 3.5 mm, length 180 cm

495 NA Same, length 230 cm

495 ND Same, length 300 cm

20134001 Cold Light Fountain XENON NOVA® 175power supply:100–125 VAC/220–240 VAC, 50/60 Hzconsisting of:400 A Mains Cord

20132026 Xenon-Spare-Lamp,only, 175 watt, 15 volt

Cold Light Fountain XENON NOVA® 175


Mobile Videocart

29003 NA Mobile Videocart, consisting of:29003 NAG Basic Mobile Cart, rides on

4 antistatic double-casters, 2 equipped with locking brakes, 1 shelf fixed, 1 shelf with mainsswitch, 1 shelf inclinable,1 drawer unit with lock, 1 push bar,with large lumen cable channelsintegrated in both columns, 1 set of non-sliding stands,1 camera mount

29003 PB Power Box with electrical supply terminal strip with 12 plugs,12 equipotential plugs

Dimensions:Mobile Cart:700 mm x 1280 mm x 686 mm (w x h x d)shelf: 630 mm x 480 mm (w x d)caster diameter: 125 mm

TFT-Flat Screen MonitorsMultinorm Liquid Crystal Display, PAL and NTSC with automatic switch-over

9415 NN / 9419 NN

9415 NNB / 9419 NNB

29003 NA

9415 NNB 15" KARL STORZ TFT Flat Screen,Wall-mounted with VESA 100 mounting,color systems PAL/NTSC, resolution max.1024 x 768, video inputs: (XGA), SDI,Composite, S-Video, RGBS/VGA, brightness430 cd/m2, contrast 500:1,power supply 100 – 240 VAC, 50/60 Hzconsisting of:9415 NNG 15" TFT Flat Screen9419 PS External 24 VDC Power Supply400 A Mains Cord2x 536 MP BNC/BNC Video Cable,

length 240 cm547 SL S-Video (Y/C) Connecting Cable,

length 350 cm20 0403 72 SVGA Connecting Cable,

length 200 cmInstructions for use on CD-ROM

9415 NN Same, desktop model, with pedestal9419 NNB 19" KARL STORZ TFT Flat Screen EndoVue

Desktop, color systems PAL/NTSC, resolutionmax. 1280 x 1024 (SXGA), video inputs: SDI,Composite, S-Video and RGBS/VGA, brightness450 cd/m2, contrast 650:1, power supply 100 – 240 VAC, 50/60 Hzconsisting of:9419 NNG 19" TFT Flat Screen9419 PS External 24VDC Power Supply400 A Mains Cord2x 536 MP BNC/BNC Video Cable,

length 240 cm547 SL S-Video (Y/C) Connecting Cable,

length 350 cm20 0403 72 SVGA Connecting Cable,

length 200 cmInstructions for use on CD-ROM

9419 NN Same, desktop model, with pedestal


Notes: