Temporal bone resection

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Sampath chandra prasad did this case

Temporal bone resection 3-10-20161.36 pm


Great teachers All this is their work . I am just the reader of their books .

Prof. Paolo castelnuovo

Prof. Aldo Stamm

Prof. Mario Sanna

Prof. Magnan


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Lateral temporal bone resection cadaver video click



Piece meal resection (STBR + ITFA - A + superficial parotidectomy) for TBSCC. Here the facial nerve is spared and rerouted.


Superficial parotidectomy must be done in temporal bone malignancy because first level of draining lymph nodes present in the parotid Dr.Satish jain


Sampath Chandra Prasad Section of the EAC taking care to achieve good margins. Blind sac closure of the remaining skin of EAC. Frozen section of margins


STBR can be married into a variety of procedures depending upon the disease extension. Here sub total petrosectomy (drilling out all the mastoid-middle ear air cells) is carried out along with Infratemporal fossa type B approach wherein FN is completely isolated and transposed. Note that superficial parotidectomy is being done which also helps release the facial nerve.


Facial nerve completely exposed from mastoid to parotid segment. SP completed.


Facial nerve completely tansposed anteriorly for which the nerve is drilled upto the geniculate ganglion. The GSPN is sectioned to obtain the release of the nerve. The nerve along with the parotid is sutured anteriorly to the flap

This is done to obtain exposure of the infratemporal fossa. Here the tumor was involving the hypotympanum. Hence the entire tympanic bone was removed. Note the exposure of the middle fossa dura, carotid and the jugular bulb.


Sampath Chandra PrasadFacial nerve transposed posteriorly. Carotid canal can be clearly seen. Jugular foramen completely exposed after excision of the IJV along with the jugular bulb.


While removing the temporal bone malignancy at Parisiers triangle ( dangerous triangle ) we have to very careful , higher chances of injuring the labyrinthine part of facial nerve if we are not careful in clearing the tumor at parisiers triangle.



Perisier's triangle is very important triangle in endoscopic ear surgery1) Superior limb is formed by inferior part of HFN2) The apex is formed by the geniculate ganglion3) The base is formed by the anterior commissure (end) of oval window4) Inferior limb is formed by tunning point of jocobson's nerve to the the geniculate ganglion.


The surgical implications are

1) This triangle contains labyrinthine part of FN.2) During transotic or transcochlear approaches surgeon should respect this triangle and drill carefully to avoid injury to FN.3) Clinically labyrinthine part consists of two segments a meatal segment of nerve, labyrinthine part of nerve. total length of this nerve is 3 to 5 mm. Anteriorly we can see these parts clearly through this triangle.4) 1st part of FN passes close to lower border of precochlear HFN towards anterior end of oval window in this triangle.5) Irregular drilling of cochlea in this triangle damages FN That is why it is called DANGERS TRIANGLE.6) During trans meatal endoscopic dissection of IAC, this triangle important for identification of nerves7) Translabyrinthine approach visualises posterior surface of 1st part of FN, in transcochlear approaches the anterior surface of the nerve is exposed. In transottic approaches 270 to 320 degrees of 1 st part of FN is exposed.8)Observe closely the labyrinthine part of FN there is a constriction of labyrinthine segment and meatal segment.Facial nerve key points1) Facial nerve changes direction 5 times during its course from brain stem to styloid foramen.2) No other nerve in body covers such a long distance in bony canal3) facial nerve contains 10000 axons that are responsible for the innervation of the face musculature and also for the communications with other nerves human body4) work with injured facial nerve requires lot of patience.







Sampath Chandra Prasadcavity obliterated with fat


Sampath Chandra Prasadblind sac closure


Sampath chandra prasad did this case https://www.facebook.com/groups/learningent/permalink/731085130262697/


Steps insubtemporalresection with neck dissection and total parotidectomy (my dad's style of en-block resection). At Gruppo Otologico, we do a piece meal resection. click https://www.facebook.com/groups/learningent/permalink/731072510263959/


Lot of material to update stay tuned


For Other powerpoint presentatioins of Skull base 360 I will update continuosly with date tag at the end as I am getting more & more information click www.skullbase360.in- you have to login toslideshare.netwith Facebook account for downloading.