Microanatomy of the middle ear and endoscopic ear surgery

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  • Okano Takayuki
    Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University

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Other Title
  • 中耳の微細解剖と内視鏡下耳科手術
  • チュウジ ノ ビサイ カイボウ ト ナイシキョウ カ ジカ シュジュツ

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Abstract

<p>Description about the middle ear compartment, which is composed of the ossicles, mucosal folds and ligaments, and the ventilation route in the middle ear dates back to Prussak’s report in 1867. In the past, the description has been mainly from the viewpoint of surgical anatomy using a microscope; however, with the recent realization of transcanal endoscopic ear surgery (TEES) realized by the high resolution of optical instruments, the mucosal folds of the middle ear cavity and the compartments of the middle ear have been redefined from the viewpoint of endoscopic otologic surgery. In particular, surgical significance of the mucosal folds in the attic, have been rediscovered and redefined from the perspective of endoscopic otologic surgery.</p><p>The mucosal folds are membranous structures that connect the contents of the middle ear to the bony wall of the middle ear or to each other, dividing the middle ear into small compartments. The mucosal folds contain blood vessels and nerves, and play a role similar to that of the mesentery. In microsurgery, mucosal folds are often considered to be remnants of inflammation or the result of adhesions, but are constitutively present in the middle ear cavity, although their position and size vary in each patient. It is important to correctly recognize the anatomy of the middle ear compartment, sectioned by the mucosal folds, in order to understand the pathogenesis of the middle ear disease. TEES has the great advantage of minimizing the need for dissecting the bony wall of the external auditory canal or the mastoid air cells to sufficiently obtain the operative field, and has an advantage in recognizing the compartments of the middle ear. Preoperatively, a thorough evaluation of the extent of the lesion should be performed in the context of the anatomical compartments formed by mucosal folds and microstructures, and the surgical approach should be determined from the viewpoint of securing the ventilation route to the attic as well as removing the lesions.</p>

Journal

  • Otology Japan

    Otology Japan 32 (1), 19-25, 2022

    Japan Otological Society

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