Atlas of temporal bone surgery PDF
Preview Atlas of temporal bone surgery
Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei Atlas of Temporal Bone Surgery ProfessorTuncay Ulug,MD IstanbulUniversity IstanbulMedicalFaculty DepartmentofOtorhinolaryngology Istanbul,Turkey 345illustrations Thieme Stuttgart·NewYork Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei IV Library of Congress Cataloging-in-Publication Data is available from Importantnote:Medicineisanever-changingscienceundergoingcon- thepublisher. tinual development. Research and clinical experience are continually expandingourknowledge,inparticularourknowledgeofpropertreat- ment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishershavemadeeveryefforttoensurethatsuchreferencesarein accordance with the state of knowledge at the time of production of thebook. Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaranteeor responsibilityonthepartofthepublishersinrespecttoanydosagein- structionsandformsofapplicationsstatedinthebook.Everyuserisre- questedtoexaminecarefullythemanufacturers’leafletsaccompanying eachdrugandtocheck,ifnecessaryinconsultationwithaphysicianor specialist,whetherthedosageschedulesmentionedthereinorthecon- traindicationsstatedbythe manufacturersdiffer fromthestatements madeinthepresentbook.Suchexaminationisparticularlyimportant withdrugsthatareeitherrarelyusedorhavebeennewlyreleasedon themarket.Everydosagescheduleoreveryformofapplicationusedis entirelyattheuser’sownriskandresponsibility.Theauthorsandpub- lishersrequesteveryusertoreporttothepublishersanydiscrepancies or inaccuraciesnoticed.Iferrors inthis workarefound after publica- tion,erratawillbepostedatwww.thieme.comontheproductdescrip- tionpage. ©2010GeorgThiemeVerlag, Someoftheproductnames,patents,andregistereddesignsreferredto Rüdigerstrasse14,70469Stuttgart,Germany in this book are in fact registered trademarks or proprietary names http://www.thieme.de even though specific reference to this fact is not always made in the ThiemeNewYork,333SeventhAvenue, text.Therefore,theappearanceofanamewithoutdesignationaspro- NewYork,NY10001,USA prietaryisnottobeconstruedasarepresentationbythepublisherthat http://www.thieme.com itisinthepublicdomain. Coverdesign:ThiemePublishingGroup Thisbook,includingallpartsthereof,islegallyprotectedbycopyright. TypesettingbySommerDruck,Feuchtwangen,Germany Any use,exploitation, orcommercialization outsidethe narrowlimits PrintedinChinabyLeoPaperProductsLtd,HongKong set bycopyright legislation, without the publisher’s consent, is illegal andliabletoprosecution.Thisappliesinparticulartophotostatrepro- ISBN978-3-13-147151-2 duction,copying,mimeographing,preparationofmicrofilms,andelec- 1 2 3 4 5 6 tronicdataprocessingandstorage. Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei V “If the discoloration extends right through the bone, it must beexcisedandalldiseasemustbeextirpated.Ifthereissound bone beneath, it suffices to remove that which is diseased. It isjustthesamewhethertheskull,thebreastboneoraribbe affected with caries; cauterization is useless. Excision is imperative.” Celsus, 2000yearsago…1 “TrephinedskullofNeolithicperiodthatshowshealedwoundedgesindicat- ingrecoveryfromanoperationwhosepurpose,whethermedicalormagi- cal,remainsunknown.”2 1BallanceC.Mastoidoperation:aglimpseintoitshistory.ArchivesofOtolaryngology 1932;6:55–75(WithreferrencetoPietzckerF.Celsus:LiberMedicinaeOctavus.Caput2. Tübingen.) 2Nationalmuseet,Copenhagen;PhotographbyLennartLarsen.In:LyonsA.S.,Petrucelli R.J.Medicine:AnIllustratedHistory.NewYork:HarryN.AbramsInc.Publishers;1987.Re- producedwithpermission. Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei VI About the Author ProfessorTuncayUlug,MD,graduatedfromIstanbulFacultyofMedicine,IstanbulUniversity,in1987,andon completinghispostgraduatetraininginotolaryngologyatthesameinstitutionin1991,hejoinedthefaculty asanacademician.Between1993and2001,overvaryingperiods,heattendedseveralwell-reputedclinicsin otology,neurotology,skullbasesurgeryandtumorsurgery,includingZürichUniversity,St.James’sHospital, Memorial Sloan–Kettering Cancer Center, New York University, Mount Sinai University, George Washington University—NeurosurgicalDepartment,theMayoClinic,andtheHouseEarInstitute.Inthisway,afterhaving learnedthemodernpracticesassimilatedover nearly80yearsinhisinstitution,andalong withtheworkof manyexperiencedandskilledcolleaguesaroundtheworld,hewasinspiredmainlybytheearandskullbase techniques of Ugo Fisch, the otologic and neurotologic concepts of the House school, the neurosurgical per- spectivesoftheskullbasesurgeonLaligamSekhar,andthetumorphilosophyofJatinShah.ProfessorUlugis currentlyaconsultantat theDepartmentof Otorhinolaryngology—Head and Neck Surgery,Istanbul Medical Faculty,IstanbulUniversity. ProfessorUlug’sclinicalinterestsencompasstheareasofotology,neurotology,skullbasesurgeryandsome fieldsoftumorsurgery.Hehasdeliveredmanyscientificpresentationsandhascontributedtomanynational andinternationalscientificpublications.HeisamemberofseveralsocietiesincludingthePolitzerSocietyand theEuropeanAcademyofOtology/Neuro-Otology.Since1998,ascoursedirector,hehasorganizedtheannual “International Istanbul Temporal Bone Dissection and Otology/Neurotology Courses,” which attracts partici- pantsfromcountriesfromallovertheworld. ProfessorUlugdesignedtherevolutionary“Ulugdouble-sidedearmicrosurgeryinstruments,”whichhave beenproducedbyKarlStorz(Tuttlingen,Germany)since2007.Hehasalsopioneeredseveralsurgicaltechni- quesandproposedanumberof landmarks,andiscurrentlyinvolvedinthedevelopmentofnewmiddleear prosthesesandmoresurgicalinstruments. Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei VII Preface Otologyandneurotologyhavebecomeanincreasinglyimportant Definition, Indications, Anatomical Orientation, Surgical Steps, benchmarkformodernmicrosurgeryoverthepastcoupleofdec- and Definitions and Tips; for some techniques, there is an addi- ades.Themasteryofdelicatetechniquesandexecutionofsurgical tional part on surgical anatomy. Under the surgical steps, the perfection in this type of high-risksurgerycan only be acquired concepts of the most important landmark (MIL) and the ideal through tremendous effort by those wishing to advance in this instrument(II)aimtodescribethemostcriticalreferencepoints area.Todevelopthebasicskillsrequiredforthissurgery,tempo- and the surgical instruments necessary for each particular stage ral bone dissections, and related courses and atlases, are the ofprocedure.Additionalinformationrequiredforeachparticular mainpracticaleducationaltoolsavailable. stageispresentedtothereaderasDefinitionsandTipsatthebot- This atlas is intentionally entitled Temporal Bone Surgery tomofthepage,precludingtheneedtorefertoothersources. rather thanTemporal Bone Dissection. This is because the proce- Thethirdsectionofthebookincludesdefinitionsofthesurgi- durescarriedoutonacadaverboneareexactlythesameasthose cal techniques described and used by the author, and presents carriedoutduringaliveoperation—theonlydifferencebeingthe surgicalinstrumentsdesignedbytheauthor. absenceofblood.Furthermore,notonlyarethecharacteristicsof The glossary in thefourth section comprises the main termi- the laboratory dissection explained in the descriptions of the nologyusedinotologyandneurotology,inalphabeticalorder.In techniques,butalsothoseoflivesurgery. this part, the terms are described and beneficial tips are also The main principle during temporal bone dissections is to given.Inaddition,eachtermhasbeenclassifiedaseitheranana- carryoutasmanyproceduresaspossibleoneachbone.Also,dur- tomical or a surgical definition. The reader should refer to the ingtheliveoperation,differentproceduresarecarriedouteither glossaryasandwhennecessary. insequenceorsimultaneously,inmanyinstances.Therefore,this From the technical publishing perspective, along with the atlas illustrates more than one procedure being executed and unique way of teaching the procedures step by step, aided by presentedineachboneand,consequently,thesequenceofsurgi- illustrations and descriptions, full-page color photographs and cal techniques presented throughout this atlas is not based on labeled orientationphotographs havebeen included for thefirst theory,butonsurgicalpractice. time in such a medical publication. The full-page color photo- The four principal sections of this book are: General Aspects, graphs show the details and make the book more attractive to Surgical Techniques, Techniques and Designs Developed by the read, and the orientation photographs enable easy and precise Author, and Appendix with Glossary. To gain a comprehensive three-dimensionalperceptionofeachtechniquewithoutcreating understandingofthecontentsofthisbook,allsectionsshouldbe confusion.Furthermore,theillustrationsofthesurgicalstepsare read in sequence. However, beforebeginning to read the princi- generouslylabeled,enablingaquickandefficientrun-throughof pal sections, the reader should first go over thelist of abbrevia- theprocedures. tions, so that the labeling of illustrations may be understood Finally, I would like to express my sincere gratitude to Neil moreeasily. Warrington and Cameron Shaw for their invaluable contribu- The GeneralAspectssectionisimportantfrom asurgicalper- tions, and toStephan Konnry, Annie Hollins, ElisabethKurz, and spective.Inthissection,readerswillfindanswerstomanyques- the editorial and production staff at Thieme Publishers for their tions relating to otologic and neurotologic practice, and tips on closecollaborationandefficientassistanceinrealizingthisardu- how toimprovetheir surgical skills,including the precise useof ouspublication. theburr. I hope that this book will provide readers with the basic, yet TheSurgicalTechniquessectionmakesupthemainandmost essential,knowledgeofskillsrequiredwhilecarryingoutotologic comprehensive part of the atlas. In this section, each surgical and neurotologic procedures, both in the laboratory and in the technique is described step bystep in detail using photographic operatingroom. illustrations,allofwhichhavebeentakenbytheauthor,showing theprocedurescarriedoutbytheauthor.Eachchapterisdevoted ProfessorTuncayUlug,MD toaparticular techniqueandissubdividedintopartsasfollows: Istanbul,Turkey Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010 FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei IX Contents I GeneralAspects ...................................................................... 1 10 Canalplasty ............................................................................. 49 Definition ............................................................................. 49 1 Introduction............................................................................ 3 Indications ............................................................................ 49 AnatomicalOrientation ......................................................... 49 2 SurgicalAnatomy ................................................................... 3 SurgicalSteps........................................................................ 51 3 SurgicalTheory....................................................................... 4 11 Antrotomy ............................................................................ 53 Definition ........................................................................... 53 4 InstrumentationandUsage ................................................... 5 Indications .......................................................................... 53 Microscope............................................................................... 5 AnatomicalOrientation ....................................................... 53 TheDrillandMicrosurgeryInstruments ................................... 5 SurgicalSteps...................................................................... 55 KeyPointsinBurrUsage ........................................................ 6 SurgicalAnatomy.................................................................. 56 BurrUsageinBleedingControl............................................... 7 BurrUsagearoundtheCriticalStructures ............................... 8 12 Tympanoplasty ..................................................................... 57 Definition ........................................................................... 57 Indications .......................................................................... 57 II SurgicalTechniques................................................................ 13 AnatomicalOrientation ....................................................... 57 SurgicalSteps...................................................................... 59 5 CorticalMastoidectomy......................................................... 15 Definition ............................................................................. 15 13 Stapedotomy ........................................................................ 63 Indications ............................................................................ 15 Definition ........................................................................... 63 AnatomicalOrientation ......................................................... 15 Indications .......................................................................... 63 SurgicalSteps........................................................................ 17 AnatomicalOrientation ....................................................... 63 SurgicalAnatomy.................................................................. 23 SurgicalSteps...................................................................... 65 6 PosteriorTympanotomy ........................................................ 25 14 IntactBridgeAtticotomy ..................................................... 69 Definition ............................................................................. 25 Definition ........................................................................... 69 Indications ............................................................................ 25 Indications .......................................................................... 69 AnatomicalOrientation ......................................................... 25 AnatomicalOrientation ....................................................... 69 SurgicalSteps........................................................................ 27 SurgicalSteps...................................................................... 71 SurgicalAnatomy.................................................................. 30 15 PartialBridgeAtticotomy .................................................... 75 7 CochlearImplantation............................................................ 31 Definition ........................................................................... 75 Definition ............................................................................. 31 Indications .......................................................................... 75 Indications ............................................................................ 31 AnatomicalOrientation ....................................................... 75 AnatomicalOrientation ......................................................... 31 SurgicalSteps...................................................................... 77 SurgicalSteps........................................................................ 33 16 Atticotomy............................................................................ 79 8 TranscorticalExposureoftheEpitympanum........................ 37 Definition ........................................................................... 79 Definition ............................................................................. 37 Indications .......................................................................... 79 Indications ............................................................................ 37 AnatomicalOrientation ....................................................... 79 AnatomicalOrientation ......................................................... 37 SurgicalSteps...................................................................... 81 SurgicalSteps........................................................................ 39 SurgicalAnatomy.................................................................. 42 17 Atticoaditotomy ................................................................... 83 Definition ........................................................................... 83 9 ExtendedCorticalMastoidectomy ........................................ 43 Indications .......................................................................... 83 Definition ............................................................................. 43 AnatomicalOrientation ....................................................... 83 Indications ............................................................................ 43 SurgicalSteps...................................................................... 85 AnatomicalOrientation ......................................................... 43 SurgicalSteps........................................................................ 45 18 Atticoantrotomy................................................................... 87 Definition ........................................................................... 87 Indications .......................................................................... 87 AnatomicalOrientation ....................................................... 87 SurgicalSteps...................................................................... 89
Description:The list of books you might like
