Endoscopic Ear Surgery: Principles, Indications, and Techniques

422 Pages·2014·80.738 MB·English

by  Livio Presutti, Daniele Marchioni

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Endoscopic Ear Surgery
Principles, Indications, and Techniques
Livio Presutti, MD
Professor and Head, Department of Otorhinolaryngology
Polyclinic, University Hospital of Modena
Modena, Italy
Daniele Marchioni, MD
Professor, Department of Otorhinolaryngology
Polyclinic, University Hospital of Modena
Modena, Italy
951 illustrations
Thieme
Stuttgart (cid:129) New York (cid:129) Delhi (cid:129) Rio
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[editedby]LivioPresutti,DanieleMarchioni. drug therapy. Insofar as this book mentions any dosage or application,
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Contents
1 StartingoffwithEndoscopicEarSurgery.................................................................... 2
DavePothier
1.1 InstrumentationandEquipment.................. 2 1.2.5 PreparingtheOperatingRoom.................... 3
1.2.6 PreparingthePatient ............................ 3
1.1.1 Overview........................................ 2
1.1.2 ChoiceofEndoscope............................. 2 1.3 Pitfalls .......................................... 3
1.2 YourFirstCase................................... 2 1.3.1 GivingUpTooEarly.............................. 3
1.3.2 ControllingHemorrhage ......................... 3
1.2.1 PatientFactors................................... 2 1.3.3 NarrowCanal.................................... 3
1.2.2 DiseaseFactors .................................. 2 1.3.4 FoggingoftheEndoscope ........................ 4
1.2.3 Investigations.................................... 3
1.2.4 IssuesofConsent ................................ 3
2 PrinciplesofEndoscopicEarSurgery......................................................................... 6
MuaazTarabichi
2.1 Introduction..................................... 6 2.6.1 EndoscopicTranscanalManagementofLimited
Cholesteatoma................................... 10
2.2 AdvantagesofTranscanalAccessto
2.6.2 EndoscopicOpenCavityManagementof
Cholesteatoma .................................. 6
Cholesteatoma................................... 11
2.6.3 ExpandedTranscanalAccesstotheMiddleEar
2.3 TranscanalAccessAllowsBetterUnderstanding
ofAnatomy,Function,andDisease................ 7 andPetrousApex................................ 12
2.4 DisadvantagesoftheEndoscope.................. 9 2.7 ManagementAlgorithm.......................... 12
2.5 SafetyConcerns.................................. 9 References....................................... 15
2.6 ProceduralOptionsinCholesteatoma............. 10
3 EarEmbryology ................................................................................................ 17
EliomariaCunsolo,FrancescoMattioli,MatteoAlicandri-Ciufelli,DanieleMarchioni
3.1 Introduction..................................... 17 3.3.5 FormationofMiddleEarSpacesandFolds......... 23
3.2 OuterEarDevelopment .......................... 17 3.4 InnerEarDevelopment........................... 26
3.2.1 ExternalAuditoryCanal,TympanicRing, 3.4.1 EarlyDevelopmentoftheMembranous
andEardrum .................................... 17 Labyrinth........................................ 26
3.4.2 DuctandEndolymphaticSac ..................... 27
3.3 MiddleEarDevelopment ......................... 18
3.4.3 SaccusandUtricle ............................... 28
3.4.4 SemicircularCanals.............................. 28
3.3.1 OssicularChain.................................. 18
3.4.5 CochlearDuct ................................... 29
3.3.2 DevelopmentoftheEustachianTubeand
3.4.6 DevelopmentoftheOticandPerilymphatic
theTympanum-AntrumMastoidPortion.......... 22
Spaces .......................................... 30
3.3.3 DevelopmentofthePrimaryTympanicCavity ..... 22
References....................................... 37
3.3.4 DevelopmentoftheTympanicAtrium............. 23
4 EndoscopicMiddleEarAnatomy ............................................................................. 39
DanieleMarchioni,MatteoAlicandri-Ciufelli,DomenicoVillari,LivioPresutti
4.1 Introduction..................................... 39 4.2.4 PyramidalEminenceandSubpyramidal
Space ........................................... 43
4.2 Retrotympanum................................. 39
4.2.5 InferiorRetrotympanum ......................... 45
4.2.1 SinusTympani................................... 39 4.3 EpitympanicDiaphragmandPrussakSpace........ 48
4.2.2 Ponticulus....................................... 42
4.2.3 Subiculum....................................... 43 4.4 FacialNerve ..................................... 49
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Contents
4.5 Epitympanum................................... 56 4.6 Protympanum................................... 60
4.5.1 PosteriorEpitympanicSpace..................... 56 4.7 Hypotympanum................................. 62
4.5.2 AnteriorEpitympanicSpace...................... 57
4.5.3 TensorFold ..................................... 57 References ...................................... 64
4.5.4 TransverseCrest(or“Cog”)....................... 59
5 VentilationandPhysiopathologyoftheMiddleEar........................................................ 66
DanieleMarchioni,MatteoAlicandri-Ciufelli,AlessiaPiccinini,LivioPresutti
5.1 Introduction..................................... 66 5.4 MastoidBuffer .................................. 68
5.2 EustachianTube ................................. 66 5.5 BlockageofMiddleEarVentilationRoutes......... 69
5.3 TransmucosalGasExchange...................... 67 References ...................................... 85
6 RadiologicalConsiderationsforEndoscopicMiddleEarSurgery.......................................... 87
LelaMigirov,DanieleMarchioni,MatteoAlicandri-Ciufelli,GahlGreenberg
6.1 Introduction..................................... 87 6.2.5 InvolvementofSubsites.......................... 91
6.2.6 EpitympanicDimensions......................... 95
6.2 PreoperativeCTEvaluationsandTheirInfluence
inSurgicalPlanning.............................. 87 6.3 PostoperativeCTResults......................... 96
6.2.1 TheExternalEarCanal........................... 88 6.4 UseofDiffusion-WeightedMRI................... 96
6.2.2 SinusTympani................................... 88
6.2.3 AntralandMastoidInvolvement.................. 89 References ...................................... 100
6.2.4 DuralPlaneAssessment.......................... 91
7 SurgicalArmamentarium..................................................................................... 102
MohamedBadr-El-Dine
7.1 Introduction..................................... 102 7.5 AdvancedNewTechnologiesUsedin
OtologySurgery................................. 105
7.2 PositioningandGeneralEquipment............... 102
7.5.1 High-DefinitionDigitalCameras.................. 105
7.2.1 OperatingRoomSetup........................... 102 7.5.2 XenonLightSources............................. 106
7.2.2 TheOperatingMicroscope ....................... 102 7.5.3 High-DefinitionDigitalMonitorsandData
7.2.3 TheContravesTable ............................. 102 ManagementandDocumentation ................ 106
7.5.4 DigitalPhotodocumentation ..................... 106
7.3 StandardInstrumentsforMicroscopic 7.5.5 MicrodrillHandpieces:AttachmentsandBurs..... 107
EarSurgery ..................................... 102
7.5.6 Piezosurgery.................................... 107
7.5.7 Vesalius......................................... 108
7.4 EndoscopesandSpecialInstrumentsfor
EndoscopicEarSurgery .......................... 103 7.5.8 Lasers........................................... 109
7.6 SpecificInstrumentationUsedforCertain
7.4.1 EarEndoscopes.................................. 103
EndoscopicNeurotologicalSkullBaseProcedures.. 110
7.4.2 RigidEndoscopes................................ 103
7.6.1 NeuronavigationandIntraoperativeDoppler...... 111
7.4.3 Instruments..................................... 104
References ...................................... 111
8 EndoscopicDiagnosisandFollow-upofRetractionPocketsandCholesteatomas ...................... 113
SeijiKakehata
8.1 Introduction..................................... 113 8.2.1 EndoscopyofRetractionPockets.................. 113
References ...................................... 119
8.2 Methods........................................ 113
9 PrinciplesofEndoscopicCadavericEarDissection.......................................................... 121
DanieleMarchioni,MatteoAlicandri-Ciufelli,LivioPresutti
9.1 Introduction..................................... 121 References ...................................... 130
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Contents
10 EndoscopicApproachestoMiddleEarCholesteatoma:ClassificationandIndicationsforSurgery.... 132
DanieleMarchioni,AlbertoGrammatica,ElisabettaGenovese,MariaConsolazioneGuarnaccia,DomenicoVillari,LivioPresutti
10.1 Introduction..................................... 132 10.3.1 LimitsoftheExclusivelyTranscanalApproach ..... 147
10.1.1 PrimaryAcquiredCholesteatoma ................. 132 10.4 SurgicalIndicationsforExclusivelyEndoscopic
10.1.2 SecondaryAcquiredCholesteatoma............... 133 ApproachtoAcquiredPrimaryCholesteatoma..... 147
10.1.3 CongenitalCholesteatoma........................ 133
10.4.1 ContraindicationstotheExclusivelyTranscanal
10.2 GeneralIndications............................... 133 Approach........................................ 147
10.4.2 PreoperativeCholesteatomaStaging .............. 147
10.2.1 IndicationsandContraindications................. 133 10.4.3 PreoperativeClinicalExamination ................ 147
10.2.2 AtticCholesteatoma.............................. 136 10.4.4 Follow-up....................................... 148
References....................................... 149
10.3 GoalsoftheTranscanalApproachtoAttic
CholesteatomaRemoval.......................... 146
11 CombinedEndoscopic–MicroscopicMiddleEarSurgeryforCholesteatoma............................. 152
DanieleMarchioni,AlessiaPiccinini,MatteoAlicandri-Ciufelli,LivioPresutti
11.1 GeneralConsiderations........................... 152 11.3.2 Advantages...................................... 166
11.3.3 EndoscopicTechniqueintheClosedApproach..... 167
11.2 Endoscopic/MicroscopicCombinedApproach...... 152
11.4 Microscopic–EndoscopicallyAssistedApproachin
11.2.1 Indications ...................................... 152
CanalWallDownTechnique ...................... 176
11.2.2 Advantages...................................... 153
11.2.3 EndoscopicSurgicalSteps ........................ 153 11.4.1 Indications ...................................... 176
11.2.4 MicroscopicSurgicalSteps........................ 158 11.4.2 Advantages...................................... 176
11.3 Microscopic–EndoscopicallyAssistedApproachin 11.5 PostoperativeCare............................... 178
CanalWallUpTechnique......................... 159
References....................................... 183
11.3.1 Indications ...................................... 159
12 ExclusivelyEndoscopicTreatmentofSevereAtticRetractionandEpitympanicCholesteatoma....... 185
DanieleMarchioni,GabrieleMolteni,LivioPresutti
12.1 SurgicalAnatomyandPhysiology................. 185 12.5.1 IncisionandTympanomeatalFlapElevation ....... 190
12.5.2 MiddleEarMucosaandEvaluationof
12.2 History.......................................... 189
VentilationRoutes ............................... 191
12.3 GeneralSurgicalEvaluation....................... 189 12.5.3 SelectiveEpitympanicRetractionPocket .......... 192
12.5.4 CholesteatomawithLimitedAtticExtension
12.3.1 IndicationsandContraindications................. 189 (StageC1) ....................................... 192
12.3.2 Advantages...................................... 189 12.5.5 EndoscopicReventilationandTympanoplasty ..... 195
12.3.3 Complications................................... 190 12.5.6 SurgeryoftheTympanicIsthmus ................. 205
12.3.4 PreoperativeEvaluations......................... 190 12.5.7 SurgeryoftheTensorFold........................ 206
12.5.8 AnatomicalFeaturesoftheEpitympanum......... 207
12.4 EpitympanicCholesteatomaStaging .............. 190 12.5.9 Second-LookTympanoplasty ..................... 208
DanieleMarchioni,LivioPresutti 12.5.10 PostoperativeCare............................... 208
References....................................... 220
12.5 SurgicalSteps.................................... 190
13 ExclusivelyEndoscopicTreatmentofRetrotympanicCholesteatoma..................................... 222
DanieleMarchioni,AlbertoGrammatica,MatteoAlicandri-Ciufelli,LivioPresutti
13.1 SurgicalAnatomy................................ 222 13.4.2 Contraindications................................ 227
13.2 History.......................................... 223
13.5 Complications ................................... 227
13.3 Advantages...................................... 225
13.6 SurgicalSteps.................................... 227
13.4 IndicationsandContraindications................. 227
13.7 PostoperativeCare............................... 236
13.4.1 Indications ...................................... 227
References....................................... 241
vii
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Contents
14 EndoscopicTreatmentofCholesteatomawithAntralExtension.......................................... 243
DanieleMarchioni,FrancescoMattioli,DomenicoVillari,LivioPresutti
14.1 Introduction..................................... 243 14.6.1 EndoscopicOpenCavity.......................... 249
14.6.2 EndoscopicOpenReconstructiveCavity........... 249
14.2 TranscanalEndoscopic“Open”Technique......... 243
14.7 IntraoperativeComplications..................... 251
14.3 Indications...................................... 243
14.8 PostoperativeComplications..................... 251
14.4 Contraindications................................ 243
14.9 PostoperativeManagement...................... 251
14.5 SurgicalSteps................................... 243
References ...................................... 261
14.6 ReconstructiveConsiderations.................... 248
15 EndoscopicMyringoplasty.................................................................................... 263
StephaneAyache,DavideSoloperto,AlessiaPiccinini,DomenicoVillari,LivioPresutti,DanieleMarchioni
15.1 SurgicalAnatomy................................ 263 15.5 MyringoplastyThroughtheCreationofa
TympanomeatalFlap............................. 265
15.2 SurgicalConcepts................................ 263
15.5.1 SamplingandPreparationoftheGraft............ 265
15.2.1 AdvantagesofEndoscopicMyringoplasty ......... 263 15.5.2 SurgicalTechnique .............................. 267
15.2.2 DisadvantagesofEndoscopicMyringoplasty....... 263 15.5.3 PostoperativeCare............................... 284
15.3 IndicationsandContraindications................. 263 15.6 DirectEndoscopicMyringoplastywithout
CreationofaTympanomeatalFlap................ 285
15.3.1 PureToneAudiometry........................... 265
15.3.2 RoleofImaging.................................. 265 15.6.1 Indications...................................... 286
15.6.2 Contraindications ............................... 286
15.4 SurgicalApproach............................... 265 15.6.3 SurgicalSteps ................................... 286
15.6.4 PostoperativeCare............................... 287
15.4.1 SetupofthePatientandSurgeon................. 265 References ...................................... 292
16 EndoscopicTranscanalStapesSurgery(Stapedotomy) .................................................... 294
JoãoFlávioNogueira,LivioPresutti,JoãoPauloSaraivaAbreu,MoisesXimenesFeijão,MatteoAlicandri-Ciufelli,DanieleMarchioni
16.1 History ......................................... 294 16.5.1 Stapedotomy/Stapedectomywithout
PreservationoftheStapedialTendon ............. 300
16.2 Advantages ..................................... 294
16.5.2 StapedotomywithPreservationofthe
StapedialTendon................................ 300
16.3 IndicationsandContraindications................. 294
16.6 PostoperativeCare .............................. 303
16.3.1 Indications...................................... 294
16.3.2 Contraindications ............................... 298
References ...................................... 303
16.4 Complications................................... 298
16.5 SurgicalSteps................................... 298
17 EndoscopicRemovalofMiddleEarNeoplasms ............................................................. 305
DanieleMarchioni,FedericoMariaGioacchini,MatteoAlicandri-Ciufelli,FrancaLauraArtioli,LivioPresutti
17.1 Introduction..................................... 305 17.3.1 Indications...................................... 307
17.3.2 SurgicalTechnique .............................. 308
17.2 TumorCharacteristics............................ 305
17.4 PostoperativeCare .............................. 314
17.2.1 GlomusTympanicum............................ 305
17.2.2 MiddleEarAdenomatousTumors................. 305 References ...................................... 314
17.2.3 MiddleEarOsteoma............................. 306
17.3 Treatment....................................... 307
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