Analysis of axial temporal bone computed tomography scans for performing a safe posterior tympanotomy.
A posterior tympanotomy is a procedure performed to access the posterior mesotympanum to remove pathologic lesions through a mastoid exposure. In this study, we aimed to evaluate and classify the anatomical relationships between the vertical segment of the facial nerve and the mastoid antrum in an axial temporal bone CT to prevent facial nerve injury when performing a posterior tympanotomy. We performed retrospective analysis of temporal bone CT scans. A cohort of 102 patients who underwent tympanomastoidectomy for chronic otitis media, and 43 patients with sensorineural hearing loss with normal temporal bone, were included. All patients had preoperative and diagnostic computed tomography of the temporal bone from January to December 2006. Anatomical relationships were evaluated according to several parameters: protrusion of the facial nerve into the mastoid antrum, status of the facial canal, new bone formation over the facial canal, and size of the mastoid antrum. Anatomical relationships between the vertical segment and the mastoid antrum were classified into six types. Type 1 has no protrusion of the facial nerve with a regular facial canal, and Type 2 has no protrusion with a partly thin facial canal. Type 3 has protrusion into the antrum with a regular facial canal, and Type 4 has protrusion with a partly thin facial canal. Type 5 has new bone formation around the facial canal, and Type 6 has new bone formation with a small or contracted antrum. These results may enable preoperative assessment of the facial nerve's status, and provide background knowledge to prevent facial nerve injury when performing a posterior tympanotomy.
Kim
Chang Woo
CW
Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, 445 Gil-Dong, Gangdong-gu, Seoul 134-701, South Korea. kcw5088@dreamwiz.com
Oh
So Jung
SJ
Kim
Han-Shin
HS
Ha
Seung-Hern
SH
Rho
Young-Soo
YS
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006319:Hearing Loss, Sensorineural; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery*; D013506:Otologic Surgical Procedures; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014432:Tympanic Membrane / Q000601:surgery*