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Medicine - Otorhinolaryngology | Endoscopic Anatomy of the Middle Ear

Endoscopic Anatomy of the Middle Ear

Tschabitscher, Manfred, Klug, Clemens

2000, XIII, 130 p.

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  • About this atlas

if indications are defined by stringent criteria, the technique will gain an impor­ tant place particularly in pediatric otology. Its clinical indications can naturally not be covered in this volume. As the working space available is limited and the structures in it are very deli­ cate, the iatrogenic trauma associated with endoscopy must be minimized at all cost. This requires a profound understanding of anatomy. This volume will help the readers acquire or broaden it. April 2000 M. Tschabitscher C.Klug VI Acknowledgements The long tradition of the Institute of Anatomy at the University of Vienna to collaborate with clinical services, which was begun by HYRTL and continued by ZUCKERKANDL, TANDLER, PERNKOPF, v. HAYEK, GISEL, KRAUSE and FERNER, gene­ rated an atmosphere which still is singularly conducive to research in gross anatomy. We gratefully acknowledge the generous support of our work by the Medical School of the University of Vienna. But we are also indebted to AESCULAP, STORZ and ZEPPELIN companies for providing us with instruments. Our special thanks go to TONI NOBLES from NOBLES-LAI INC., who made the Hawk Vision System with its ultrathin flexible scopes available to us. Without it endoscopic work of this quality would not have been possible. With gratitude we recognize the assistance of Balas Fabinyi, M.D., semor resident at the ENT Service, Krems Hospital, in clinical matters. We are very grateful to Mag. Krista Schmidt for preparing the English-language manuscripts.

Content Level » Research

Keywords » Endoskop - Eustachian tube - Eustachische Röhre - Minimal Invasive Surgery - Minimal invasive Chirurgie - Mittelohr - Trommelfell - biportal approach - endoscope - tympanic membrane

Related subjects » Internal Medicine - Otorhinolaryngology - Surgery

Table of contents 

A Transmeatal approach (4 mm rigid scope).- A 1.1 Site of approach.- A 1.2 Following the chorda tympani (70° scope).- A 1.3 View into the anterior epitympanic recess (30°, 70° scopes).- A 1.4 Overview of protympanum (30° scope).- A 1.5 Central mesotympanum seen through 70°, 30°, 0° scopes.- A 1.6 Incus (30°, 70° scopes).- A 1.7 Stapes (70° scope).- A 1.8 Mucosal folds surrounding ossicular chain (70° scope).- A 1.9 Posterior wall of tympanic cavity (70° scope).- A 1.10 Epitympanic recess (70° scope).- A 1.11 Hypotympanum (30° scope).- A 1.12 Some variants of round window niche (30°, 70° scopes).- B Transtympanic approach.- B 1 Anterior inferior transtympanic approach.- B 1.1 Site of approach.- B 1.2 Overview of protympanum from the top down (rigid scope 2.7 mm, 30°).- B 1.3.1 Protympanic region close to tympanic membrane (rigid scope, 1.9 mm, 30°).- B 1.3.2 Medial wall of protympanum and tympanic opening of EUSTACHIAN tube (rigid scope, 1.9 mm, 30°).- B 1.4.1 Center of protympanum (rigid scope, 1.9 mm, 60°).- B 1.4.2 Roof of protympanum (rigid scope, 1.9 mm, 60°).- B 1.4.3 Bottom of protympanum (rigid scope, 1.9 mm, 60°).- B 2 Posterior superior transtympanic approach (1.9 mm rigid scope).- B 2.1 Site of approach.- B 2.2.1 Course of chorda tympani.- B 2.2.2 Posterior wall with pyramidal eminence (30° scope).- B 2.2.3 Facial canal (30° scope).- B 2.3.1 Oval window niche (30° scope).- B 2.3.2 Stapes (30° scope).- B 2.3.3 Anterior tympanic isthmus (30° scope).- B 2.4 Anterior epitympanic recess (60° scope).- B 4.5 Aditus ad antrum (60° scope).- B 2.6 Protympanum and hypotympanum (60° scope).- B 3 Posterior inferior transtympanic approach (1.9 mm rigid scope).- B 3.1 Site of approach.- B 3.2.1 Approaching the round window niche (30° scope).- B 3.2.2 Secondary tympanic membrane (30° scope).- B 3.3.1 Stapes ( 30° scope).- B 3.3.2 View into vestibule (stapes removed) (30° scope).- B 3.4 Posterior wall of tympanic cavity (30° scope).- B 3.5 Posterior wall (60° scope).- B 3.6 Stapes seen from below (60° scope).- B 3.7 Roof and medial wall of protympanum (60° scope).- B 3.8 Floor of protympanum and hypotympanum (60° scope).- C Transmastoid approach.- C 1 Through antrum.- C 1.1 Site of approach.- C 1.2 Antrum mastoideum (rigid scope, 4 mm, 0°).- C 1.3 View into mesotympanum from the top down (rigid scope, 2.7 mm, 30°).- C 1.4.1 Incudostapedial joint and anterior tympanic isthmus (rigid scope, 1.9 mm, 30°).- C 1.4.2 Cochleariform process and anterior epitympanic recess (rigid scope, 1.9 mm, 30°).- C 1.5.1 Incudomallear joint and chorda tympani (rigid scope, 1.9 mm, 60°).- C 1.5.2 Stapes and posterior tympanic isthmus (rigid scope, 1.9 mm, 60°).- C 2 Through facial recess (1.9 mm rigid scope).- C 2.1 Site of approach.- C 2.2.1 Tympanic membrane (30° scope).- C 2.2.2 Pyramidal eminence (30° scope).- C 2.2.3 Facial canal (30° scope).- C 2.2.4 Promontory and round window niche (30° scope).- C 2.2.5 Hypotympanum.- C 2.3.1 Round window niche (60° scope).- C 2.3.2 Tympanic ring and tympanic membrane (60° scope).- C 2.3.3 PRUSSAK’s space (60° scope).- D Transtubal approach (0.8 mm flexible steerable scope).- D 1.1 Site of approach.- D 1.2.1 View from tympanic opening of EUSTACHIAN tube into mesotympanum.- D 1.2.2 Scope kept straight to approach mesotympanic structures.- D 1.2.3 Scope advanced into central mesotympanum.- D 1.2.4 Scope crosses over stapes (medially to incus) and looks into mesotympanum.- D 1.2.5 Scope between long limb of incus and facial canal: Aditus ad antrum.- D 1.3.1 Scope in mesotympanum bent laterally: Lateral wall of tympanic cavity.- D 1.3.2 Scope in mesotympanum bent laterally and upward: PRUSSAK’s space.- D 1.3.3 Scope in mesotympanum bent laterally and downward: Hypotympanum.- D 1.4.1 Scope in protympanum bent upward: Mucosal fold of tensor tympani.- D 1.4.2 Scope advanced: Perforation of mucosal fold of tensor tympani.- D 1.4.3 Scope above tendon of tensor tympani: Incudomallear joint.- D 1.4.4 Scope medial to incudomallear joint: Posterior epitympanic recess.- D 1.5.1 Scope below tendon of tensor tympani: Incudostapedial joint.- D 1.5.2 Scope medial to long limb of incus: Facial canal and lateral semicircular canal.- D 1.5.3 Scope crosses over stapes: Aditus ad antrum.- D 1.6.1 Scope bent laterally and upward behind handle of malleus: Chorda tympani.- D 1.6.2 Scope lateral to long limb of incus: Course of chorda tympani.- D 1.7.1 Scope in the plane of the handle of malleus: Stapes.- D 1.7.2 Scope below incudostapedial joint: Posterior wall.- E Two-port approach (1.9 mm rigid scope, 30° ’ 0.8 mm flexible steerable scope).- E 1.1 Transtubal scope crosses above the tendon of the tensor tympani.- E 1.2 Transtubal scope crosses below the tendon of the tensor tympani.- E 1.3 Transtubal scope looks at the ossicular chain.- E 1.4 Transtubal scope looks at the posterior wall.

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