By M. Barbara
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Drilling of the anterior EAC wall (AW), according to the Mickey Mouse technique popularised by the House Ear Institute in Los An- Fig. 32. Drilling of the anterior canal wall (AW) is an important step during classic radical mastoidectomy. TMJ= Temporo-mandibular joint. 31 Fig. 33. Drawing showing the Mickey-Mouse technique for drilling of the anterior canal wall. geles, which aims at avoiding direct penetration of the glenoid fossa and, therefore, of the temporomandibular joint (TMJ) (Fig. 32).
The ES will certainly have been found when – depressing the corresponding dura – the surgeon can see the anterior prolongation medially to the labyrinthine block (PSC), which is still the ES and not yet the duct (ED). 44 Phase 14: Isolation of the labyrinthine block Drilling of the pre-sinus cells, performed to expose the PCF dura above Donaldson’s line as well, enables the posterior edge of the posterior labyrinthine block to be reached; this is represented by the three semicircular canals (SCs).
Fig. 34. The petrous apex (PA) is entered between the internal carotid artery (ICA) and the basal turn of the cochlea (BCT). FN= Facial nerve. 34 Phase 10: Cochleostomy and cochlear visualisation This phase of the dissection contains anatomical and practical elements with respect to cochlear implant surgery. Looking at the medial wall of the tympanic cavity, everyone knows that the promontory (a convex area) corresponds to part of the basal turn of the cochlea. The surgical landmarks for the identification of the deep projection of the cochlea are: • round window (RW) niche • stapes (S) and oval window (OW) • cochleariform process (CP) • semicanal of the tensor tympani muscle (STTM) • tubal orifice (TO) • vertical trait of the ICA • Jacobson’s nerve (J) It is important to remember that the baso-apical direction of the cochlear turn is opposite to the side operated: left direction in a right cochlea and vice versa.