Temporal Bone Surgical Dissection Manual by Ralph A Nelson

By Ralph A Nelson

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This dissection is usually performed with small diamond burrs and a small suction-irrigator, which prevents the accumulation of bone dust from obscuring the underlying dissection area. The middle fossa dura is located and followed in an ever-deepeningtrench, with preservation of a thin layer of bone over the superior portion of the internal auditory canal. At the deepest portion of this dissection, which is at the superior lip of the porus acusticus, exposure is extremelv limited. With patience and persistence, however, the posterior superior portion of the internal auditory canal can be well exposed.

After the superior vestibular nerve is identified, a one-millimeter hook may be inseited deep to the vestibular nerve directly anterior and medial to the superior vestibular nerve to palpate the shelf of bone that separates the superior nerve from the facial canal. The superior vestibular nerve occupies a recess medially. The recess may be safely probed and the posterior edge of it palpated. Bill's bar, as this shelf of bone is called, represents the posterior wall of the fallopian canal. With identification of the bar and the fallopian canal, the superior vestibular nerve may then be avulsed from its attachments in the ampulla area.

Burring p,oe:er-r,orX1or superiorlv in the horizontal segment will lead to injury of *jre horizonmi canal. This thinning process should be completed over the enLtinenmastoid and middle ear segments of the facial nerve. Then the burr rs set aside. Eastric muscle I v t I , , t, ) t t q I t t Figure 20 t t Stylomastoid foramen Horizontal Posterior )t t t 1 I 4 sern icircular sern i circular canal canal ?! ^{ tlt Step 6 lFigs. 21,221= -t tJ ti Uncoveringthe Sheath I \ The eggshell-thin bone is gently pried off the sheath of the facial.

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