A rigorous understanding of anatomy underlies safe and effective ear microsurgery. Traditionally, anatomical dissection of temporal bones was the primary educational means of being introduced to the complex and convoluted relationships of the ear and its related structures. With the increasing difficulty in obtaining anatomical material coupled with the expense of maintaining temporal bone labs, which tend to occupy the most lightly used space in academic departments, imaging-based anatomical tools are likely to gradually supplant dissection as the dominant educational method. Conventional CT and MRI images are a valuable means of learning temporal bone anatomy. With experience, mastery of relationships in the axial, coronal, and sagittal planes can translate into a fused three-dimensional awareness. While the two-dimensionality of the illustrations in this atlas may be considered a limitation, their use of enhanced color and highlighting of surgically relevant structures while eliminating the extraneous efficiently conveys much useful anatomical and surgical information. Although not yet a mature technology at the time of publication, it seems clear that the future of ear microsurgical training lies in virtual three-dimensional simulation using haptically reinforced, computer-generated microsurgical tools.
Further Reading
Andersen SAW, Cayé-Thomasen P, Sørensen MS. Mastoidectomy performance assessment of virtual simulation training using final-product analysis. Laryngoscope 2015;125(2):431–435 PubMed
Awad Z, Tornari C, Ahmed S, Tolley NS. Construct validity of cadaveric temporal bones for training and assessment in mastoidectomy. Laryngoscope 2015;125(10):2376–2381 PubMed
Chan S, Li P, Locketz G, Salisbury K, Blevins NH. High-fidelity haptic and visual rendering for patient-specific simulation of temporal bone surgery. Comput Assist Surg (Abingdon) 2016;21(1):85–101 PubMed
Cheattle AH. The Surgical Anatomy of the Temporal Bone. London: J&A Churchill Ltd; 1907
Donaldson JA, Duckert LG, Lambert PM, Rubel EW. Surgical Anatomy of the Temporal Bone. 4th ed. New York, NY: Raven Press; 1992
Gulya AJ. Anatomy of the Temporal Bone with Surgical Implications, 3rd ed. New York, NY: Informa Healthcare USA; 2007
Locketz GD, Lui JT, Chan S, et al. Anatomy-specific virtual reality simulation in temporal bone dissection: perceived utility and impact on surgeon confidence. Otolaryngol Head Neck Surg 2017;156(6):1142–1149 PubMed
Lustig LR, Jackler RK, Mandelcorn R. The history of otology through its eponyms I: anatomy. Am J Otol 1998;19(3):371–389 PubMed
Piromchai P, Wijewickrema S, Smeds H, Kennedy G, O’Leary S. Correlations of external landmarks with internal structures of the temporal bone. Otol Neurotol 2015;36(8):1366–1373 PubMed
Sanna M, Russo A, Taibah A, Piras G, Tang W. The Temporal Bone: Anatomical Dissection and Surgical Approaches. New York, NY: Thieme; 2018
1.2 Temporal Bone
Fig. 1.1 Coronal perspective of the anatomy of the ear which is the illustration used on the cover of this Atlas. This drawing was an effort to modernize the classical coronal depiction of the ear created in 1939 by the eminent medical illustrator Max Brödel. Compressing three dimensional structures into a proportionally correct illustration with accurate anatomical relationships, yet simplified enough to convey an overall perspective, took many iterations over the course of an entire year. For the story of the centuries-long effort to illustrate overall ear anatomy, please see the following study on the subject: Jackler RK, Gralapp CL, Mudry A. Revisiting Max Brödel’s classic coronal illustration of the ear. Otol Neurotol 2014;35:555–560.
Fig. 1.2 Lateral perspective of the anatomy of the ear. LSCC, lateral semicircular canal; PSCC, posterior semicircular canal; RW, round window; SSCC, superior semicircular canal.
Fig. 1.3 Axial perspective of the anatomy of the ear.
Fig. 1.4 Surface anatomy of the temporal bone.
Fig. 1.5 The relationship between the temporalis muscle and the linea temporalis.
Fig. 1.6 The four osseous components of the temporal bone from lateral perspective.
Fig. 1.7 The four osseous components of the temporal bone from medial perspective.
Fig. 1.8 The three fossae of the skull base. The petrous pyramid containing the ear structures separates the middle fossa from the posterior fossa.
Fig. 1.9 The cranial base as seen from above.
Fig. 1.10 The cranial base as seen from below.
Fig. 1.11 Anatomical dissection of the temporal floor peering from above via the middle fossa approach. EAC, external auditory canal; LSCC, lateral semicircular canal; PSCC, posterior semicircular canal; TMJ, temporomandibular joint; SSCC, superior semicircular canal.
1.3 External Ear
Fig. 1.12 Anatomy of the pinna (auricle).
Fig. 1.13 The pinna is tilted posteriorly from the axis of the malleus. Understanding this is important to patient positioning during surgery.
Fig. 1.14 Cartilage skeleton of the auricle. Note the incisura between the crus of the helix and the tragus. This is the location of an endaural incision.
Fig. 1.15 Sensory innervation of the pinna and external auditory canal.
Fig. 1.16 Sensory innervation of the external auditory canal.
1.4 Middle Ear and Mastoid
Fig. 1.17 Anatomy of the middle and inner ear.
Fig. 1.18 Relationships of the middle ear: coronal aspect.
Fig. 1.19 The tympanic membrane and ossicles.
Fig. 1.20 The medial wall of the middle ear and mastoid. Components of the facial nerve: GSPN, greater superficial petrosal nerve; Lab, labyrinthine segment; Horiz, horizontal or tympanic segment; Vert, vertical or mastoid segment; LSCC, lateral semicircular canal; PSCC, posterior semicircular canal.
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