Anatomy • Temporal bone – Squamous portion – Mastoid portion – Petrous portion – Tympanic portion – Styloid process
External auditory canal • • • •
Approximately 2.5-3.5 cm long 6-9 mm wide Outer 1/3 : extension of the cartilage of the auricle Inner 2/3 : incomplete ring of the tympanic bone Lined by skin
Tympanic membrane • •
•
•
• •
Separates the EAC from middle ear cavity Fibroelastic layer – Outer surface : covered by canal c anal skin – Medial surface : by the middle ear e ar mucosa The circumference of the membrane – Thickened and forms annulus – Open anterosuperiorly Pars flaccida – Triangular segment, bordered by mallear fold – Devoid of fibroelastic layer Pars tensa Convex medially : umbo
Middle ear •
Air-filled irregular space • Boundary – Lateral : TM, lateral attic wall – Medial : capsule of the inner ear – Superior : tegmen tympani – Inferior : hypotympanic floor • Three portions – Mesotympanum – Epitympanum – Hypotympanum : covers the jugular bulb
Middle ear •
•
•
Pyramidal eminence – In the posterior wall of of the mesotympanum – Conical bony protrusion – Stapedius m. & its tendon Facial recess – Lateral to the pyramidal eminence – Covers the upper portion of the mastoid segment of the facial canal Sinus tympani – Medial to the pyramidal eminence – Posterior pocket of mesotympanum
Tympanic membrane
Middle ear • •
-
Ossicles Malleus, incus, stapes In the attic, head of malleus articulates with the incus body Malleus handle extends inferiorly to the TM The long process of the incus articulates with the head of stapes Ice-cream appearance : head of malleus & incus body, short process
Ossicles
• Posterior tympanum • Pyramidal eminance 를 기준으로 sup 와 inf, • facial canal 을 중심으로 lat 과 med 로 구분 • Superolateral : facial sinus • Inferolateral : lateral tympanic sinus • Superomedial : posterior tympanic sinus
• Ponticulus : pyramidal eminance 에서 promontory 로 이어지는 bony ridge • Subiculum : styloid eminance 에서 round window niche 의 post. lip 으로 이어지는 bony ridge – 이사이에 가장 큰 sinus tympani 존재
Tympanic Isthmus • Two openings between mesotympanum and attic – Anterior isthmus • Between tensor tympani tendon and the stapes
– Posterior isthmus • Between the short process of the incus i ncus and the stapedial tendon and pyramidal eminence
Prussak’s space •
Prussak’s space – Laterally pars flaccida – Medially the neck of the malleus – Superiorly lateral malleal ligament – Inferiorly the lateral process of the malleus
Facial nerve 1. Intracranial(Pontine) segment - 23-24mm length - from brain stem to the internal auditory canal 2. IAC(Meatal) segment - 8-10mm length - from the fundus of the IAC to the meatal foramen - anterior superior part of IAC 3. Labyrinthine segment - 3-5mm length - from the meatal foramen to the geniculate ganglion - branch: GSPN
Facial nerve 4. Tympanic segment - 8-12mm length - from first genu to second genu - inferior part of LSCC - Superior part of oval window 5. Mastoid segment - 10-15mm length - from second genu to stylomastoid foramen - chorda tympani 6. Extratemporal segment - from the stylomastoid foramen to the the muscles of innervation
Facial nerve
Dimensions of the Facial Nerve
Common Site of FN Injury during Otologic Surgery 1) Intracranial segment: Brainstem-CPA lesions 2) Mastoid segment: Mastoidectomy 3) Tympanic segment - Stapedectomy - Labyrinthectomy (medial side) 4) Extracranial segment - Parotidectomy
Facial nerve geniculate ganglion Superior SCC
Common crus Lateral SCC Vestibular aqueduct Posterior SCC
