Facial nerve surgery 2

Part 1: Combined transtemporal-transmastoid approach with meato-tympanic Rerouting and double grafting of theFacial Nerve after Longitudinal Fracture of the Temporal Bone (Right side 27 min)

Highlights:

1. Introduction with Figures ( 5 min)
2. Transmastoid Approach (4 min):
   1. exposure of mastoid, pyramidal and tympanic segments of the Facial Nerve (1 min)
   2. Identification of Facial Nerve lesion (3 min)
3. Transtemporal (MCF) Approach (5 min):
   1. exposure of genu and labyrinthine segment of the Facial Nerve (4 min)
   2. meato-tympanic rerouting of Fallopian canal (1 min)
4. Transmastoid approach (1 min): elevation of proximal stump of FN and enlargement of the Fallopian canal with the drill
5. Transtemporal (MCF) Approach (4 min):
   1. decompression of lateral cistern of the posterior fossa (1 min)
   2. section of petrosal nerve distal to geniculum and of labyrinthine segment of the FN (1 min)
6. Measurement, Harvesting and preparation of graft from the greater auricular nerve (2 min)
7. Transmastoid Approach (1 min): introduction of double nerve graft
8. Transtemporal (MCF) Approach (4 min):
   1. double grafting of proximal stump of the FN (3 min)
   2. wound closure with free muscle graft and craniotomy flap (1 min)
9. Transmastoid approach: double grafting of distal stump of the FN (2 min) 
10. Combined Transtemporal-Transmastoid Approach final situation (1 min)

Part 2: Subtotal Petrosectomy with removal of the otic capsula , meato-cochleo-mastoid rerouting and grafting of the Facial Nerve after transverse fracture of the Temporal Bone (Right side 18 min)

Highlights:

1. Introduction with figures (5 min)
2. Mastoidectomy with exposure of fracture line from oval window to supralabyrinthine recess (2 min)
3. Identification of traumatized tympanic segment of Facial Nerve (30 sec)
4. Removal of otic capsula leaving the medial portion of the basal turn (1 min)
5. Section of petrosal nerve and mobilization of the swollen labyrinthine segment of the Facial Nerve (1 min)
6. Harvesting and preparation of the nerve graft (greater auricular nerve) (1 min)
7. Drilling new meato-cocleo-mastoid Fallopian canal (1 min)
8. Preparation of proximal stump of the Facial Nerve for grafting (30 sec)
9. Preparation of distal stump of the Facial Nerve for grafting (30 sec)
10. Introduction of single nerve graft (30 sec)
11. Proximal coaptation of nerve graft (2 min)
12. Distal coaptation of nerve graft (3 min)
13. Wound closure (30 sec)