Videos

Highlights

1. Skin Incision (13 min)
2. Exposure of Facial Nerve in the Parotid region (7 min)
3. Exposure of main Nerves and Vessels in the Neck (5 min)
4. Exposure of Temporal squama (2 min)
5. Subtotal Petrosectomy (5 min)

Highlights

1. Subtotal petrosectomy (cont.): skeletonization and exposure of tympanic and mastoid segments of the Facial Nerve – removal of stapes arch (12 min)
2. New anterior bony groove for anterior transposition of Facial Nerve – exposure of geniculate ganglion (2 min)
3. Exposure of Internal Carotid Artery – Oblteration of tympanic ostium of Eustachian Tube (2 min)
4. Anterior transposition of Facial Nerve (10 min)
5. Ligation of Sigmoid Sinus (4 min)
6. Placement of Infratemporal Fossa Retractor (4 min)
7. Protection of anteriorly displaced Facial Nerve (2 min)
8. Anterior exposure: Internal Carotid Artery, tympanic Ostium of Eustachian Tube (7 min)
9. Superior exposure: Basal turn of Cochlea (3 min)
10.  Posterior exposure: Posterior Fossa Dura, Sigmoid Sinus, Jugular Bulb (5 min)
11. Inferior exposure: Jugular vein, XI Nerve, opening of Jugular Bulb, pars venosa and pars nervosa of jugular foramen (12 min)
12. Anatomical situation after removal of a tumor that did not invade the cerebello-pontine-angle (1 min)
13. New fallopian canal in the Temporal Squama for grafting of the Facial Nerve with Superior Temporal Rerouting (2 min)

Part 1: Removal of C2 Paraganglioma (Right side 65 min)

Highlights 

1. Preoperative Radiology (1 min)
2. Introduction with Figures (6 min)
3. Subtotal Petrosectomy (8 min)
4. Exposure of tympanic and mastoid Segment of the Facial Nerve using Facial Nerve Monitor ( 3 min)
5. Elevation and anterior transposition of Facial Nerve ( 7 min)
6. Exposure and ligation of Sigmoid Sinus (5 min)
7. Exposure of vertical intratemporal segment of Internal Carotid Artery, occlusion of Tympanic Ostium of Eustachian Tube ( 5 min)
8. Tumor exposure (16 min)
   1. Anterior Pole (2 min)
   2. Superior Pole (3 min)
   3. Posterior Pole (3 min)
   4. Inferior Pole (8 min)
9. Tumor removal (12 min)
10. Wound closure (1 min)

Part 2: Segmental removal of infiltrated Epineurium after anterior rerouting of the Facial Nerve (Left side 13 min)

Highlights

1. Preoperative Radiology (1 min)
2. Introduction with Figures (4 min)
3. Segmental removal of Epineurium with anterior Rerouting of the Facial Nerve after removal of a C2 Paraganglioma (7 min)

Highlights:

1. Introduction and preoperative radiology (6 min)
2. Subtotal Petrosectomy (7 min)
3. Exposure and mobilization of the intrapetrousFacial Nerve (5 min)
4. Anterior transposition of the Facial Nerve (18 min)
5. Exposure and ligation of Sigmoid Sinus (4 min)
6. Exposure of ICA at the skull base (4 min)
7. Introduction of infratemporal fossa retractor (1 min)
8. Exposure of inferior tumor pole (1 min)
9. Mobilization of superior tumor pole (5 min)
10. Obliteration of Isthmus of the Eustachian Tube (1 min)
11. Separation of anterior tumor pole from ICA (4 min)
12. Mobilization of posterior tumor pole (2 min)
13. Mobilization of inferior tumor pole (4 min)
14. Separation of medial tumor extension from the posterior fossa dura (5 min)
15. Removal of intradural tumor extension (7 min)
16. Wound closure (2 min)
17. Postoperative radiology (1 min)

Highlights:

1. Preoperative information incl. radiology ( 2 min)
2. Mastoidectomy (3 min)
3. Canalplasty (3 min)
4. Identification of traumatized Facial Nerve (3 min)
5. Decision to perform Subtotal Petrosectomy with preservation of otic capsule (3 min)
6. Exposure of traumatized Facial Nerve (1 min)
7. Exenteration of hypotympanic and infralabyrinthine pneumatic cells (1 MIN)
8. Obliteration of Eustachian tube (2 min)
9. Preparation of Facial Nerve for grafting (6 min)
10. Preparation of Nerve graft (1 min)
11. Tympano-mastoid double grafting of Facial Nerve (8 min)
12. Wound closure (2 min)

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)

Highlights:

1. Information with Figures (6 min)
2. Separation of superior pole of tumor (2 min)
3. Separation of posterior pole of tumor (1 min)
4. Exposure of inferior tumor pole (3 min)
5. Exposure of anterior tumor pole (3 min)
6. Separation of tumor from ICA and cranial nerves at the jugular foramen (2 min)
7. Removal of tumor along vertical intrapetrous segment of ICA (4 min)
8. Removal of tumor from otic capsula (1 min)
9. Removal of tumor from the pyramid apex (2 min)
10. Removal of tumor remnants in the spongiotic bone (3 min)
11. Removal of last portion of tumor at the carotid bend (6 min)
12. Further removal of infiltrated spongiotic bone (12 min)
13. Final view after tumor removal(1 min)
14. Operative specimen and wound closure (1 min)

2ndt Part Clinical Cases

Case 1: Removal of apical cyst (Lt 22 min)

Case 2: Drainage of apical cyst (Rt 10 min)

Case 3: lRemoval of epidermoid cyst – apical cholesteatoma (Rt 11 min)

Highlights

1. Retroauriculo-temporal skin incision
2. Main trunk and frontal branch of the facial nerve identified
3. Zygomatic arch and temporalis muscle reflected inferiorly
4. Subtotal petrosectomy
5. Horizontal intratemporal carotid artery, middle meningeal artery and mandibular nerve exposed by removal of mandibibular tubercle
6. Mandibular condyle displaced inferiorly
7. Pyramid tip and clivus exposed for tumor removal
8. Wound obliterated with temporalis muscle

Part 1: Anatomical Dissection (right side)

Part 2: Clinical Cases (Case 1 and 2)

Highlights (MSB p. 350)

1. Retroauriculo-temporal skin incision
2. Frontal branch of VII exposed
3. Zygomatic arch, temporalis muscle inferiorly displaced
4. Subtotal petrosectomy
5. meningeal artery and mandibular branch of Vth nerve sectioned
6. Inferior displacement of mandibular condyle
7. Pterygoid process and surrounding bone at the skull base removed
8. Maxillary branch of the trigeminal nerve (V) divided
9. Exposure of the internal carotid artery from carotid foramen to foramen lacerum and cavernous sinus
10. Exposure of infratemporal fossa, pterygopalatine fossa, parasellar region and nasopharynx for tumor removal
11. Zygomatic arch rewired into place
12. Operative cavity obliterated with temporalis, retroauriculo-occipital or sternocleidomastoid muscle flaps

• Anatomical Dissection: 2D with 3D-upscaling (Rt 14 min)
• Clin.case 1: Parapharyngeal Neurofibroma (Lt 17 min)
• Clin.case 2: Parapharyngeal Pleomorphic Adenoma (Lt 24 min)
• Clin.case 3: Arachnoid Cyst of Ala magna of sphenoid bone (Lt 12 min)

SURGICAL HIGHLIGHTS

1. Preauricular skin incision with extension into the neck and toward the orbit
2. Exposured of FN in the parotid
3. Elevation of temporal muscle
4. Exposure of zygomatic arch and lateral orbital rim
5. Division and reflection of zygomatic arch
6. Anterior elevation of temporalis muscle
7. Removal of posterior root of zygomatic arch
8. Inferior displacement of mandibular condyle
9. Removal of bone at the base of MCF (incl. tuberculum articulare)
10. Separation of soft tissues from base of MCF
11. Exposure of pterygoid process
12. Exposure of pterygopalatine fossa
13. Exposure of F. rotundum and V2 in upper sphenopalatine fossa
14. Exposure of sphenoid sinus
15. Exposure of F. rotundum and V2 in upper sphenopalatine fossa
16. Elevation of dura from base of MCF for exposure of trigeminal ganglion with V3 and V2
17. Opening of sphenoid sinus
18. Entering nasal cavity
19. Exposure of foramen lacerum
20. Exposure of cavernous sinus
21. Obliteration of the cavity and wound closure (not shown)

• Exposure of IAC
• Vestibular Neurectomy
• Wound Closure

SURGICAL HIGHLIGHTS (MSB p.436-457)

1. Preauricular skin incision with extension into temporal region
2. Exposure of Temporal squama
3. Craniotomy
4. Elevation of Middle Cranial Fossa Dura
5. Exposure of Meatal Plane
6. Introduction of Articulated Middle Fossa Retractor
7. Identification of blue line of Superior Semicircular canal
8. Identification and exposure of the Internal Auditory Canal
9. Removal of the meatal segment of vestibular nerve
10. Wound closure: sealing of internal auditory canal
11. Recontruction of tegmen tympani
12. Suspension of middle cranial fossa dura from temporalis muscle
13. Repositioning of the craniotomy flap
14. Suction drain
15. Skin closure

Part 1: Tympano-Antrotomy (56 min)

1. Skin Incision (10 sec)
2. Meatoplasty (10 sec)
3. Canalplasty (25 min)
4. Myringoplasty (8 min)
5. Antrotomy (5 min)
6. Epitympanotomy (2 min)
7. Transmastoid Drainage of the Antrum (30 sec)
8. Myringoplasty (6 min)
9. Ossiculoplasty (6 min)

Part 2: Tympano-Mastoidectomy (13 min)

10. Mastoidectomy (6 min)
11. Posterior Tympanotomy (7 min)

Highlights

1. Canalpasty (10 min)
2. Myringoplasty (8 min)
3. Antrotomy (1 min)
4. Epitympanotomy (1 min)
5. Ossiculoplasty (1 min)
6. Mastoid Drainage (1 min)
7. Wound Closure (4 min)

With original intraoperative comments by Prof. U.F

Highlights

1. Canalplasty (12 min)
2. Mastoidectomy (11 min)
3. Posterior Tympanotomy (27 min)
4. Removal of skin from Middle Ear (8 min)
5. Myringoplasty (3 min)
6. Epitympanotomy (1 min)
7. Ossiculoplasty (5 min)
8. Mastoid Drainage (1 min)

With original intraoperative comments by Prof. U.F.

Highlights:

1. Information with preop. Radiology (5 min)
2. Retroauricular skin incision (1 min)
3. Revision mastoidectomy (4 min)
4. Revision Canalplasty (5 min)
5. Ossiculoplasty: inspection of the ossicular chain (2 min)
6. Antrotomy (1 min)
7. Epitympanotomy (1 min)
8. Ossiculoplasty: lateralization of the malleus (3 min)
9. Myringoplasty: water test (1 min)
10. Mastoidectomy (5 min): 10a retrograde exposure of FN and identification of nerve injury (4 min), 10b exposure of tympanic segment of FN (1 min)
11. Drilling of new Fallopian canal for grafting (1 min)
12. Elevation of distal stump of the FN (1 min)
13. Reconstruction of bony posterior canal with bone flap from the temporal squama (3 min)
14. Harvesting and preparation of nerve graft (greater auricular nerve) (3 min)
15. Introduction and coaptation of reverse nerve graft (4 min)
16. Myringoplasty with temporalis fascia (3 min)
17. Wound closure and postoperative results (1 min)

Highlights

1. Endaural skin incision
2. Meatal skin flap with ant. extension
3. Anterosuperior  canalplasty for evaluation of mobility of malleus and incus
4. Exposure of oval window
5. Evaluation of stapes mobility
6. Trimming of stapes prosthesis
7. Stapedotomy with manual perforators
8. Introduction and crimping of stapes prosthesis
9. Removal of stapes arch
10. Sealing of stapedotomy opening
11. Packing and wound closure

Highlights

1. Endaural incision
2. Meatal skin flap with anterior extension
3. Anterosuperior canalplasty
4. Exposure of ant. tymp. Spine and ant. mallear proc. and lig. for assessment of malleus mobility
5. Removal of incus
6. Drilling away ossified ant. mallear lig. and removal of malleus head
7. Introduction of Titanium Stapes Prosthesis (straight or angled) between malleus handle and stapes footplate
8. Stapedotomy with manual perforators
9. Removal of stapes arch with crurotomy scissors
10. Introduction of stapes piston into vestibule
11. Crimping of titanium loop to malleus handle and sealing of stapedotomy opening
12. Packing and wound closure

Part 1: Mastoidectomy, Epitympanectomy  41 min
Part 2: Tympanoplasty (first stage)  13 min

Highlights

1. Retroauricular approach
2. Meatal skin flap (alternative technique)
3. Canalplasty
4. Wide removal of bone over middle cranial fossa dura, sigmoid sinus and sinus dura angle
5. Exposure of digastric muscle
6. Epitympanotomy with identification of tympanic segment of facial nerve
7. Lowering facial ridge over mastoid segment of fallopian canal
8. Radical exenteration and exposure of retrofacial and retrolabyrinthine cells
9. Radical exenteration and exposure of supralabyrinthine and supratubal recesses (epitympanectomy)
10. Extended canalplasty with removal of antero-inferior overhang of tympanic bone
11. Radical removal of matrix from tympanic cavity
12. Formation of a new tympanic sulcus
13. Removal of mastoid tip
14. Tympanoplasty (first stage)
15. Obliteration of posterior cavity with occipital myosubcutaneous flap
16. Meatoplasty
17. Reposition of meatal skin flap and packing

Highlights

1. Retroauricular skin incision
2. Meatal skin flap
3. Canalplasty
4. Wide removal of bone over middle cranial fossa dura, sigmoid sinus and sinus dura angle
5. Exposure of digastric muscle
6. Epitympanotomy with identification of tympanic segment of facial nerve
7. Lowering facial ridge over mastoid segment of fallopian canal
8. Radical exenteration and exposure of retrofacial and retrolabyrinthine cells
9. Radical exenteration and exposure of supralabyrinthine and supratubal recesses (epitympanectomy)
10. Extended canalplasty with removal of antero-inferior overhang of tympanic bone
11. Radical removal of matrix from tympanic cavity
12. Formation of a new tympanic sulcus
13. Removal of mastoid tip
14. Tympanoplasty (Type III)
15. Obliteration of posterior cavity with occipital myosubcutaneous flap
16. Meatoplasty
17. Reposition of meatal skin flap and packing
18. Wound closure and packing

Highlights

1. Retroauricular skin incision
2. Meatal skin flap
3. Exploration of Middle Ear (Cholesteatoma)
4. Canalplasty
5. Antrotomy
6. Mastoidectomy
7. Epitympanectomy with removal of Cholesteatoma and identification of tympanic segment of facial nerve
8. Extended canalplasty
9. Myringoplasty
10. Posterior obliteration of open cavity with occipital myosubcutaneous flap
11. Meatoplasty
12. Wound closure and packing

Highlights

1. Mastoidectomy (retroauricular approach)
2. Epitympanectomy
3. Canalplasty
4. Cholesteatoma removal (middle ear)
5. Cholesteatoma removal (epitympanum)
6. Epitympanectomy (radical exenteration and exteriorization of supratubal and supralabyrinthine recess
7. Myringoplasty
8. Anterior packing of open cavity
9. Posterior obliteration of open cavity with occipital myosubcutaneous flap
10. Meatoplasty
11. Wound closure and packing

Highlights

1. Canalplasty (retroauricular approach)
2. Mastoidectomy
3. Epitympanectomy
4. Cholesteatoma removal
5. Myringoplasty
6. Posterior obliteration of open cavity with occipital myosubcutaneous flap
7. Meatoplasty
8. Wound closure and packing

Indications

• Case 1: Meatoplasty for narrow EAC
• Case 2: Meatoplasty in closed cavity
• Case 3: Meatoplasty in open cavity
• Case 4. Blind sac closure of EAC
• Case 5. Canalplasty for Exostosis
• Case 6. Canalplasty for Otitis externa stenosans

Highlights

MEATOPLASTY (Case 1-4)

1. Endaural/retroauricular skin incision
2. Removal of excess conchal cartilage
3. Removal of excess bony canal
4. Elevation and rotation of skin flaps
5. Packing of enlarged meatus

CANALPLASTY (Case 5-6)

1. Endaural incision
2. Elevation of meatal skin flaps
3. Canalplasty
4. Removal of exostosis/obliterating tissue
5. Exposure of new tympanic sulcus
6. Reposition and fixation of meatal skin flaps
7. Wound closure and packing

Indications:

• Case 1: Congenital bilateral total deafness
• Case 2: Bilateral deafness after open Mastoidectomy
• Case 3: bilateral deafness after transmastoid extracochlear Implant

Highlights

1. L-shaped retroauricular incision for skin flaps
2. Inverted L-shaped incision for musculoperiosteal flap
3. Bed for the receiver/stimulator package
4. Partial anterior mastoidectomy
5. Retrograde exposure of mastoid segment of fallopian canal
6. Posterior tympanotomy with exposure of round window niche
7. Formation of mastoid groove for the electrode lead
8. Placement of receiver/stimulation package in its bony bed and fixation under parietosquamous periosteal pouch
9. Introduction of electrode array into basal turn of the cochlea
10. Placement of electrode lead in its bony groove
11. Wound closure in layers