Lecture: Principles of temporal bone surgery

Principles of Temporal Bone Surgery – Dr. Byl – 3/8/16

1.     Know the anatomy

2.     Go from KNOWN to UNKNOWN

3.     Operate on the best ear unless you have no other choice

4.     Three outcomes: Better, same, WORSE

a.     Goal is better but you don’t want to risk making things worse

5.     Goals of ear surgery (in ORDER)

a.     Safe ear (don’t trap disease)

b.     Dry ear (free from infection)

c.      Better hearing ear

6.     Enemy of GOOD is BETTER

7.     Difficult to differentiate FN from granulation

a.     Especially true in the age BEFORE FN monitoring in full use

b.     Still a good general principle

8.     If the FN is cut, it takes THREE days for it to lose its excitability

9.     FN excitability in infants and children is unpredictable

10. BEWARE OF THE RED HERRING

a.     Don’t get stuck thinking one way

b.     A headache has other causes besides sinusitis

11. Surgical Pearls

a.     When using curette, start at vital structures and sweep away

b.     Know the following possible mistakes when drilling

                                      i.   Run – losing control, drill opposite the rotation of the drill

                                     ii.   Heat – more of a concern with diamond burrs

                                   iii.    Plunges – drilling a hole

c.      Different between cutting and diamond burrs

                                      i.   Cutting burrs

1.     Faster

2.     Less heat

3.     Less likely to plunge

d.     Microscope details

                                      i.     Focal length

1.     The distance you can view objects

a.     Too close = less working room for arms

b.     Too far = less light and lower magnification

                                     ii.     Magnification

                                   iii.     Axis of vision

1.     Ideal if straight on like microdirect laryngoscopy

2.     However, ability to adjust eyepiece can be valuable as well to get in a COMFORTABLE position

e.     Good ergonomics

                                      i.     Avoid extreme positions that are unsustainable