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A Guide to Temporal Bone Dissection: Cortical Mastoidectomy & Facial Recess Approach (Part 1 of 6)

Authors

Mohamedkazim M. Alwani, MD1, 3

Jon L. Harper, BS1, 3

Rick F. Nelson, MD PhD1, 2, 3

Author Affiliations

Department of Otolaryngology – Head and Neck Surgery1

Department of Neurological Surgery2

Indiana University School of Medicine3

Description

This video covers the key steps of a cortical mastoidectomy and facial recess approach during lab dissection of the temporal bone.  The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique.  The first part of this video demonstrates a basic cortical mastoidectomy and focuses on fundamental principles including the preservation of the tegmen and sigmoid plate, adequate posterior canal wall thinning, continual saucerization, adequate removal of air cells, and early identification of the lateral semicircular canal and incus. The second part of the video discusses the facial recess approach and enlightens the viewer on the boundaries of the facial recess, the course of the mastoid segment of the facial nerve, and the location of the round window. Key surgical landmarks demonstrated in the course of this video include: zygomatic root, temporal line, posterior meatal wall, Henle’s spine, mastoid tip, tegmen mastoideum, sigmoid sinus, Koerner’s septum, lateral semicircular canal, incus, incus buttress, chorda tympani nerve, mastoid segment of the facial nerve, facial recess, round window niche, and round window.

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