Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach
Video Type: CVideo- 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
- Clearly annotated and narration is a must in these videos
- These have clear but concise abstracts are not able to be indexed in PubMed
- Distributed in newsletters, featured on our website and social media
- Peer reviewed
Author: Gavriel Kohlberg
Published:
Specialties: Neurosurgery, Neurotology Otology, Otolaryngology
Schools:





You need to be a registered member to rate this post.

Authors:
Gavriel D. Kohlberg, MD - University of Cincinnati
Noga Lipschitz, MD - University of Cincinnati
Charlie Poff, BS - Medical University of South Carolina
Ravi N. Samy, MD, FACS - University of Cincinnati
Procedure
Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach
Indications
- Temporal bone trauma
- Iatrogenic facial nerve injury
- Tumor resection
- Recurrent Bell's palsy
Contraindications
- Inability to tolerate temporal craniotomy / middle cranial fossa approach
Instrumentation
Setup
- Patient positioned supine with head turned to the side
Preoperative Workup
- Computed Tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Electroneuronography (ENoG)
- Facial Electromyography (EMG)
Anatomy and Landmarks
Middle cranial fossa approach:
- A 4cm x 5 cm is created centered on the zygomatic root
- The temporal lobe is retracted to expose the middle cranial fossa floor
- The greater superficial petrosal nerve (GSPN) is identified
- The middle ear space is identified via unroofing of the middle ear space
- The tympanic segment of the facial nerve is identified and decompressed by following GSPN posteriorly
- The superior semicircular canal is identified
- The internal auditory canal is idenified
- The labyrinthine segment of the facial nerve is identified and decompressed of bone
- The internal auditory canal dura is opened and the facial nerve is evaluated proximally to the brainstem
Transmastoid:
- The sigmoid sinus is identified
- The posterior external auditory canal is identified
- The tegmen mastoidium is identified
- The digastric muscle is identified
- The lateral semicircular canal is identified
- The incus is identified
- The mastoid segment of the facial nerve is identified and decompressed
- The facial recess is identified and opened
- The stapes is identified
- The incudostapedial joint is identified and separated
- The tympanic segment of the facial nerve is identified and decompressed of bone
Advantages/Disadvantages
Advantages:
- The surgery allows for total decompression and evaluation of the facial nerve from the brainstem through the mastoid component of the nerve
- The surgery allows for hearing preservation (both conductive and sensorineural) by sparing the ossicular chain and the labyrinth (compared to the translabyrinthine approach for example)
Disadvantage:
- The surgery requires a temporal craniotomy and retraction of the temporal lobe (something that is not required in the translabyrinthine approach)
Complications/Risks
- Bleeding, pain, infection, cerebrospinal fluid leak, meningitis, facial nerve paralysis or weakness, deafness, dizziness, tinnitus, taste change
Disclosure of Conflicts
Dr. Ravi N. Samy, MD, FACS receives research support from Cochlear Corporation
Acknowledgements
References
Our Partners
Grace Medical – Bryan Medical – American Pediatric Surgical Association – American Association of Surgical Physician Assistants – American Pediatric Surgical Nurses Association – International Association of Student Surgical Societies – International Journal of Medical Students – InciSion – Global Surgery Student Alliance – National Surgery Association – Women in Surgical Education – Australasian Students’ Surgical Association – Surgeon Masters – Physicians for Peace – The Physician’s Edge – MultiLearning Group
Institutions using CSurgeries
Associations
American Pediatric Surgical Association American Association of Surgical Physician Assistants American Pediatric Surgical Nurses Association International Association of Student Surgical Societies Global Surgery Student Alliance National Surgery Association Australasian Students’ Surgical Association MultiLearning Group
Home Page Video Credit
Airman 1st Class Kirsten Brandes | Date Taken: 03/30/2017
Leave a Reply
Want to join the discussion?Feel free to contribute!