By John S. Oghalai, Colin L. W. Driscoll
Long awaited, this tremendous surgical atlas covers all elements of neuro-otology and lateral cranium base strategies in comprehensively intimately. The lavishly illustrated step by step consultant is written by way of American specialists to make sure continuity among themes. The textual content is extremely based with step by step clarification of every surgery and tips and strategies sections in addition to a PEARLS part in each one bankruptcy. greater than two hundred fantastic art illustrations describe every one surgery with approximately six hundred extra intraoperative photographs with CT and MRI pictures to educate particular case examples. this gives an entire academic adventure for the cranium base health care provider in education and a radical reference for the skilled surgeon.
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Additional resources for Atlas of Neurotologic and Lateral Skull Base Surgery
A bicoronal incision was used for this approach. For personal reasons, this patient requested a complete shave of the head rather than a strip as we more commonly do at this time. 68. The temporalis muscle (T) was left down, but the periosteum was elevated off the zygoma (Z) and the frontal bone (F) in order to preserve the temporal branch of the facial nerve. Note that the lateral periorbita (P) has been violated, exposing the orbital fat. Ideally, the periorbita would have been left intact as this procedure does not include intraorbital dissection.
The periorbita is released along the lateral and superior orbit, with care taken to preserve the supraorbital nerve (arrow). The dotted lines show where the cuts should be made to remove the zygoma. We like to use the reciprocating saw because its kerf is thin, preserving as much bone as possible. The strategy of creating a V at the anterior segment is helpful when plating the zygoma back at the end of the procedure because it helps to align the bone properly. Alternatively, prior to making the cuts, the plates can be bent, the holes drilled, and the screws put in and taken out again.
After removing the bone flap, malleable retractors are used to carefully elevate the contents of the anterior cranial fossa and retract the temporal horn. All dissection is done in an extradural fashion if the pathology allows. The gasserian ganglion, cranial nerve V3 (entering the foramen ovale), and cranial nerve V2 (entering the foramen rotundum) are easily visible after this process. Bleeding from around them comes from the cavernous sinus and can be controlled with gentle packing and pressure.