Location of the stapedius muscle with reference to the facial nerve in patients with unilateral congenital aural atresia: implication for active middle ear implants surgery

Ikeda, Ryoukichi; Hidaka, Hiroshi; Murata, Takaki; Kawase, Tetsuaki; Katori, Yukio; Kobayashi, Toshimitsu

doi:10.1080/00016489.2020.1725113

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…The retrofacial approach sometimes is used in the otological surgery for CI implantations in cases of malformations (16,17), for cases of poor visibility of the round window (18), for cholesteatoma removal from the sinus tympani (19,20) and middle ear implant surgeries (21,22) but none of the reviewed work aimed to create a direct access to the SM.…”

Section: Discussionmentioning

confidence: 99%

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Arnold

Schneider

Volk

et al. 2021

Otology &Amp; Neurotology

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Hypothesis: Despite the complete embodiment of the stapedius muscle (SM) into the pyramidal eminence, it is possible to safely gain access to the SM belly via a retrofacial approach. This presents a novel approach to directly measure the electrically evoked stapedius reflex threshold (eSRT). Background: Objective fitting of maximum comfortable loudness levels for cochlear implant users can improve the benefit introduced by the device. Sensing SM activity via direct surgical access represents a potential tool for objective eSRT fitting. Methods: Eighteen human temporal bones (TBs) were used. Micro-computed tomography was performed for six TBs. Standard computed tomography for six TBs. Manual 3Dsegmentation of the relevant middle and inner ear anatomy was performed on 12 TBs. Mastoidectomy and posterior tympanotomy allowed the access to middle ear of all 18 the TBs. Once identified the mastoidal segment of the facial nerve (FN), the retrofacial access to the SM was drilled.Results: The total access rate was 72.2%. Only in the first three cases the posterior semi-circular canal was hit. The SM access was identified posterior to the FN at a 4 AE 0.78 mm distance from the stapes' head, almost halfway to the chorda tympani's branching point along the FN direction. The drilling depth to access the SM posterior to the external surface of FN on average was 2 AE 0.30 mm. The exposure took on average of 5 to 8 minutes. Conclusions: The retrofacial approach seems to offer a feasible and reproducible access to the SM belly opening an avenue to electromyographic sensing of eSRT.

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Section: Discussionmentioning

confidence: 99%

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Arnold

Schneider

Volk

et al. 2021

Otology &Amp; Neurotology

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“…If a sinus is present in the cavum conchae, the removal of the sinus exposes cartilage, which requires either a concomitant resection or reconstruction with a skin flap. Clinical doctors should be aware of the anatomical variations in facial nerve course to avoid an injury [ 16 , 17 ]. In our case, the defect was not reconstructed but sutured.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Congenital Preauricular Fistula of the Cavum Conchae

Koizumi¹,

Yoshida²,

Ishigaki³

et al. 2023

Cureus

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A 16-year-old female who had left auricular sinus infections was admitted to our hospital. On physical examination, bilateral sinus tract openings were noted at the cavum conchae. We used a surgical microscope to complete the total resection of the bilateral sinus at the cavum conchae. Also dissected was the cartilage from the cavum conchae. To our knowledge, surgical excision of cavum conchae sinuses has not been previously described.

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“…Especially, the rate of transient postoperative facial palsy was in the expected range and no permanent facial palsy occurred. The retrofacial approach is a well-known technique performed in otologic surgery for cholesteatoma removal from the sinus tympani [ 22 , 23 ], for CI implantation on malformed anatomies [ 24 , 25 ] and in cases of poor visibility of round windows [ 26 ] and for middle ear implant surgeries [ 27 , 28 ]. Still, to our knowledge, there is no literature discussing its use for accessing the SM.…”

Section: Discussionmentioning

confidence: 99%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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Human stapedius muscle (SM) can be directly and safely accessed via retrofacial approach, opening new approaches to directly measure the electrically evoked stapedius reflex threshold (eSRT). The measurement of the SM activity via direct surgical access represents a potential tool for objective eSRT fitting of cochlear implants (CI), increasing the benefit experienced by the CI users and leading to new perspectives in the development of smart implantable neurostimulators. 3D middle-ear reconstructions created after manual segmentation and related SM accessibility metrics were evaluated before the CI surgery for 16 candidates with assessed stapedius reflex. Retrofacial approach to access the SM was performed after facial recess exposure. In cases of poor exposition of SM, the access was performed anteriorly to the FN via drilling of the pyramidal eminence (PE). The total access rate of the SM via both the retrofacial and anterior approach of the FN was 100%. In 81.2% of cases (13/16), the retrofacial approach allowed to access the SM on previously categorized well exposed (8/8), partially exposed (4/5), and wholly concealed (1/3) SM with respect to FN. Following intraoperative evaluation in the remaining 18.8% (3/16), the SM was accessed anteriorly via drilling of the PE. Exposure of SM with respect to the FN and the sigmoid sinus’s prominence was a predictor for the suitable surgical approach. The retrofacial approach offers feasible and reproducible access to the SM belly, opening direct access to electromyographic sensing of the eSRT. Surgical planner tools can quantitatively assist pre-surgical assessment.

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Location of the stapedius muscle with reference to the facial nerve in patients with unilateral congenital aural atresia: implication for active middle ear implants surgery

Cited by 4 publications

References 17 publications

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Bilateral Congenital Preauricular Fistula of the Cavum Conchae

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

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