The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach

Abstract

Objective Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals. Design Comparative human temporal bone study. Setting Otopathology laboratory. Participants We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma, and then compared those 2 groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease. Main outcome measures We analyzed the middle ear, carotid artery canal, and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy. Results We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease. Conclusion The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery. Level of Evidence N/A.

Impact of occlusive material and cochlea‐carotid artery relation on eustachian tube occlusion in subtotal petrosectomy

“…Pauna and colleagues found on serial histological sections an increased incidence of carotid canal dehiscence in temporal bones of deceased donors with chronic otitis media compared to a control group. 22 The dehiscence, which was frequently closer to the promontory, was larger in size and the bony wall (when present) was thinner compared to findings in non-diseased ears. On the other hand, in cases with active chronic otitis media the mucosa is usually scarred, hyperplastic and vulnerable with good blood supply so that its removal is performed under a suboptimal operative view.…”

“…Pauna and colleagues found on serial histological sections an increased incidence of carotid canal dehiscence in temporal bones of deceased donors with chronic otitis media compared to a control group 22 . The dehiscence, which was frequently closer to the promontory, was larger in size and the bony wall (when present) was thinner compared to findings in non‐diseased ears.…”

Eight Items to Check on a Temporal Bone CT-Scan

“…The estimate of proper ventilation of the middle ear and mastoid is important to verify the aeration at the time of the CT-scan. Among patients with chronic middle ear disease, the rate of dehiscence of the intern carotid artery and of the Fallopian canal increases significantly [3]. In this scenario, the prevalence of dehiscence of the latter ranges from 25 to 57% [4].…”

Unilateral Pulsatile Tinnitus Associated with an Internal Carotid Artery–Eustachian Tube Dehiscence

“…An earlier histologic temporal bone study showed that in normal temporal bones without cholesteatoma or chronic otitis media, most ICA dehiscences occur at the level of the middle ear (57.14%) and less often at the level of the ET (42.85%). 5 Other ICA dehiscences, such as an ICA-cochlear dehiscence 4 or a dehiscence of the ICA in the middle ear associated with pulsatile tinnitus, 2 have been reported and should be taken in account in the differential diagnosis.…”