EXERCISE 3

PHOTO ATLAS OF ENDOSCOPIC ENDOMEATAL TEMPORAL BONE DISSECTION

EXPOSURE OF EUSTACHIAN TUBE MOUTH:
STEP A – Mouth of eustachian tube exposure, using 0 and
45 degree endoscopes placing infront of handle of malleus focussing anteriorly the followin structures are visualised from above downwards ie., supratubal recess, extension of STR, common ventilation pathway , tensor muscle canal, eustachian tube lumen and finally at floor ICA genu
STEP B – Pathway of common ventilation
Common ventilation pathway is noted including any deviation or obstruction to pathway
STEP C – Identification of
ponticulum. The position of ponticulum is noted and its relation to genu of ica observed
STEP D – Exposure of genu of ICA. gentle drilling of
ponticulumwith coarse diamond burr or using pizzo exposes starting point if genu of ICA and it is followed to bend

Surgical Implications:
Eustachian tube exposure through the endoscope is very important step and it is useful in tuboplasty and tubotomy procedures

Labelling:
1) Extension of supratubal recess into eustachian tube canal
2) Supratubal recess
3) Common ventilatory pathway
4) Tensor muscle canal
5) Eustachian tube canal
6) Genu of ICA
Pt.. ponticulum pTS …protympanic sinus