Microsurgery of the temporal bone

What is microsurgery of the temporal bone?

Microsurgery of the temporal bone is the intervention of the even bone that is part of the skull and is part of the lateral wall and base of the skull, besides constituting 2/3 of the middle cranial fossa and 1/3 of the posterior fossa. Officially it is a bone that has only three portions: squamous portion, mastoid portion and petrous portion. In order to give a better description, two portions are added: tympanic portion and styloid process (styloid portion), adding up to five portions.

The functions of the temporal bone are:

– To protect the encephalon and the auditory organs.

– To provide part of the articular surfaces for the temporomandibular joint.

– Part of the temporal region and the temporal fossa.

As the temporal bone contains several cavities and recesses related to the ear (such as the tympanic cavity and the Eustachian tube), it is a bone related to several ear pathologies, such as tinnitus or ringing in the ears (tinnitus), including dizziness and Mèniere’s Syndrome.

The temporal bone can be related to ear pathologies or traumatisms.

Why is it performed?

Microsurgery of the temporal bone may be due to ear pathology or trauma to the temporal bone. In fact, fractures are the most frequent injuries. If the fracture is not correctly visualized, some indirect signs can increase the suspicion: occupation of soft parts in mastoid cells or in the tympanic box and air in unusual places. The ossicles chain of the ear can be injured by dislocations or fractures, which will be studied with computed tomography.

Although trauma affecting the skull is the most common cause of temporal bone injuries, it can also be the result of direct impacts, foreign bodies or penetrating wounds. Usually when there is a temporal bone fracture there has been a high-energy trauma involved, so the association with other skull fractures is common.

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What does it consist of?

Temporal bone dissection is a complex surgery for otologists, neuro otologists and those specialists who perform ear/skull surgery. Adequate surgical skill and anatomical knowledge is essential in order to manage pathologies affecting the bone correctly. Thus, there are different surgical processes depending on what the problem to be addressed is. Some of them are:

  • Simple mastoidectomy: removal of the mastoid cells, i.e. the hollow, air-filled spaces in the skull behind the ear. In most cases it is a condition caused by an infection in the ear that spreads to the surrounding bone in the skull.
  • Posterior tympanotomy: opening of the facial recess by mastoidectomy to communicate the middle ear with the mastoid. It is the surgery of the posterior ear cavities. It allows direct access and treatment of pathological processes located in these cavities, but also allows access to other cavities, such as the epitympanum and the tympanic box.

Preparation for microsurgery of the temporal bone

Depending on the intervention to be performed, the specialist will request one preparation or another. It is necessary to perform a computerized tomography beforehand, to be able to study the depth and typology of the lesion. Once diagnosed, the ENT specialist will be the one to stipulate the preparation to be followed by the patient.

Care after the operation

Certain care will be necessary after the intervention. It should not be forgotten that the operated area is delicate, since it includes the skull and a series of bones that are also fragile, such as all those that form the auditory structures. It will be the ENT specialist who will recommend the best post-operative care in each case.

Alternatives to this treatment

Advances are continually being made in the search for minimally invasive techniques. The field of temporal bone surgery is no exception. It is an extremely delicate region, with many nerve endings and very sensitive structures, so minimal invasion will always be a good thing.