Temporal Bone Surgical Dissection Manual by Ralph A Nelson

By Ralph A Nelson

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With identification of the bar and the fallopian canal, the superior vestibular nerve may then be avulsed from its attachments in the ampulla area. When gently lifting the superior vestibular nerve, one should carefully look for the facial nerye as it exits the fallopian canal into the internal auditory canal. Vestibulofacial anastomoses that occur here should be carefullv sectioned. Directly inferior to the superior vestibular and facial nen'es. a bonlprominence protrudes into the fundus of the internal auditory canalThis shelf of bone.

Although some of the labyrinthine portion may be decompressedvia the mastoid, it is a tedious and difflcult dissection. In addition, the medial porus of the fallopian canal cannot be opened from this approach, and this is the narrowest part of the canal and the area most susceptible to constriction. J a- a" rb J ra f 15 T-T':Epanic s€gmcnt of tr-In L Buttress L Descending segment of MI tl a |l t ,: ! i rt j ! t f t I a , t a a ! ,ra Figure 23 External genu Horizontal semicircular canal F a - a!

Landmark: \ Facial nerve i . t! c-. j - Be certain to examine the nerve for circular fibrous bands that will constrict the nerve fibers. These bands must be lysed. j i The mastoid and middle ear portions of the facial nerve are now decompressed. Further decompression of the labyrinthine segment must be carried out through the middle fossa. Although some of the labyrinthine portion may be decompressedvia the mastoid, it is a tedious and difflcult dissection. In addition, the medial porus of the fallopian canal cannot be opened from this approach, and this is the narrowest part of the canal and the area most susceptible to constriction.

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