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

AbstractObjectiveTo ascertain in what proportion the vertical segment of the intratemporal carotid artery on its medial aspect anatomically separates the peri-tubal cells and Eustachian tube from the remainder of the pneumatised spaces of the temporal bone.MethodA retrospective review was conducted of 222 adult and 29 paediatric consecutive computed tomography scans of petrous temporal bones from a single tertiary referral centre.ResultsIn 96 per cent of temporal bones, the carotid artery formed a lateral barrier (with no communication pathway medially) between air spaces anterior and posterior to it. This equated to 94 per cent when chronic otitis media cases were excluded.ConclusionThe degree of separation of middle-ear air cells from the Eustachian tube or nasopharynx, and the relevant anatomy, are reviewed. This knowledge helps to optimise the outcome of subtotal petrosectomy and blind sac closure. The frequency and process of pneumatisation of the petrous apex, and its connections with the middle ear, have been radiologically confirmed.

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Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation

Otolaryngology ◽

10.1177/0194599821994817 ◽

2021 ◽

pp. 019459982199481

Author(s):

Isabelle Magro ◽

David Pastel ◽

Jace Hilton ◽

Mia Miller ◽

James Saunders ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Eustachian Tube ◽

Internal Carotid ◽

Tertiary Care ◽

Balloon Dilation ◽

Care Hospital ◽

Developmental Anatomy ◽

Nasal Floor

Objective To describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography. Study Design Case series with chart review. Setting A tertiary care hospital. Methods ET anatomy was assessed with reformatted high-resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor. Results The distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4-year-olds (2.4 ± 0.6 mm) and the 5- to 7-year-olds (2.0 ± 0.3 mm, P = .001). The ET length increased among the <4-year-olds (32 mm), 5- to 7-year-olds (36 mm), and 8- to 18-year-olds (41 mm, P < .0001). The cartilaginous ET increased among the <4-year-olds (20 mm), 5- to 7-year-olds (25 mm), and 8- to 18-year-olds (28 mm, P < .0001). The ET horizontal angle increased among the <4-year-olds (17°), 5- to 7-year-olds (21°), and 8- to 18-year-olds (23°, P≤ .003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4-year-olds (4 mm), 5- to 7-year-olds (7 mm), and 8- to 18-year-olds (11 mm, P < .0001). Conclusion The ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.

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Complete or Partial Eustachian Tube Resection during Endoscopic Nasopharyngectomy: Importance of Anatomic Variance of the Carotid Artery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1600747 ◽

2017 ◽

Vol 78 (S 01) ◽

pp. S1-S156

Author(s):

Guanglong Huang ◽

Deema Mutawa ◽

Arnau Benet ◽

Ivan El-Sayed

Keyword(s):

Carotid Artery ◽

Eustachian Tube

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A case of multiple abnormalities with eustachian tube obstruction by a protruded internal carotid artery

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2010.12.011 ◽

2011 ◽

Vol 75 (3) ◽

pp. 441-443 ◽

Cited By ~ 1

Author(s):

Akihiro Shinnabe ◽

Mariko Hara ◽

Shingo Matsuzawa ◽

Masayo Hasegawa ◽

Kozue Kodama ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Eustachian Tube ◽

Internal Carotid ◽

Tube Obstruction ◽

Multiple Abnormalities

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Eustachian tube and internal carotid artery in skull base surgery: An anatomical study

The Laryngoscope ◽

10.1002/lary.24808 ◽

2014 ◽

Vol 124 (12) ◽

pp. 2655-2664 ◽

Cited By ~ 28

Author(s):

Jianfeng Liu ◽

Carlos D. Pinheiro-Neto ◽

Juan C. Fernandez-Miranda ◽

Carl H. Snyderman ◽

Paul A. Gardner ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Eustachian Tube ◽

Internal Carotid ◽

Skull Base Surgery ◽

Anatomical Study

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Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report

Journal of International Medical Research ◽

10.1177/0300060520963005 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096300

Author(s):

Jianfeng Li ◽

Xiaohong Chen ◽

Jing Zhou

Keyword(s):

Malignant Melanoma ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Digital Subtraction Angiography ◽

Eustachian Tube ◽

Internal Carotid ◽

Shock Treatment ◽

Comprehensive Treatment ◽

Digital Subtraction ◽

Mucosal Malignant Melanoma

Mucosal melanoma of the eustachian tube is a rare and highly malignant tumour. Local radical resection combined with radiotherapy and systemic chemotherapy is a classic treatment strategy for this tumour. The internal carotid artery (ICA) is easily damaged when this tumour is removed. Once the ICA ruptures and causes haemorrhage, it can be fatal. We report a case of mucosal malignant melanoma of the eustachian tube with ICA rupture and haemorrhage in a 62-year-old woman 3 days after resection of the tumour. After successful emergency endotracheal intubation, anti-shock treatment was performed. Further, the ICA was examined using digital subtraction angiography under general anaesthesia and the bleeding site was embolized. The patient recovered uneventfully after surgery and was discharged from hospital without hemiplegia, aphasia, or other intracranial complications. Because of economic reasons, the patient discontinued comprehensive treatment after being discharged from the hospital. Finally, she developed bone and kidney metastases 8 months after surgery and died of distant metastases 1.5 years later. When removing eustachian tube lesions, the ICA must be particularly protected. Once the ICA ruptures and there is postoperative haemorrhage, prevention of airway asphyxia, timely anti-shock treatment, and emergency digital subtraction angiography and vascular embolization are effective treatment methods.

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