The posterior ligament of the incus (“white dot”): A reliable surgical landmark for the facial recess

2022 ◽  
Vol 43 (2) ◽  
pp. 103304
Author(s):  
Ryan A. McMillan ◽  
Ashley M. Nassiri ◽  
Luciano C. Leonel ◽  
Natalia C. Rezende ◽  
Maria Peris Celda ◽  
...  
Author(s):  
Bridget Copson ◽  
Sudanthi Wijewickrema ◽  
Xingjun Ma ◽  
Yun Zhou ◽  
Jean-Marc Gerard ◽  
...  

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Tom Williamson ◽  
Xinli Du ◽  
Brett Bell ◽  
Chris Coulson ◽  
Marco Caversaccio ◽  
...  

Robotic assistance in the context of lateral skull base surgery, particularly during cochlear implantation procedures, has been the subject of considerable research over the last decade. The use of robotics during these procedures has the potential to provide significant benefits to the patient by reducing invasiveness when gaining access to the cochlea, as well as reducing intracochlear trauma when performing a cochleostomy. Presented herein is preliminary work on the combination of two robotic systems for reducing invasiveness and trauma in cochlear implantation procedures. A robotic system for minimally invasive inner ear access was combined with a smart drilling tool for robust and safe cochleostomy; evaluation was completed on a single human cadaver specimen. Access to the middle ear was successfully achieved through the facial recess without damage to surrounding anatomical structures; cochleostomy was completed at the planned position with the endosteum remaining intact after drilling as confirmed by microscope evaluation.


1987 ◽  
Vol 96 (1_suppl) ◽  
pp. 111-113 ◽  
Author(s):  
B. Fraysse ◽  
M. J. Soulier ◽  
H. Urgell ◽  
P. Levy ◽  
F. Furia ◽  
...  

The authors present an overview of the technique and results in the rehabilitation of totally deaf adults by an extracochlear single-channel electrode. Eight patients were implanted with a follow-up of at least 6 months. Sound signal processing, the receiver, and the electrode are described. The access to the round window is through the facial recess. The internal coil is placed over the pectoral muscle. The rehabilitation program consists of training patients to recognize background sounds up to more discriminating exercises. The results are discussed.


2020 ◽  
Vol 10 (5) ◽  
pp. 648-656
Author(s):  
Jianwen Li ◽  
Songbo Li ◽  
Xianyin Liu ◽  
Fuxin Wei ◽  
Xiaoshuai Wang ◽  
...  

Background: Laminectomy and decompression is a common procedure for treating spine diseases. However, due to the lack of a posterior, bony braced structure, the dural sac and nerve roots can adhere to the surrounding tissues, and scar formation can occur in muscle and soft tissues. This can cause new compression post surgery, and failure of the operation. Objective: This study aimed to produce an individualized titanium alloy spine lamina using 3D printing technology, and to evaluate its effectiveness by implantation in human cadaveric spines. Methods: Six adult lumbar cadaver specimens were used, and computed tomography (CT) was used to obtain DICOM medical digital image standard data. The lumbar vertebrae structure was reconstructed by three-dimensional (3D) modeling software, and then simulated lumbar laminectomy was performed. Based on the characteristics of the original lamina, an artificial spine lamina was designed, including suture holes at the posterior ligament attachment point and a locking screw hole for fixation. A titanium alloy spine lamina was fabricated by 3D printing, and a guide plate to assist artificial lamina implantation was designed. Using the guide plated, L4 lumbar vertebrae segment laminectomy was performed on the 6 lumbar spine specimens, titanium alloy spine lamina were implanted and fixed with cortical bone trajectory screws. After implantation, CT was performed to record the length of the screw, the trajectory of the screw in the pedicle, and changes of bony spinal canal volume and anteroposterior diameter of the spinal canal. Results: The morphology of artificial spine lamina matched that of the original lamina. The artificial lamina was easy to implant, and matched the original lamina. The laminas were fixed by 12 cortical screws (diameter, 4.5 mm; median length, 34.67 ± 1.97 mm). CT scan indicated that all screws passed through the pedicle cortex by < 2 mm (2 screws penetrated the inner wall). The bony canal volume of the L4 vertebral pedicle was 311.23 ± 38.17 mm2 before operation and 356.17 ± 43.11 mm2 after operation, and there was statistical difference (P < 0.001). The anteroposterior diameter of spinal canal was 17.82 ± 2.03 mm before surgery and 20.67 ± 2.38 mm after surgery, and they were statistically different (P < 0.001). Conclusion: An individualized artificial titanium alloy spine lamina designed and produced with 3D printing technology can be used to reconstruct the structure of the posterior spine complex after lumbar laminectomy. The artificial lamina can increase the volume of the spinal canal and provide a posterior ligament reconstruction attachment point.


1998 ◽  
Vol 112 (10) ◽  
pp. 956-958 ◽  
Author(s):  
N. C. Molony ◽  
M. Salto-Tellez ◽  
W. E. Grant

AbstractA 39-year-old female with a two-year history of mild hearing loss and discomfort on air flight descent was found to have a pulsatile mass behind an intact tympanic membrane. A suspected diagnosis of glomus tympanicum was confirmed by computed tomography (CT) scan imaging. The lesion filled the mesotympanum and hypotympanum but the jugular bony plate was intact, confirming the tympanic site of the lesion. This very vascular tumour was exposed by a tympanomeatal flap and the KTP laser used to shrink and coagulate the tumour progressively with minimal haemorrhage and blood loss. Complete excision of the lesion was achieved without the need for bony removal, and with minimal blood loss. The use of the KTP laser to coagulate this vascular lesion allowed safe removal of the tumour and avoided the need for extended facial recess or hypotympanotomy surgery.


Author(s):  
Stewart D. McLachlin ◽  
Parham Rasoulinejad ◽  
Kevin R. Gurr ◽  
Stewart I. Bailey ◽  
Chris S. Bailey ◽  
...  

Unilateral facet injuries are relatively common in the sub-axial cervical spine. Facet fractures, capsular disruptions, and posterior ligament tears can all contribute to this type of injury resulting in a range of instability spanning undisplaced fractures to complete unilateral dislocations [1]. For a particular injury pattern, considerable variability exists in the choice of treatment, and the modality selected is frequently based on surgeon preference [2]. This is due, in part, to a lack of biomechanical studies focused on increasing the understanding of changes in spinal stability that occur following cervical spine injury.


Excluding the isomyarian family Dimyidae, the Pectinacea comprise the families Propeamussidae, Pectinidae, Spondylidae and Plicatulidae. Present investigations are primarily concerned with species of the last two, both of which are cemented by the right valve, with secondary teeth and sockets which form ball and socket joints between the valves. Neither has previously been examined in life or the hinge and ligament critically studied. Comparing throughout with conditions in the Pectinidae, the ctenidia in Plicatula are simpler (like those of Propeamussium ) but both here and in Spondylus the ciliary pattern (type B (1a)) is more primitive. Spondylus resembles the Pectinidae in that it has elaborate arborescent lips and pallial eyes; Plicatula (and Propeamussium ) has neither, and the inner mantle folds (velum) are reduced (though enlarged in Propeamussium ). The foot is lost in Plicatula and in Spondylus has solely to do with cleansing; the Pectinidae display a range of pedal form and function - from locomotion to byssal attachment and to cleansing. The ratio of ‘quick’ to ‘catch’ muscle in the adductor is associated with habit, being greatest where need for rapid adduction is greatest, primarily in connexion with cleansing, a matter of particular urgency in horizontally disposed bivalves. Pallial eyes - as well developed in permanently attached as in swimming species - are most probably concerned with immediate response to predatory attack on pallial tissues widely exposed when the valves gape. The ligament in both Spondylus and Plicatula is surprisingly different from that in the Pectinidae (and Propeamussidae). The long anterior and posterior outer ligament layers found in the two last which unite the valves at either end of the condensed rounded inner ligament layer are replaced in Spondylus by fused periostracum . The outer ligament layers have migrated inwards and, after dividing on either side of the unchanged inner ligament layer, unite (topographically) above and below it, forming morphologically left and right areas composed equally of anterior and posterior outer ligament layers. The inward extensions of the fused periostracal grooves which form the secondary extensions to the primary ligament may well be associated with the change in nature of the hinge plate (and thus of teeth and sockets) to crossed-lamellar aragonite instead of the foliated calcite present in the Pectinidae. The combined inner and outer ligament layers produce the more powerful ligament demanded by the more massive valves; the secondary periostracal extensions serve only to unite the valves which are maintained in alinement by way of the secondary teeth and sockets. The conspicuous bilateral asymmetry in the hinge and ligament is a result of cementation; similar conditions exist in the cemented pectinid, Hinnites . In Plicatula differences are much greater. Inward growth of the mantle margins results in union above the now submarginal ligament. This is extremely compressed in the transverse plane becoming hoop-like with the right limb the longer. Basally it fractures, although the two halves remain in contact and function is unaffected. As in Spondylus, the halves of the anterior and posterior ligament layers unite on the two sides of the inner ligament layer. Owing to dorsal overgrowth by the hinge plate, the epithelia secreting the outer ligament layers form the two sides and roof of a chamber the base of which is the mantle isthmus (forming the inner ligament layer). Contact with the valves is exclusively by way of the outer ligament layers. The periostracum fuses in the mid-line dorsally and does not contribute to the ligament from which it is separated. Owing to the division of the inner ligament layer into right and left halves, union of the valves is effectively by way of the secondary teeth, here more dorsally extended than in Spondylus but, as there, composed of crossed-lamellar aragonite. Evolution of these four families starts in Palaeozoic stocks with modifications of organs in the mantle cavity - ctenidia, lips, pallial eyes, etc. - proceeding along lines distinct from those involving modifications in the ligament. The former particularly concern the primitive Propeamussidae, largely confined to deep water, and the universally distributed Pectinidae, the latter the Spondylidae and the Plicatulidae. Modifications of the foot have to do with final habit which is invariable freedom in the Propeamussidae, byssal attachment, freedom or cementation in the Pectinidae, and invariable cementation in the Spondylidae and Plicatulidae, the process occurring earlier in the latter and involving loss of the foot. Separation of the Spondylidae from the Pectinidae is more fully established with the present demonstration of the totally different ligamental structure; the difference is so profound in the Plicatulidae as to raise the question of elevating this to superfamily status.


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