Abushara Temporal Bone Dissection Manual
Abushara Temporal Bone Dissection Manual
Abushara Temporal Bone Dissection Manual
Education: Publications:
■ M.D. Ear, Nose and Throat Surgery. 19 publications in national, regional and international
May 1992, Faculty of medicine, journals, 12 presentations, 8 posters and booklets.
Cairo University Kasr Al-Ainy Medical School
■ M.S. Ear, Nose and Throat Surgery.
May 1985 (very good degree), faculty of medicine, Awards and certificates of honor:
Cairo University Kasr Al-Ainy Medical School 1. From KMA on the occasion of obtaining the M.D.
■ M B & Bch Nov. 1981 (very good degree), faculty of degree.
medicine, Cairo University Kasr Al-Ainy Medical 2. From the Egyptian medical syndicate on the occasion
School of obtaining the M.D. degree.
3. The first prize of the 11th course in otology and oto-
neurosurgery, 5–7 Dec. 2000, hôpital Purpan,
Posts: Toulouse, France.
■ Senior Consultant at ENT department, Sabah and MTC 4. From the 3rd International Conference of the Gulf
hospitals, Ministry of Health (MOH), Kuwait Cooperation Council (GCC) Otorhinological, Head &
■ Lecturer of otorhinolaryngology, department of Neck Societies & Associations. March 98.
surgery, faculty of medicine, Kuwait university 1996, 5. From the Sudanese ENT association.
ongoing. (Mandated from MOH). 6. From the minister of health of Kuwait for editing the
■ X-Chairman of ENT medical council in Kuwait. operational policy of the ENT departments in Kuwait,
December 1999 – April 2006. May 2000.
■ X-Chairman of ENT department, Al-Sabah Hospital, 7. From the minister of health, Kuwait, for the 3rd edition
Kuwait, July 1999 – April 2006. of the operational policy of the ENT departments in
■ Resident at Cairo University Medical School, ENT Kuwait, Febr. 2002.
department, Kasr Al-Ainy Hospital, Egypt, 8. Support for research from the “Kuwait Foundation for
from 2nd March 1983 until 28 Feb. 1986. Advancement of Science” (KFAS).
■ House officer at Cairo university hospitals, Egypt, 9. From the faculty of surgery, Kuwait Institute for Medical
from 1st march 1982 – 28 Feb. 1983. Specialization (KIMS)
10. From the director of Sabah medical area.
DISSECTION MANUAL FOR THE
TEMPORAL BONE LABORATORY
KHAIRY ALHAG ABU SHARA, M.D.
Senior Consultant ENT, Head and Neck Surgeon
Sabah and MTC Hospitals, Kuwait
X-Chairman of ENT Medical Council – MOH 99-06
To my mother,
from whom I have learned how
sincere hard work can be
an endless source of enjoyment.
To my Family,
for their unlimited support
and understanding of the medical profession
as well as its obligations and commitments.
4 Dissection Manual for the Temporal Bone Laboratory
Acknowledgement
The growth of medico-legal problems related to surgical practices
necessitates greater emphasis on clinical training. Lab practice on
cadavers and various models is becoming increasingly popular for both
research and training.
The challenges of ear surgery are unique because the density of
anatomical structures in a relatively small space is unlike any other
organ in the human body. This consequently calls for extensive lab train-
ing before starting to operate in the theater—a step that should only be
taken once both the trainer and trainee are satisfied with the level of
skills achieved.
For those reasons, the establishment of a temporal bone lab within the
otology center is an inevitable option.
Considering the short time frame given during a temporal bone dissec-
tion course – in which the participants are concerned mainly with hands-
on training rather than going into further theoretical details – this manual
nevertheless provides practical and concise orientation to the topic. The
author’s aim was not to write a textbook, but to address the actual
needs in a temporal bone lab, which is why this manual should be sup-
ported by more detailed training instructions and further readings.
I hope, this booklet will be of great help to our junior candidates and to
the seniors who are planning to establish a temporal bone lab.
A special word of gratitude goes to KARL STORZ company for their kind
support and valuable assistance in the preparation of this booklet.
Khairy Alhag Abu Shara, M.D.
Senior Consultant ENT, Head and Neck Surgeon
Sabah and MTC Hospitals, Kuwait
Email: [email protected]
Phone: 00965 9784104
Dissection Manual for the Temporal Bone Laboratory 5
Foreword
Middle ear surgery involves procedures that are among the most chal-
lenging in the field of ORL, demanding a high degree of technical skill,
expertise and precision. To become a proficient otologist requires good
orientation skills and thorough knowledge of numerous anatomical
structures confined to a space amounting to less than one cubic inch.
Furthermore, the introduction of the surgical microscope, dental drill and
fine instruments requires the development of precise operative tech-
niques.
The introduction of high-resolution CT scanners, 1 mm cuts and MRI
enables surgeons to gain a more detailed knowledge of fine anatomical
structures, e.g., the thickness of the stapes foot plate in stapes surgery,
the facial nerve anatomy, and the possibility of any associated congenit-
al anomalies in cochlear implantation.
Full anatomical orientation regarding both normal and abnormal variants
is the first step to be taught in temporal bone labs. Otherwise avoidable
complications could occur.
It has been suggested by many authors that prior to performing in-vivo
surgery in an operating theater, a trainee surgeon should acquire good
knowledge of temporal bone anatomy and develop proper navigational
skills to such a degree comparable to the uncanny sense of direction
that allows us to find our way through our own bedroom in complete
darkness. It takes a long time to become an ear surgeon and even more
time to gain the required level of proficiency to successfully manage dif-
ficult and complicated cases. The temporal bone dissection lab pro-
vides an entry point, where candidates can devote their efforts to work-
ing toward this goal.
In this manual, information is given about the anatomy of the temporal
bone, the various surgical procedures, that can be practiced on cadaver
specimen in the lab (including photos, adressing procedures, and con-
cepts), imaging procedures, and a suggested temporal bone laboratory
setup.
6 Dissection Manual for the Temporal Bone Laboratory
Anatomical schematic drawings: Dissection Manual for the Temporal Bone Laboratory
Mr. Andreas Mücke Khairy Alhag Abu Shara, M.D.
Karl-Frank-Str. 32 Senior Consultant ENT, Head and Neck Surgeon
12587 Berlin, Germany Sabah and MTC Hospitals, Kuwait
X-Chairman of ENT Medical Council – MOH 99-06
Table of Contents
Acknowledgement ................................................................................................................... 4
Forword...................................................................................................................................... 5
Remember ......................................................................................................................... 42
8 Dissection Manual for the Temporal Bone Laboratory
1.0 Introduction
Squamous portion
Petrous portion
Mandibular fossa
Tympanic portion
Zygomatic process
Mastoid portion
Styloid portion
Fig. 1
Left temporal bone, lateral view with the squama sculptured as
an auricle. There are two temporal bones. Each is composed of
five parts: mastoid, petrous, squamous, tympanic plate and
styloid process.
Basiocciput
Sigmoid sinus
Jugular tubercle
Occipitomastoid suture
Occipital condyle
Squamous part of the
occipital bone
Fig. 2
Right temporal bone attached to the occipital bone. View of the
posterior cranial fossa. The internal auditory meatus (IAM),
jugular foramen and notch, sigmoid sinus, superior and inferior
petrosal sinuses, petrous apex, clivus, and hypoglossal canal
can be seen.
Dissection Manual for the Temporal Bone Laboratory 9
Foramen rotundum
Foramen ovale
Anterior clinoid process
Superior petrosal sulcus
Occipital condyle
Fig. 3
Right temporal bone attached to sphenoid and occipital bones.
View of the middle cranial fossa. The foramina (rotundum, ovale,
spinosum, and lacerum), the superior orbital fissure, internal
carotid artery, anterior clinoid process, clivus, petrous apex,
cavum trigeminale, greater wing of the sphenoid, petro-
sphenoid and petro-occipital suture lines are visible.
Tympanic plate
Squamo-sphenoid suture
Mastoid tip
Stylo-mastoid foramen
Foramen spinosum
Digastric fossa
Foramen ovale
Styloid process
Carotid canal
Jugular tubercle
Occipital condyle
Jugular bulb
Fig. 4
External view of the skull base. The jugular foramen, carotid
canal, greater wing of the sphenoid, the foramina (ovale,
spinosum, lacerum), zygomatic root, mandibular fossa, styloid
process, squamo-sphenoid suture, occipital condyle, digastric
fossa, stylo-mastoid foramen, and mastoid tip are visible.
10 Dissection Manual for the Temporal Bone Laboratory
Superior SCC
Cochlea
Common crus
Oval window
Fig. 5
Right inner ear. The three semicircular canals (SCC) are open,
the lateral, the posterior and the superior with crus commune
are visible. The cochlea and oval window are also exposed.
Superior SCC
Lateral SCC
Oval window
Facial nerve
Modulus
Remnant of promontory
Round window
Fig. 6
Left inner ear. The superior and lateral SCC, facial nerve,
oval and round windows, cochlea, modulus, and promontory.
Dissection Manual for the Temporal Bone Laboratory 11
Stapes head
Incudo-stapedial joint
Fig. 7
Anatomy of the left middle ear: The incudo-stapedial joint, the
stapes head and the crura, facial nerve, stapedial tendon,
promontory, and tympanomeatal flap are visible.
2 Incus
Short process
2 Body
1 Malleus
1 Lenticular process
Head
Neck Long process
Lateral process
Handle
3 Stapes
Posterior crus
Head
Neck
Anterior crus
3
Footplate
Fig. 8
The auditory ossicles.
1 The malleus, head, neck, lateral process, and handle.
2 The incus: body, short, long, and lenticular processes.
3 The stapes: head, neck, anterior and posterior crura,
and footplate.
12 Dissection Manual for the Temporal Bone Laboratory
Cochleariform process
Semi-canal of the
Facial nerve tensor tympani muscle
(transverse segment)
Middle ear Transverse part
of the carotid canal
Vertical part
of the carotid canal
Jugular bulb
Carotico-jugular foramen
Fig. 9
Right side dissection. Notice the jugular bulb, carotid canal,
both vertical and horizontal parts, carotico-jugular septum,
and foramen for the IX cranial nerve, cochlea, oval window,
facial nerve, cochleariform process, semi-canal of the tensor
tympani muscle, and lateral SCC.
Dissection Manual for the Temporal Bone Laboratory 13
The bones should be removed from the surgical position, as if in the operating theater.
refridgerator at least one hour before dissection. The zygomatic root is anterior, and the mastoid
First, determine whether the bone is right or left, tip is inferior (Fig. 10a)
and secure it with a temporal bone holder in a
Zygomatic root
Digastric notch
Fig. 10a
Left temporal bone with soft tissues.
Identify important landmarks related to different anatomic views of the temporal bone, for example:
• Zygomatic root • Petrous part of temporal bone and its apex
• Mastoid tip • Cavum trigeminale
• Digastric notch • Arcuate eminence
• External auditory meatus • Internal auditory meatus
• Squamous part of temporal bone • Cranial nerves VII, VIII, IX and X
(spaghetti-like structure)
14 Dissection Manual for the Temporal Bone Laboratory
Vertical and
transverse incisions
Transmeatal transverse and
T- shaped incision vertical skin incisions
Craniotomy flap
U- shaped incision
Obliteration flap
Fig. 10b
Different periosteal incisions and flaps.
Dural plate
Cells of the mastoid tip
Lateral SCC
Digastric ridge
Posterior tympanotomy
Fig. 10c
The art of drilling.
Squama
Zygomatic root
Mastoid
External auditory meatus
Tympanic plate
Carotid canal
Digastric notch
Petrous bone
Fig. 10d
Anatomy of macerated bones. Lateral surface.
Squama
Mastoid
Arcuate eminence
Petrous bone
Fig. 10e
Anatomy of macerated bones: Medial surface.
16 Dissection Manual for the Temporal Bone Laboratory
Fig. 10f
Left myringotomy and grommet insertion.
Stapes head
Incudo-stapedial joint
Promontory
Stapedial tendon
Fig. 11
Left anterior tympanotomy.
Dissection Manual for the Temporal Bone Laboratory 17
Tympanomeatal flap
Chorda tympani
Fig. 12a
Left anterior tympanotomy (schematic drawing).
Teflon piston
Promontory
Shaft
Fig. 12b
Left stapedectomy and teflon piston insertion.
4. Practice anterior tympanotomy: a tympano- Check the annulus, incudo-stapedial joint, stapes
meatal flap is created by removal of the suprastructures, stapedial tendon, pyramidal
posterior meatal wall and exploration of the process, facial nerve, chorda tympani, malleus
middle ear (Figs. 11, 12a). Practice stape- handle, tympanic membrane, promontory, and
dectomy and teflon piston insertion (Fig.12b) round window.
In-vitro fixation can be achieved by injecting
adhesive glue around the footplate or into
the labyrinth through a “decapitated” superior
SCC at the arcuate eminence.
18 Dissection Manual for the Temporal Bone Laboratory
Zygomatic root
Antrum
External auditory meatus
Squama
Posterior meatal wall
Lateral SCC Tip cells
Sinodural angle
Fig. 13
Right cortical mastoidectomy.
Facial nerve
Dural plate
Digastric ridge
Antrum
Sinus plate
Sinodural angle
Fig. 14
Right cortical mastoidectomy (schematic drawing).
5. Perform myringoplasty, in which a piece of serves as a landmark for localizing the mastoid
periosteum is harvested and used as a graft antrum. Drilling should be accompanied by con-
which is positioned with the underlay tech- tinuous irrigation and performed parallel to the
nique to repair a previously created tympanic anticipated border without leaving behind any
membrane perforation. overhangs. Never work blindly. The antrum, which
is the largest mastoid air cell, has the lateral SCC
6. Practice a cortical mastoidectomy (Figs. on its floor. Cells over the dural and sinus plates
13, 14). Identify the spine of Henle, then are drilled, the sinodural angle is identified, and
start with the largest cutting burr in the cells behind the sinus are cleared. Identify the
MacEwen’s triangle between the inferior digastric ridge and clear the peri-facial and deep
temporal line, tangent to the posterior meatal mastoid air cells. Keep the posterior bony
wall and the spine of Henle. This triangle meatal wall intact.
Dissection Manual for the Temporal Bone Laboratory 19
Incus body
Incudo-stapedial joint
Facial nerve
Fig. 15
Left posterior tympanotomy.
Incudo-stapedial joint
Promontory
Chorda tympani Round window
Fig. 16
Left posterior tympanotomy (schematic drawing).
7. Perform posterior tympanotomy (Figs. 15, 16) tympani, and facial nerve down to the middle
by initially gaining access to the middle ear ear. The incudostapedial joint, promontory and
from the mastoid cavity while ensuring that round window niche should be visible.
the tympanic membrane and annulus
remain intact. A cortical mastoidectomy is Note: You can fill the external auditory meatus
performed to deepen the sinodural angle with a colored fluid. This fluid should not leak
and thin the posterior meatal wall. The incus into the mastoid. If leakage occurs, it is an
body and its short process are identified. early alarm that the annulus, tympanic mem-
Drilling begins with the 2 mm-diamond burr brane or posterior meatal wall was injured.
between the incus short process, chorda
20 Dissection Manual for the Temporal Bone Laboratory
Perifacial cells
Antrum
Sigmoid sinus
Fig. 17
Right saccus decompression.
Sinus plate
Sinodural angle
Fig. 18
Right saccus decompression (schematic drawing).
8. Identify the endolymphatic sac (Figs. 17, 18). rior SCC. The bone inferior to this line is then
Both lateral and posterior SCCs are exposed thinned out and removed with a needle. The
but not opened. The peri-sinus cells are lateral wall of the sac is identified and incised
drilled, and an imaginary line is passed along using a sickle knife.
the lateral SCC, perpendicular to the poste-
Dissection Manual for the Temporal Bone Laboratory 21
Cortical
mastoid
Nose of the
implant
dummy in
the recess
created for
electrodes
Dummy
inserted
into the
implant site
Fig. 19
Cochlear implant bed.
Posterior
meatal wall
Second
cochleostomy
Window of
the posterior
tympanotomy
Cochleostomy
Fig. 20 Fig. 21
Right double cochleostomy. Electrode hugging the modulus of the right
cochlea (counter-clockwise).
9. A cochleostomy is performed (Fig. 20) after Note: This step needs to be performed under
preparation of the cochlear implant bed
(Fig. 19) and cortical mastoidectomy with supervision of a trainer.
posterior tympanotomy. An attempt can be
made under visual control with the cochlea
opened from posterior so the electrode is
constantly under direct vision during inser-
tion (Fig. 21).
22 Dissection Manual for the Temporal Bone Laboratory
Zygomatic root
Tip cells
Sinodural angle
Sinus plate
Fig. 22
Right radical mastoidectomy.
Stapes
Dural plate
Sinus plate
Fig. 23
Right radical mastoidectomy (schematic drawing).
10. Perform a radical mastoidectomy (Figs. 22, well as the anterior and posterior buttresses. The
23) by drilling through the posterior meatal anterior attic is also cleared. Identify the facial
bony wall down to a level just above a line nerve, semicanal of the tensor tympani muscle
from the lateral SCC to the digastric ridge, and the cochleariform process tendon. Try to com-
removing the bridge over the attic area, as plete an ossiculoplasty procedure.
Dissection Manual for the Temporal Bone Laboratory 23
Facial nerve
Superior SCC
Lateral SCC
Posterior SCC
Fig. 24
Left labyrinthectomy.
Stapes
Facial nerve
Superior semicircular canal
Lateral semicircular canal
Posterior semicircular canal
Dural plate
Sinus plate
Fig. 25
Left labyrinthectomy (schematical drawing).
11. Perform a labyrinthectomy (Fig. 24, 25) by mond burr to the vestibule. Preserve the anterior
first identifying the domes of the three SCC. part of the lateral SCC to avoid injury to the facial
Open the canals and follow with a small dia- nerve.
24 Dissection Manual for the Temporal Bone Laboratory
Pars flaccida
Malleus handle
Pars tensa
Fig. 26
Right tympanic membrane.
Semicanal of the
tensor tympani muscle
Tendon of the tensor
tympani muscle Long incus process
Malleus handle
Middle ear
Tympanic membrane
Incudo-stapedial joint
Umbo
Eustachian tube
Fig. 27
Oto-endoscopic view of the right middle ear through the
Eustachian tube.
Dissection Manual for the Temporal Bone Laboratory 25
Attic
Semicanal of the
tensor tympani muscle
Facial nerve
Mesotympanum Pyramid
Ponticulus promontorii
Subiculum promontorii
Promontory
Sinus tympani
Fig. 28
Left middle ear.
Fallopian canal
Bill’s bar
Superior vestibular area
Transverse crest
Cochlear area
Singular nerve
Fig. 29
Right internal auditory meatus.
26 Dissection Manual for the Temporal Bone Laboratory
Fallopian canal
Superior vestibular area
Bill’s bar
Transverse crest
Cochlear area
Inferior vestibular area
Singular nerve
Fig. 30
Left internal auditory meatus.
Spiral lamina
Modiolus
Cochlea (opened)
a b
Fig. 31a, b
a Right internal auditory meatus (de-roofed) and cochlea
opened with modiolous and spiral lamina visible.
b MRI insert image provides orientation about the position of
the cochlea in (a).
Dissection Manual for the Temporal Bone Laboratory 27
Facial nerve
Dural sleeve
Fig. 32
Endoscopic view of the right internal auditory meatus (IAM).
The vestibular, cochlear and facial nerves are contained within
the sheath of the dura mater.
28 Dissection Manual for the Temporal Bone Laboratory
Internal
Jugular bulb
auditory
and inferior
meatus
petrosal sinus
(IAM)
Duck bill Funnel
Horns Inverted L
Vestibular
Common crus
aqueduct
Slit
Spot
Sphenoid sinus
Foramen spinosum
Anterior cranial fossa
Great wing of the sphenoid
Squamo-sphenoid suture
Foramen ovale
Carotid artery (transverse)
Mandibular condyle
Sphenoid body
Carotid artery (vertical)
External auditory meatus
Inferior petrosal sinus
Jugular vein
Sinus plate
Fig. 33
Sphenoid sinus
Foramen ovale
Foramen spinosum
Mandibular condyle Carotid artery (transverse)
Petrous apex
External auditory meatus
Facial nerve Sphenoid body
Jugular vein
Mastoid cortex
Posterior cranial fossa
Sigmoid sinus
Fig. 34
30 Dissection Manual for the Temporal Bone Laboratory
Sphenoid sinus
Foramen spinosum
Great wing of the sphenoid
Sphenoid body
Middle ear
Carotid artery (transverse)
External auditory meatus
Eustachian tube
Fig. 35
Foramen ovale
Mandibular condyle
Carotid artery (transverse)
Tympanic membrane Sphenoid body
and malleus
Petrous apex
External auditory meatus
Cochlea
Facial nerve
Fig. 36
Notice the basal turn of the cochlea, middle ear and the
cochlear aqueduct.
Dissection Manual for the Temporal Bone Laboratory 31
Foramen rotundum
Fig. 37
Notice the cochlea, posterior SCC, sinus tympani, semi-canal
of the tensor tympani muscle, round window, facial nerve,
chorda tympani, tympanic membrane, and malleus handle.
Foramen rotundum
Sinus tympani
Posterior cranial fossa
Common crus
Fig. 38
32 Dissection Manual for the Temporal Bone Laboratory
Fig. 39
Notice the long incus process.
Fig. 40
Notice the stapes, vestibule, common crus, and facial nerve.
Dissection Manual for the Temporal Bone Laboratory 33
Mid-cranial fossa
Greater superficial
Malleus head petrosal nerve
Petrous apex
Incus body
Geniculate ganglion
Superior semicircular canal Internal auditory meatus
Fig. 41
Notice the “ice cream cone” (incus and malleus) ossicular
complex, vestibule, lateral SCC, facial nerve, IAM, and attic.
Mid-cranial fossa
Greater superficial
petrosal nerve
Superior semicircular canal
Petrous apex
Attic
Aditus ad antrum Internal auditory meatus
Antrum
Posterior semicircular canal Posterior cranial fossa
Fig. 42
Notice the posterior and superior semicircular canals.
34 Dissection Manual for the Temporal Bone Laboratory
Superior SCC
Fig. 43
Notice the superior SCC extending to the dome, which is
equivalent to the arcuate eminence at the mid-cranial fossa.
Dissection Manual for the Temporal Bone Laboratory 35
Superior SCC,
lateral SCC,
Scutum
basal turn of
cochlean
Three fingers Pyramid
Transverse
Malleus
crest IAM
Hammer
Labyrinth and
Vestibule and tympanic facial
round window nerve seg-
ments
Inverted tear drop Snail eyes
Eustachian
Cochlea
tube
Snail shell Inverted triangle
36 Dissection Manual for the Temporal Bone Laboratory
Fig. 44
Notice the cochlea, carotid artery, Eustachian tube, middle ear,
attic, digastric notch, tympanomastoid suture, and mandibular
condyle.
Fig. 45
Notice the attic, malleus head and neck, tendon of tensor tym-
pani muscle, tympanic membrane, middle and external ear,
Eustachian tube, petro-occipital suture, cochlea, mandibular
condyle, petrous apex, annulus, scutum, tegmen and cochleari-
form process.
Malleus Attic
Annulus
Mandibular condyle
Fig. 46
Notice the internal auditory meatus and transverse crest, attic,
malleus, scutum, tegmen, mastoid air cells, external auditory
meatus, tympanic membrane, mandibular condyle, annulus,
petro-occipital suture, petrous apex and middle ear.
Dissection Manual for the Temporal Bone Laboratory 37
Arcuate eminence
Lateral semicircular canal
Superior semicircular canal
Tegmen tympani Vestibule
Mastoid air cells Internal auditory meatus
Body of incus Stapes footplate
Scutum Petrous apex
External ear Petro-occipital fissure
Basal turn of the cochlea
Tympanic membrane
Middle ear
Incudo-stapedial joint
Fig. 47
Notice the internal auditory meatus, basal turn of the cochlea,
superior (arcuate eminence) and lateral SCC, tympanic mem-
brane, incus, stapes footplate, tegmen tympani, lateral semicir-
cular canal, mastoid air cells, body of incus, scutum, external
ear, incudo-stapedial joint, vestibule, petrous apex, petro-
occipital fissure and middle ear.
Tegmen tympani
Middle ear
Mastoid air cells
Antrum Vestibule
Petrous apex
Tympanic membrane
Fig. 48
Notice the vestibule, round window, petromastoid suture,
hypoglossal canal, and jugular bulb.
Jugular vein
Fig. 49
Notice the jugular bulb, hypoglossal canal, mastoid cells, and
SCC.
38 Dissection Manual for the Temporal Bone Laboratory
Tegmen tympani
Superior semicircular canal
Jugular vein
Hypoglossal canal
Mastoid tip
Fig. 50
Notice the posterior SCC, mastoid air cells, jugular bulb,
tegmen tympani, mastoid tip, lateral and superior SSCs and
hypoglossal canal.
Dissection Manual for the Temporal Bone Laboratory 39
Cochleostomy
Eustachian tube
Superior SCC
Solid angle
Posterior SCC
Digastric ridge
Fig. 51
Body of incus
Posterior tympanotomy
Fig. 52
40 Dissection Manual for the Temporal Bone Laboratory
Tympanic plate
Incus Annulus
Posterior SCC
Fig. 53
Chorda tympani
Semicanal of tensor tympani
Tympanic membrane
Cochleariform process
Tendon of the tensor
tympani muscle Facial nerve
Malleus handle Incudostapedial joint
Superior SCC
Head of malleus
Lateral SCC
Body of incus
Fig. 54
Malleus
Anterior wall of external
auditory meatus
Incus
Malleus handle
Attic
Tympanic membrane
Lateral SCC
Incudostapedial joint
Pyramidal process
Promontory
Fig. 55
Dissection Manual for the Temporal Bone Laboratory 41
Fig. 56
Oval window
Sinus plate
Fig. 57
42 Dissection Manual for the Temporal Bone Laboratory
Remember
☞ When is the right time to begin with ☞ When back to the operating room,
training in the operating room? never forget
● When both the trainer and trainee are ● Morbid anatomy.
equally satisfied about the outcome. ● Congenital anomalies.
● When the trainee is able to identify ear ● Continuous polishing of your skills.
structures as if within one’s own bedroom
in the dark.
● After watching various live surgeries.
Please note: The temporal bone dissection laboratory should be located away from all clinical and surgical activities with sanitary
arrangements managed by the infection control officer of the hospital. The number of stations is subject to the number of participants.
The main station should be equipped with a video camera and monitor for demonstration purposes. The lab should be equipped with a
large double level refrigerator for storage of the temporal bone specimens.
224001 225205
223803
208015
123207 HOLMGREEN Endaural Ear Speculum, 208015 Blades, Fig. 15, non-sterile, package of 100
self-retaining, outer diameter 7 mm 223803 Seeker, with ball end, angled 45°, size 3,
212803 LEMPERT Elevator, width 3 mm, length 15.5 cm
length 19 cm 224001 HOUSE Curette, large,
213008 PLESTER Elevator, width 8 mm, spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm,
length 18 cm length 15 cm
208000 Surgical Handle, Fig. 3, length 12.5 cm, 225205 Pick, 90º, length 16 cm, 0.5 mm
for Blades 208010 – 19, 208210 – 19
46 Dissection Manual for the Temporal Bone Laboratory
8c
m
161000
223500
152301
161000
11 c
m
9 cm
203710 203730
UNIDRIVE® ENT
The high-end multifunction system for excellent
handling and convenience in the OR
UNIDRIVE® ENT
Saves time
• 2 motors can be connected simultaneously
왘 no plugging or unplugging during the operation
• Automatic display of error messages
왘 no time-consuming error tracing in the operating room
• Exact reading and adjustment of motor speed
• Preselected parameters can be stored
왘 set-point values for motor speed and flow rate do not need to be readjusted with each new procedure
• Quick and easy connection of the tubing set to the pump
Relieves OR personnel
• The time for preparation prior to surgery is considerably reduced by standardization
• Irrigation flow rate and motor speed adjustable via footswitch
• Easy to use due to clearly structured design and optimized function selection
• Personnel can use the time saved for other tasks
• User can control multiple functions from the sterile area via footswitch
Saves money
• Only one unit required to perform six functions
• Most of the available shaver blades, burrs and drills are reuseable
왘 enables perfect hygienic reprocessing
• EC micro motor is compatible with various INTRA drill handpieces
Dissection Manual for the Temporal Bone Laboratory 49
UNIDRIVE® ENT
Technical specifications:
Shaver mode
Operation mode: oscillating
Max. rev. (rpm): in conjunction with Micro Shaver Handpiece 40 7110 35 3,000*
in conjunction with Paranasal Sinus Shaver Handpiece 40 7110 39 7,000*
in conjunction with DrillCut-X Shaver Handpiece 40 7110 40 7,000*
Drilling mode
Operation mode: counter-clockwise or clockwise
Max. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 40,000
and Connecting Cable 20 7110 72
Dermatome mode
Max. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 8,000
and Connecting Cable 20 7110 72
* Approx. 3000 rpm is recommended as this is the most efficient suction/performance ratio.
Weight: 6.1 kg
Selectable
display English, French, German, Spanish,
languages: Italian, Portuguese, Greek, Turkish
50 Dissection Manual for the Temporal Bone Laboratory
UNIDRIVE® ENT
20 7116 20-1
System Components
20 0126 30 20 7116 40
UNIDRIVE® ENT
U N I T S I D E
PAT I E N T S I D E
20 7110 32 40 7110 39
20 7110 72 40 7110 40 20 7110 70 40 7110 35
Dermatome
253000 - 253300
52 Dissection Manual for the Temporal Bone Laboratory
Burrs
Straight Shaft Burrs, length 7 cm
7 cm
Standard Diamond
Transverse
Dia. Tungsten Diamond,
Detail Size for single Tungsten for single
mm Carbide coarse
use, sterile, sterilizable Carbide use, sterile, sterilizable
set of 5 set of 5
006 0.6 – 260006 261006 – – 262006 –
260000 Standard Straight Shaft Burr, stainless, 262000 Diamond Straight Shaft Burr, stainless,
sizes 006 – 070, length 7 cm, set of 15 sizes 006 – 070, length 7 cm, set of 15
Dissection Manual for the Temporal Bone Laboratory 53
TELECAM® SL II n
Camera Heads
TELECAM® SL II
Camera Control Unit
Video Output Input Control Output Control Unit (CCU) Power Supply Certified to:
- Composite signal at Keyboard input for title 3.5 mm stereo jack plug - Dimensions: 100-240 VAC, 50/60 Hz IEC 601-1, 601-2-18,
BNC socket generator and camera (ACC 1, ACC 2) 305 x 88 x 254 mm CSA 22.2 No. 601,
- S-Video signal to 4 pin functions to 5 pin DIN (w x h x d) UL 2601, and CE accor-
Mini DIN socket (2x) socket - Weight: ding to MDD, protection
- DV signal 2.7 kg class 1/BF
to 6 pin DV socket
54 Dissection Manual for the Temporal Bone Laboratory
Camera Heads for quick coupling of Endovision® Camera Heads for use with TV Adaptor 301677:
camera with C-MOUNT Adaptor 2010 Z: Direct C-MOUNT Adaptation
Indirect C-MOUNT Adaptation
20 2120 30 20 2120 34
20 2121 30 20 2121 34
20 2200 40
C-MOUNT
Microscope Adaptor
301513
2010 Z
301677
2010 Z C-MOUNT Adaptor, allows quick 301677 TV-Adaptor, for ZEISS operating microscope
coupling of Endovision® camera e. g. or colposcope, f = 85 mm, for use with
with operating microscopes (the Optical Beamsplitter 301513 and C-MOUNT
camera’s coupling device is mounted Adaptor 2010 Z or TELECAM® C-MOUNT
on the 2010 Z adaptor which fits to an One-Chip Camera Head
operating microscope’s C-MOUNT ring) 20 2120 34/20 2121 34
301513 Optical Beamsplitter 50/50, 20 2200 40 C-Mount Microscope Adaptor for use with
for use with ZEISS operating micro- KARL STORZ Endovision TRICAM® C Camera
scope or colposcope Head 20 2210 34/20 2211 34
56 Dissection Manual for the Temporal Bone Laboratory
KARL STORZ AIDA™ compact II combines all the required functions for integrated and precise
documentation of endoscopic procedures and open surgeries in a single system.
Data Acquisition
AIDA compact II records still images, video sequences and spoken
comments of findings and intraoperative procedures directly from the
sterile area. Recordings are activated via touch screen, voice control,
footswitch or camera head buttons.
Live display of camera images on the touch screen enables immediate
monitoring and selection of the recorded data.
AIDA compact II:
Voice control
Flexible Review
Before final archiving, the saved data can be viewed or listened to on
the review screen. Data no longer required can be simply deleted.
Individual images, video and audio sequences can be renamed and
given more meaningful names. A pre-defined selection list with key-
AIDA compact II:
words simplifies and speeds up data entry. Furthermore, a comment
Review screen
field is available for entering relevant details of an intervention.
A voice entry of the case report can yet be recorded while viewing
video and image files.
Special Features:
● Digital storage of still images, video sequences and audio files
● Sterile, ergonomic operation via touch screen, voice control, camera head buttons
and/or footswitch
● Efficient archiving on DVD, CD-ROM or USB stick, multisession and multipatient
● Computers and monitors for use in the OR area certified according to EN 60601-1
● Compatible with KARL STORZ Communication Bus (SCB) and OR1™ connect series
Specifications:
Video Systems Signal Inputs Image Formats Video Formats Audio Formats Storage Media
KARL STORZ TM
DVD-M with SmartscreenTM
Advanced Image and Data Archieving System
Special Features:
● Digital storage of still images, ● SDI, S-video (Y/C) and composite
video sequences and audio files video inputs
● Digital alternative to video printers, ● Network storage is possible
video recorders and dictaphone ● All video signals are through-patchable to
● Easy and intuitive handling via touch screen, the video monitor
camera head buttons or footswitch ● Print-out of still images via ink jet printer
● Compact design possible
● Efficient archiving on DVD-R, DVD+R, ● Compatible with KARL STORZ Communication
CD-R, USB Stick, multisession and Bus (SCB) and OR1™ connect series
multipatient
Notes: