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Middle ear microvascularization: an “in vivo” endoscopic anatomical study

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To describe the in vivo vascularization of middle ear by an endoscopic point of view, particularly focusing on the medial wall of tympanic cavity and incudostapedial region (ISR).

Study design

Case series with surgical videos review and anatomical description.

Methods

48 videos from exclusive endoscopic middle ear surgery performed at the University Hospital of Modena from November 2015 to July 2017 were reviewed. Data about anatomy of vessels, and blood flow direction (BFD) were collected in an appropriate database for further analyses.

Results

48 cases were included in the present study. In 18/48 patients (37,5%), a clearly identifiable inferior tympanic artery (ITA) was present, running just anteriorly to the round window (RW), with a superior BFD (65% of cases) from the hypotympanic region toward the epitympanum. Some promontorial variants were described in 67% of cases and the most common finding was a mucosal vascular network with a multidirectional BFD. On the ISR, an incudostapedial artery (ISA) was detected in 65% of cases with BFD going from the long process of the incus (LPI) toward the pyramidal eminence in the majority of cases.

Conclusion

The vascular anatomy and BFD of the medial wall of the tympanic cavity can be easily studied in transcanal endoscopy. ITA (with a superior BFD in most cases) and ISA (with a main BFD from the incus to the stapes) are the most constant identifiable vessels.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy

    Matteo Alicandri-Ciufelli, Pierre Guarino, Filippo Fabbri, Elio Maria Cunsolo, Livio Presutti & Lukas Anschuetz

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Lukas Anschuetz

  3. Department of Neurosurgery, New Civil Hospital Sant’Agostino-Estense, Baggiovara, Modena, MO, Italy

    Matteo Alicandri-Ciufelli

Authors
  1. Matteo Alicandri-Ciufelli
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  2. Pierre Guarino
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  3. Filippo Fabbri
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  4. Elio Maria Cunsolo
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  5. Livio Presutti
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  6. Lukas Anschuetz
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Contributions

MAC: conception and design; data collection and statistical analysis; manuscript edition, revision and approval. FF: conception and design; data collection; manuscript revision and approval; PG, LA: conception and design; data interpretation supervision; manuscript revision and approval. LP, EMC: conception and design, senior supervision and critical revision of data analysis; manuscript revision and approval. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MAC and PG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Pierre Guarino.

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The authors declare that they have no conflict of interest nor financial relationship to disclose.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

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For this type of study, formal consent was not required from local IRB.

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Alicandri-Ciufelli, M., Guarino, P., Fabbri, F. et al. Middle ear microvascularization: an “in vivo” endoscopic anatomical study. Eur Arch Otorhinolaryngol 275, 889–894 (2018). https://doi.org/10.1007/s00405-018-4905-8

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  • DOI: https://doi.org/10.1007/s00405-018-4905-8

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