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Suprameatal–transzygomatic root endoscopic approach to the geniculate ganglion: an anatomical and radiological study

  • Otology
  • Published:
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Abstract

Purpose

To describe the suprameatal–transzygomatic root endoscopic approach (STEA) to the geniculate ganglion (GG), the labyrinthine facial nerve (FN) and epitympanum.

Methods

The feasibility and limits of the STEA, maintaining the integrity of the ossicular chain, were analysed. Ten human cadaveric ears were dissected. Step-by-step description of the technique and relevant measurements were taken during the approach. The visualization and surgical working field on the anterior and posterior medial epitympanum, GG, greater superficial petrosal nerve, the labyrinthine FN and suprageniculate area were evaluated. The range of motion through the approach and the rate of the decompression of the GG and the labyrinthine portion of the FN were assessed as well. CT-scan measurements were compared with those obtained during the dissection.

Results

A complete exploration of the epitympanum was possible in every specimen. Decompression of the GG and first portion of the FN was achieved without any trauma to the ossicular chain in nine ears. The endoscope movements were mainly limited by the distance between bony buttress–short process of the incus–tegmen. The working space, during GG and labyrinthine FN decompression, was limited by the distance between malleus head–medial epitympanic wall and malleus head–GG. Radiologic measurements were consistent with those obtained during the dissections.

Conclusion

The STEA is a promising minimally invasive approach for decompression of the GG and FN’s labyrinthine portion. The applications of this corridor include the exploration and surgery of the medial epitympanum, preserving the ossicular chain.

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Authors and Affiliations

  1. Otolaryngology Head and Neck Surgery Department, University of Bologna, IRCCS Policlinico Sant’Orsola - Malpighi, Via Massarenti 9, 40138, Bologna, Italy

    Ignacio Javier Fernandez & Matteo Fermi

  2. Department of Biomedical and Neuro-Motor Sciences (DIBINEM), Institute of Human Anatomy, University of Bologna, Bologna, Italy

    Lucia Manzoli

  3. Otolaryngology Head and Neck Surgery Department, University of Bologna, Bologna, Italy

    Livio Presutti

Authors
  1. Ignacio Javier Fernandez
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  2. Matteo Fermi
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  3. Lucia Manzoli
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  4. Livio Presutti
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Contributions

IJF: conception and design of the study, collection of data, conducted analysis of results and drafted the manuscript; MF: collection of data, interpretation of results, drafted the manuscript; LM: collection of data, critical review of the final version; LP: interpretation of results, critical review of the final version. All the authors approved the manuscript.

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Correspondence to Ignacio Javier Fernandez.

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Fernandez, I.J., Fermi, M., Manzoli, L. et al. Suprameatal–transzygomatic root endoscopic approach to the geniculate ganglion: an anatomical and radiological study . Eur Arch Otorhinolaryngol 279, 2391–2399 (2022). https://doi.org/10.1007/s00405-021-06965-5

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  • DOI: https://doi.org/10.1007/s00405-021-06965-5

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