Fundamentals of Ear Surgery

The three variables for positioning of the head in ear microsurgery: rotation, tilt, and flexion–extension.

Patient Positioning

Incorrect hand position for ear microsurgery, which is less stable and limits visibility. The correct hand position has three-point stabilization.

Microinstrument Hand Positioning

$A sizable fraction of ear microsurgeons develop back problems over time. This can be mitigated by using proper posture during microsurgery. This involves upright posture and good lumbar support as shown here. Many surgeons use rests to enhance stability and alleviate arm fatigue.$

Ergonomics

The pinna tilts posterior about 15 degrees with respect to the axis of the malleus.

Postauricular Incision

Commencing elevation of the ear canal flap (skin and periosteum) from Henle’s spine. Note the cribriform region just posterior to the spine.

Postauricular Canal Flap Design

Endaural Incision

In closing a postauricular incision following tympanomastoid procedures, the pinna may rotate outward and develop a cosmetically undesirable prominence (i.e., lop ear). This is especially the case in children due to the flexibility of their cartilage.

Incision Closure

Dr. Jackler and Ms. Gralapp retain copyright for all of their original illustrations which appear in this online atlas. We encourage use of our illustrations for educational purposes, but copyright permission should be sought before publication or commercial use. To request permission for publication or commercial use please contact Christine Gralapp (eyeart@chrisgralapp.com, https://www.chrisgralapp.com).