Fundamentals of Ear Surgery – Oto Surgery Atlas

Fundamentals of Ear SurgeryTori Lewis Fibonacci Web Studio2020-08-19T21:21:11-07:00

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

There are three segments to an endaural incision: circumferential, intercartilaginous (between the helical crus and the tragus), and the vertical limb. It is less commonly used today compared to the postauricular incision due to the visibility of the scar and limitation of exposure posteriorly.

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