Middle Ear Microvascularization: an "in Vivo" Endoscopic Anatomical Study

Overview

Journal Eur Arch Otorhinolaryngol

Specialty Otorhinolaryngology

Date 2018 Feb 12

PMID 29429024

Citations 4

Authors

Matteo Alicandri-Ciufelli

Pierre Guarino

Filippo Fabbri

Elio Maria Cunsolo

Livio Presutti

Lukas Anschuetz

Affiliations

Soon will be listed here.

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.

Citing Articles

Endoscopic Ear Surgery, from the Last Ten to the Next Ten Years: A Critical Perspective.

Alicandri-Ciufelli M, Molinari G, DAlessandro E, Nocini R, Presutti L, Marchioni D J Clin Med. 2024; 13(21).

PMID: 39518439 PMC: 11546356. DOI: 10.3390/jcm13216300.

Combined underwater endoscopic and microscopic surgery for tympanic paraganglioma: A case report.

Takata Y, Anzai T, Sonoda K, Okada H, Ishimizu E, Nakamura M Sci Prog. 2024; 107(3):368504241263524.

PMID: 39043202 PMC: 11271120. DOI: 10.1177/00368504241263524.

Internal vascular channel architecture in human auditory ossicles.

Manoharan S, Gray R, Hamilton J, Mason M J Anat. 2022; 241(2):245-258.

PMID: 35357009 PMC: 9296027. DOI: 10.1111/joa.13661.

Taste impairment after endoscopic stapes surgery: Do anatomic variability of chorda tympani and surgical technique matter? : Post-operative dysgeusia after EStS.

Molinari G, Reale M, Bonali M, Anschuetz L, Lucidi D, Presutti L Eur Arch Otorhinolaryngol. 2021; 279(5):2269-2277.

PMID: 34236486 DOI: 10.1007/s00405-021-06908-0.

References

Alberti P, Dawes J . Necrosis of the lenticular process of the incus after stapes surgery and its treatment. A case report. J Laryngol Otol. 1961; 75:821-5. DOI: 10.1017/s0022215100058473. View

Bonali M, Anschuetz L, Fermi M, Villari D, Mariani G, Manzoli L . The variants of the retro- and hypotympanum: an endoscopic anatomical study. Eur Arch Otorhinolaryngol. 2017; 274(5):2141-2148. DOI: 10.1007/s00405-017-4492-0. View

Vallejo-Valdezate L, Herrero-Calvo D, Garrosa-Garcia M . Vascularization of the long process of the malleus: surgical implications. Eur Arch Otorhinolaryngol. 2015; 273(9):2335-42. DOI: 10.1007/s00405-015-3787-2. View

Gros A, Zargi M, Vatovec J . Does it make sense to preserve the stapedial muscle during surgical treatment for otosclerosis?. J Laryngol Otol. 2001; 114(12):930-4. DOI: 10.1258/0022215001904644. View

Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F . Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience. Int J Pediatr Otorhinolaryngol. 2015; 79(3):316-22. DOI: 10.1016/j.ijporl.2014.12.008. View

ANSON B, Harper D, Hanson J . Vascular anatomy of the auditory ossicles and petrous part of the temporal bone in man. Trans Am Otol Soc. 1962; 50:21-32. View

Nager G, Nager M . The arteries of the human middle ear, with particular regard to the blood supply of the auditory ossicles. Ann Otol Rhinol Laryngol. 1953; 62(4):923-49. DOI: 10.1177/000348945306200401. View

Vallejo L, Gil-Carcedo E, Herrero D, Sanchez C, Sanchez E, Gil-Carcedo L . [Analysis of the mechanical-acoustic features of the middle ear after stapedial surgery both with and without stapes muscle preservation]. Acta Otorrinolaringol Esp. 2007; 58(7):302-10. View

Alberti P . The blood supply of the incudostapedial joint and the lenticular process. Laryngoscope. 1963; 73:605-28. DOI: 10.1288/00005537-196305000-00012. View

10.

Rasmy E . Stapedius reflex after stapedectomy with preservation of the stapedius tendon. J Laryngol Otol. 1986; 100(5):521-7. DOI: 10.1017/s0022215100099618. View

11.

Marchioni D, Alicandri-Ciufelli M, Rubini A, Masotto B, Pavesi G, Presutti L . Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment. J Neurosurg. 2016; 126(1):98-105. DOI: 10.3171/2015.11.JNS15952. View

12.

LINDEMAN H . SOME HISTOLOGICAL EXAMINATIONS OF THE INCUS AND STAPES WITH ESPECIAL REGARD TO THEIR VASCULARIZATION. Acta Otolaryngol Suppl. 1964; 188:SUPPL 188:319+. DOI: 10.3109/00016486409134582. View

13.

Anschuetz L, Bonali M, Guarino P, Fabbri F, Alicandri-Ciufelli M, Villari D . Management of Bleeding in Exclusive Endoscopic Ear Surgery: Pilot Clinical Experience. Otolaryngol Head Neck Surg. 2017; 157(4):700-706. DOI: 10.1177/0194599817726982. View

14.

Lannigan F, OHiggins P, McPhie P . The vascular supply of the lenticular and long processes of the incus. Clin Otolaryngol Allied Sci. 1993; 18(5):387-9. DOI: 10.1111/j.1365-2273.1993.tb00597.x. View

15.

Colletti V, Sittoni V, Fiorino F . Stapedotomy with and without stapedius tendon preservation versus stapedectomy: long-term results. Am J Otol. 1988; 9(2):136-41. View

16.

Yong M, Mijovic T, Lea J . Endoscopic ear surgery in Canada: a cross-sectional study. J Otolaryngol Head Neck Surg. 2016; 45:4. PMC: 4717547. DOI: 10.1186/s40463-016-0117-7. View

17.

Gerlinger I, Toth M, Lujber L, Szanyi I, Moricz P, Somogyvari K . Necrosis of the long process of the incus following stapes surgery: new anatomical observations. Laryngoscope. 2009; 119(4):721-6. DOI: 10.1002/lary.20166. View

18.

Arnold A, Blaser B, Hausler R . Audiological long-term results following stapedotomy with stapedial tendon preservation. Adv Otorhinolaryngol. 2007; 65:210-214. DOI: 10.1159/000098824. View

19.

Silverstein H, Hester T, Deems D, Rosenberg S, Crosby N, Kwiatkowski T . Outcomes after laser stapedotomy with and without preservation of the stapedius tendon. Ear Nose Throat J. 2000; 78(12):923-8. View