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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2019; 23(03): e281-e291
DOI: 10.1055/s-0038-1676100
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature

Shraddha Jain 
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
,
PT Deshmukh
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
,
Pooja Lakhotia
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
,
Sanika Kalambe
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
,
Deepshikha Chandravanshi
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
,
Mohnish Khatri
1   Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
› Author Affiliations
Further Information

Publication History

01 May 2018

06 October 2018

Publication Date:
01 March 2019 (online)

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Abstract

Introduction Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR.

Objective The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery.

Methods Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters.

Results The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24–3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm.

Conclusion The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.

Keywords

facial nerve - round window membrane - cochlear implantation - chorda tympani nerve
 

  • References

  • 1 Franz BK, Clark GM, Bloom DM. Surgical anatomy of the round window with special reference to cochlear implantation. J Laryngol Otol 1987; 101 (02) 97-102
    CrossrefPubMedGoogle Scholar
  • 2 Gudis DA, Montes M, Bigelow DC, Ruckenstein MJ. The round window: is it the “cochleostomy” of choice? Experience in 130 consecutive cochlear implants. Otol Neurotol 2012; 33 (09) 1497-1501
    CrossrefPubMedGoogle Scholar
  • 3 Richard C, Fayad JN, Doherty J, Linthicum Jr FH. Round window versus cochleostomy technique in cochlear implantation: histologic findings. Otol Neurotol 2012; 33 (07) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 4 Shapira Y, Eshraghi AA, Balkany TJ. The perceived angle of the round window affects electrode insertion trauma in round window insertion - an anatomical study. Acta Otolaryngol 2011; 131 (03) 284-289
    CrossrefPubMedGoogle Scholar
  • 5 Connor SE, Holland NJ, Agger A. , et al. Round window electrode insertion potentiates retention in the scala tympani. Acta Otolaryngol 2012; 132 (09) 932-937
    CrossrefPubMedGoogle Scholar
  • 6 Addams-Williams J, Munaweera L, Coleman B, Shepherd R, Backhouse S. Cochlear implant electrode insertion: in defence of cochleostomy and factors against the round window membrane approach. Cochlear Implants Int 2011; 12 (Suppl. 02) S36-S39
    CrossrefPubMedGoogle Scholar
  • 7 Adunka OF, Dillon MT, Adunka MC, King ER, Pillsbury HC, Buchman CA. Cochleostomy versus round window insertions: influence on functional outcomes in electric-acoustic stimulation of the auditory system. Otol Neurotol 2014; 35 (04) 613-618
    CrossrefPubMedGoogle Scholar
  • 8 Briggs RJ, Tykocinski M, Stidham K, Roberson JB. Cochleostomy site: implications for electrode placement and hearing preservation. Acta Otolaryngol 2005; 125 (08) 870-876
    CrossrefPubMedGoogle Scholar
  • 9 Adunka OF, Buchman CA. Scala tympani cochleostomy I: results of a survey. Laryngoscope 2007; 117 (12) 2187-2194
    CrossrefPubMedGoogle Scholar
  • 10 Gantz BJ, Turner CW. Combining acoustic and electrical hearing. Laryngoscope 2003; 113 (10) 1726-1730
    PubMedGoogle Scholar
  • 11 Martins GdeS, Brito Neto RV, Tsuji RK, Gebrim EM, Bento RF. Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window. BioMed Res Int 2015; 2015: 236364
    PubMedGoogle Scholar
  • 12 Zernotti ME, Suárez A, Slavutsky V, Nicenboim L, Di Gregorio MF, Soto JA. Comparison of complications by technique used in cochlear implants. Acta Otorrinolaringol Esp 2012; 63 (05) 327-331
    CrossrefPubMedGoogle Scholar
  • 13 Liu L, Arnold R, Robinson M. Dissection and exposure of the whole course of deep nerves in human head specimens after decalcification. Int J Otolaryngol 2012; 2012: 418650
    PubMedGoogle Scholar
  • 14 Trost O, Rouchy RC, Teyssier C. , et al. CT-scan imaging of iron marked chorda tympani nerve: anatomical study and educational perspectives. Surg Radiol Anat 2011; 33 (06) 515-521
    CrossrefPubMedGoogle Scholar
  • 15 Davies DV, Coupland RE. in Gray's Anatomy, D.V. Davies, Ed., p. 1161, Longmans, Green, and Co, London, UK, 34th edition, 1967
  • 16 Hamamoto M, Murakami G, Kataura A. Topographical relationships among the facial nerve, chorda tympani nerve and round window with special reference to the approach route for cochlear implant surgery. Clin Anat 2000; 13 (04) 251-256
    CrossrefPubMedGoogle Scholar
  • 17 Öztürk K, Göde S, Çelik S. , et al. Revisiting the Anatomy of the Facial Recess: The Boundaries of the Round Window Exposure. Balkan Med J 2016; 33 (05) 552-555
    CrossrefPubMedGoogle Scholar
  • 18 Durcan DJ, Shea JJ, Sleeckx JP. Bifurcation of the facial nerve. Arch Otolaryngol 1967; 86 (06) 619-631
    CrossrefPubMedGoogle Scholar
  • 19 Kullman GL, Dyck PJ, Cody DT. Anatomy of the mastoid portion of the facial nerve. Arch Otolaryngol 1971; 93 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 20 Muren C, Wadin K, Wilbrand HF. Anatomic variations of the chorda tympani canal. Acta Otolaryngol 1990; 110 (3–4): 262-265
    CrossrefPubMedGoogle Scholar
  • 21 Nager GT, Proctor B. Anatomic variations and anomalies involving the facial canal. Otolaryngol Clin North Am 1991; 24 (03) 531-553
    CrossrefPubMedGoogle Scholar
  • 22 Yadav SPS, Ranga A, Sirohiwal BL, Chanda R. Surgical anatomy of tympano-mastoid segment of facial nerve. Indian J Otolaryngol Head Neck Surg 2006; 58 (01) 27-30
    Google Scholar
  • 23 Măru N, Cheiţă AC, Mogoantă CA, Prejoianu B. Intratemporal course of the facial nerve: morphological, topographic and morphometric features. Rom J Morphol Embryol 2010; 51 (02) 243-248
    Google Scholar
  • 24 Zou T, Xie N, Guo M, Shu F, Zhang H. [Applied anatomy of facial recess and posterior tympanum related to cochlear implantation]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26 (10) 445-448
    PubMedGoogle Scholar
  • 25 Haynes DR. The relations of the facial nerve in the temporal bone. Ann R Coll Surg Engl 1955; 16 (03) 175-185
    PubMedGoogle Scholar
  • 26 Minnigerode B. Mitteilung einer seltenen intratympanalen Abteilung der Chorda Tympani. Acta otolaryngologica 1965; 59: 20-22
    PubMedGoogle Scholar
  • 27 Bosman DH. The distribution of the chorda tympani in the middle ear area in man and two other primates. J Anat. 1978; 127 (Pt 2): 443-445
    PubMedGoogle Scholar
  • 28 Histelberger WE, House WP. Acoustic neuroma diagnosis-external auditory canal hyperplasia as an early sign. Arch. Otolaryngol 1966; 83: 50-53
    Google Scholar
  • 29 Low WK. Chorda tympani as landmark for facial nerve: racial considerations. In: Magnan J, Chays A (eds), Proceedings of the Sixth International Conference on Cholesteatoma and Ear Surgery, 2000, 621–623
  • 30 Zhu Y, Tong B, Xu S, Liu Y, Duan M. [Applied anatomy of operation through posterior tympanum approach]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 22 (19) 867-870
    PubMedGoogle Scholar
  • 31 Calli C, Pinar E, Oncel S, Tatar B, Tuncbilek MA. Measurements of the facial recess anatomy: implications for sparing the facial nerve and chorda tympani during posterior tympanotomy. Ear Nose Throat J 2010; 89 (10) 490-494
    PubMedGoogle Scholar
  • 32 Jeon EJ, Jun B, Song JN, Kim JE, Lee DH, Chang KH. Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images. Surg Radiol Anat 2013; 35: 471-475
    CrossrefPubMedGoogle Scholar
  • 33 Diogo I, Walliczeck U, Taube J, Franke N, Teymoortash A, Werner J, Güldner C. Possibility of differentiation of cochlear electrodes in radiological measurements of the intracochlear and chorda-facial angle position. Acta Otorhinolaryngol Ital 2016; 36 (04) 310-316
    PubMedGoogle Scholar
  • 34 Su WY, Marion MS, Hinojosa R, Matz GJ. Anatomical measurements of the cochlear aqueduct, round window membrane, round window niche, and facial recess. Laryngoscope 1982; 92: 483-486
    PubMedGoogle Scholar
  • 35 Young YS, Nadol JB Jr. Dimensions of the extended facial recess. Ann Otol Rhinol Laryngol 1989; 98: 336-338
    CrossrefPubMedGoogle Scholar
  • 36 Wang L, Yang J, Jiang C, Zhang D. Cochlear implantation surgery in patients with narrow facial recess. Acta Otolaryngol 2013; 133: 935-938
    CrossrefPubMedGoogle Scholar
  • 37 Wang LE, Xia J, Shen XX, Wang ZX, Wang W, Zhang DX. Retaining Chorda Tympani Nerve Integrity During Cochlear Implant Surgery. Chin Med J (Engl) 2015; 128: 2115-2118
    CrossrefPubMedGoogle Scholar
  • 38 Wang H, Shan X, Meng Z, Sun H, Zhao L. [Anatomical measurements and clinical applications through facial recess approach]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27 (13) 708-711
    PubMedGoogle Scholar
  • 39 Vaid S, Vaid N, Manikoth M, Zope A. Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery. Indian J Otolaryngol Head Neck Surg 2015; 67 (02) 150-158
    CrossrefPubMedGoogle Scholar
  • 40 He X, Feng Y, Chen D, Mei L, He C, Cai X. [Study of the anatomy related to cochlear implantation guided by HRCT]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 25: 433-435
    PubMedGoogle Scholar
  • 41 Leong AC, Jiang D, Agger A, Fitzgerald-O’Connor A. Evaluation of round window accessibility to cochlear implant insertion. Eur Arch Otorhinolaryngol 2013; 270 (04) 1237-1242
    CrossrefPubMedGoogle Scholar
  • 42 Lee DH, Kim JK, Seo JH, Lee BJ. Anatomic limitations of posterior tympanotomy: What is the major radiologic determinant for the view field through posterior tympanotomy?. J Craniofac Surg 2012; 23: 817-820
    CrossrefPubMedGoogle Scholar
  • 43 Pendem SK, Rangasami R, Arunachalam RK, Mohanarangam VS, Natarajan P. HRCT Correlation with Round Window Identification during Cochlear Implantation in Children. J Clin Imaging Sci 2014; 31 (04) 70
    Google Scholar
  • 44 Eby TL. Development of the facial recess: implications for cochlear implantation. Laryngoscope 1996; 106 (5 Pt 2 Suppl 80): 1-7
    PubMedGoogle Scholar
  • 45 Bielamowicz SA, Coker NJ, Jenkins HA, Igarashi M. Surgical dimensions of the facial recess in adults and children. Arch Otolaryngol Head Neck Surg 1988; 114 (05) 534-537
    CrossrefPubMedGoogle Scholar
  • 46 Tian H, Zhang D. [The measurement of pneumatized mastoid and facial recess in cochlear implant recipients younger than three years old]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006; 20 (10) 441-443
    PubMedGoogle Scholar
  • 47 Lloyd SK, Kasbekar AV, Kenway B, Prevost T, Hockman M, Beale T. , et al. Developmental changes in cochlear orientation implications for Cochlear implantation. Otol Neurotol 2010; 31: 902-907
    CrossrefPubMedGoogle Scholar
  • 48 McRackan TR, Reda FA, Rivas A, Noble JH, Dietrich MS, Dawant BM. , et al. Comparison of cochlear implant relevant anatomy in children versus adults. Otol Neurotol 2012; 33: 328-334
    CrossrefPubMedGoogle Scholar