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The protympanum, protiniculum and subtensor recess: an endoscopic morphological anatomy study

Published online by Cambridge University Press:  11 June 2018

N Jufas ,
A Rubini ,
D Soloperto ,
M Alnoury ,
M Tarabichi ,
D Marchioni  and
N Patel
N Jufas*
Affiliation:
Kolling Deafness Research Centre, Royal North Shore Hospital and Macquarie University, Sydney, Australia Discipline of Surgery, Sydney Medical School, University of Sydney, Australia Sydney Endoscopic Ear Surgery (‘SEES’) Research Group, Australia Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
A Rubini
Affiliation:
Otolaryngology Department, University Hospital of Verona, Italy
D Soloperto
Affiliation:
Otolaryngology Department, University Hospital of Verona, Italy
M Alnoury
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
M Tarabichi
Affiliation:
Tarabichi-Stammberger Ear and Sinus Institute, Dubai, United Arab Emirates
D Marchioni
Affiliation:
Otolaryngology Department, University Hospital of Verona, Italy
N Patel
Affiliation:
Kolling Deafness Research Centre, Royal North Shore Hospital and Macquarie University, Sydney, Australia Discipline of Surgery, Sydney Medical School, University of Sydney, Australia Sydney Endoscopic Ear Surgery (‘SEES’) Research Group, Australia Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
*
Address for correspondence: Dr Nicholas Jufas, Kolling Deafness Research Centre, Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia E-mail: [email protected]
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Abstract

Objectives

An anatomical study was performed to describe the endoscopic anatomy and variations of the protympanum, including classification of the protiniculum and subtensor recess.

Methods

A retrospective review was conducted of video recordings of cadaveric dissections and surgical procedures, which included visualisation of the protympanum, across 4 tertiary university referral centres over a 16-month period. A total of 97 ears were used in the analysis.

Results

A quadrangular conformation of the protympanum was seen in 60 per cent of ears and a triangular conformation in 40 per cent. The protiniculum was type A (ridge) in 58 per cent, type B (bridge) in 23 per cent and type C (absent) in 19 per cent. The subtensor recess was type A (absent) in 30 per cent, type B (shallow) in 48 per cent and type C (deep) in 22 per cent.

Conclusion

The protympanum is an area that has been ignored for many years because of difficulties in visualising it with an operating microscope. However, modern endoscopic equipment has changed this, providing detailed anatomical knowledge fundamental to ensuring the safety of endoscopic surgical procedures in the region.

Keywords

EndoscopyEarMiddleEustachian TubeAnatomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 6 , June 2018 , pp. 489 - 492
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr N Jufas takes responsibility for the integrity of the content of the paper

References

1Jufas, N, Marchioni, D, Tarabichi, M, Patel, N. Endoscopic anatomy of the protympanum. Otolaryngol Clin North Am 2016;49:1107–19Google Scholar
2Bennett, ML, Zhang, D, Labadie, RF, Noble, JH. Comparison of middle ear visualization with endoscopy and microscopy. Otol Neurotol 2016;37:362–6Google Scholar
3Djerić, D, Savić, D. Anatomical variations and relations of the bony portion of the eustachian tube. Acta Otolaryngol 1985;99:543–50Google Scholar
4Marchioni, D, Alicandri-Ciufelli, M, Piccinini, A, Genovese, E, Presutti, L. Inferior retrotympanum revisited: an endoscopic anatomic study. Laryngoscope 2010;120:1880–6CrossRefGoogle ScholarPubMed
5Tóth, M, Medvegy, T, Moser, G, Patonay, L. Development of the protympanum. Ann Anat 2006;188:267–73Google Scholar
6Marchioni, D, Mattioli, F, Alicandri-Ciufelli, M, Presutti, L. Transcanal endoscopic approach to the sinus tympani: a clinical report. Otol Neurotol 2009;30:758–65Google Scholar
7Abou-Bieh, AA, Al-Abdulhadi, K, Al-Tubaikh, J, Haberkamp, T. The protympanic crest. Otolaryngol Head Neck Surg 2009;141(suppl 1):P92Google Scholar
8Holt, JJ. The ponticulus: an anatomic study. Otol Neurotol 2005;26:1122–4CrossRefGoogle ScholarPubMed
9Marchioni, D, Soloperto, D, Colleselli, E, Tatti, MF, Patel, N, Jufas, N. Round window chamber and fustis: endoscopic anatomy and surgical implications. Surg Radiol Anat 2016;38:1013–19Google Scholar
10Savić, D, Djerić, D. Anatomical variations and relations in the medial wall of the bony portion of the eustachian tube. Acta Otolaryngol 1985;99:551–6Google Scholar
11Moreano, EH, Paparella, MM, Zelterman, D, Goycoolea, MV. Prevalence of carotid canal dehiscence in the human middle ear: a report of 1000 temporal bones. Laryngoscope 1994;104:612–18Google Scholar
12Deep, NL, Weisskopf, PA. Transmastoid endoscopic-assisted eustachian tube packing after translabyrinthine tumor resection: a cadaveric feasibility study. Otol Neurotol 2017;38:283–9CrossRefGoogle ScholarPubMed
13Jufas, N, Treble, A, Newey, A, Patel, N. Endoscopically guided transtympanic balloon catheter dilatation of the eustachian tube: a cadaveric pilot study. Otol Neurotol 2016;37:350–5Google Scholar
14Tarabichi, M, Najmi, M. Transtympanic dilatation of the eustachian tube during chronic ear surgery. Acta Otolaryngol 2015;135:640–4Google Scholar
15Oh, SJ, Lee, IW, Goh, EK, Kong, SK. Trans-tympanic catheter insertion for treatment of patulous eustachian tube. Am J Otolaryngol 2015;36:748–52CrossRefGoogle ScholarPubMed