Bonali Marco, Anschuetz Lukas, Fermi Matteo, Villari Domenico, Mariani Giulia Adalgisa, Manzoli Lucia, Caversaccio Marco, Presutti Livio
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Eur Arch Otorhinolaryngol. 2017 May;274(5):2141-2148. doi: 10.1007/s00405-017-4492-0. Epub 2017 Feb 27.
The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I-IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.
鼓室后隐窝和下鼓室是中耳的隐蔽区域，人们对其认识不足。然而，该区域具有重要的临床意义，因为它经常受到胆脂瘤等疾病的影响。本研究的目的是通过经耳道内镜探索并描述下鼓室和鼓室后隐窝的解剖变异。我们推测中耳这个隐蔽区域存在显著变异性。此外，我们认为使用角度内镜进行微创检查是合适的，因为可以使用角度内镜来探查该区域。为此，我们使用3毫米直镜和角度内镜对总共125个中耳（83例尸体解剖、42例手术病例）进行了探查。对变异情况进行了拍照记录并制成表格。骨嵴小桥、下丘和小丘最常表现为嵴状。小桥的变异最大，呈嵴状的占38%，呈桥状的占35%，不完全呈现的占27%。下丘仅8%的病例呈桥状，小丘为17%。鼓室窦66%形态正常。50%可检测到耳蜗下小管。根据现有的骨嵴和鼓室窦，将鼓室后隐窝和下鼓室分别分为I - IV型新分类。总之，我们发现鼓室后隐窝和下鼓室的骨质结构存在丰富的变异性。内镜检查是合适的，能够提供对这些隐蔽区域的透彻理解和全景视野。
