The narrowest part is located at the beginning of the labyrinthine segment and midpoint of tympanic segment. The mastoid segment starts from the second bend of the facial canal, going downwards, towards the stylomastoid foramen. It lies superior to the oval window and inferior to the lateral semicircular canal. It is closely related to the posterior and medial walls of the tympanic cavity. The tympanic segment starts from the geniculate ganglion and until the second bend of the facial canal. Initially, it runs anterolaterally before turning sharply posterolaterally at the geniculate ganglion (first bend of the facial canal). The labyrinthine segment runs from the internal auditory meatus to the geniculate ganglion, superior to cochlea. It contains the facial nerve (CN VII), after which it is named. It is located within the middle ear region, according to its shape it is divided into three main segments: the labyrinthine, the tympanic, and the mastoidal segment. In humans it is approximately 3 cm long, which makes it the longest human osseous canal of a nerve. The facial canal runs from the internal auditory meatus to the stylomastoid foramen. It runs from the internal acoustic meatus to the stylomastoid foramen. And at the end of the procedure ,use catheter suction to suck out blood clots or saline from the airway if any….The facial canal ( canalis nervi facialis), also known as the Fallopian canal, is a Z-shaped canal running through the temporal bone of the skull. Do not ablate more laterally to prevent bleeding, if at all it happens, use patties or coagulation switch for hemostasis.Ħ. Firm holding of coblation device will help to prevent injury to surrounding structures like anterior 2/3 vocal cord, opposite side vocal cord, medial surface of vocal cord or aryteroid posteriorlyĥ. Topical anaesthesia before and after the procedure will prevent sudden laryngeal spasmĤ. Appropriate exposure will help you to delineate the surgical marginsģ. Nasopharyngeal insufflation technique with entropy monitor will give adequate and safe surgical fieldĢ. So lets have a look on some tips & tricks for the safe procedure-– Patient was called for follow up on post op day 14th and good voice outcomes were achieved. The patient was shifted to the ward without oxygen, the voice was assessed on post op day 2. Once the final airway was achieved, the topical lignocaine was used to prevent laryngeal spasm post extubation. 5 mm depth was defined to prevent injury to the superior laryngeal artery branch and further bleeding. Superely till the ventricle and inferioly till the medial most surface of the subglottis. The surgical limits were-anteriorly the junction between ant 2/3 and post 1/3 of the vocal cord, posteriorly just anterior to the vocal process of arytenoid to prevent cartilage exposure and post operative granulations. The vocal cord retractor was fixed and coblation wand was then used with 7:3 settings for ablation and coagulation respectively. As the patient was spontaneously breathing, the stridor became more prominent, with stable vitals and the procedure was continued. Tube position was confirmed with endoscopic view and Benjamin lindohlm laryngoscope was suspended. Entropy leads were placed over forehead to monitor the depth of anaesthesia. Nasopharyngeal intubation with spontaneous breathing technique was used. She also started having stridor after induction. Patient was taken up for procedure under general anaesthesia. She was planned for coblation assisted cordectomy. Flexible laryngoscopy confirmed bilateral vocal cord paralysis. Here, we have a 39 yrs old female with complaints of noisy breathing for last two years post thyroidectomy. Key surgical landmarks demonstrated in the course of this video include: internal auditory canal, cochlear aqueduct, meatal segment of the facial nerve, labyrinthine segment of the facial nerve, 1st genu of the facial nerve, tympanic segment of the facial nerve, 2nd genu of the facial nerve, mastoid segment of the facial nerve.ĬAC (Coblation Assisted Cordectomy) in Bilateral Vocal Cord Palsy –tips & tricks This video builds on part four of our video series and demonstrates fundamental steps involved in the dissection of the internal auditory canal including: establishing an inferior trough and identification of the cochlear aqueduct, establishing a superior trough and identification of the labyrinthine segment of the facial nerve, and blue-lining the internal auditory canal from porous to fundus. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video demonstrates key steps in the dissection of the internal auditory canal during lab dissection of the temporal bone. Department of Otolaryngology – Head and Neck Surgery1
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