Temporal Bone Dissection Gauri S Belsare
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1Step by Step® Temporal Bone Dissection2
Dissection Laboratory at Bharati Vidyapeeth Deemed University Medical College Pune, Maharashtra, India
3Step by Step® Temporal Bone Dissection
Gauri S Belsare MS (ENT) Consultant ENT Surgeon Belsare ENT Hospital Vishrantwadi, Pune, Maharashtra, India Head Department of ENT Ruby Hall Clinic, Grant Medical Foundation Station Road, Pune, Maharashtra, India Honorary Associate Professor in Department of ENT and In-Charge Principal, School of Audiology and Speech Language Pathology Cochlear Implant Program Bharati Vidyapeeth's Medical College Pune, Maharashtra, India Email: gsbelsare@gmail.com Foreword KP Morwani
4
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Step by Step® Temporal Bone Dissection
First Edition: 2014
9789351521303
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5Dedicated to
My Beloved Family
My Parents Shri Ramkrishna and Sou Asha Chiplunkar, My In-laws Shri Shrikrishna and Sou Lalita Belsare, My Brother Shri Vivek Chiplunkar, My Husband Shri Sudheer and My Daughter Sai Belsare, Whose constant encouragement and unwavering support has been instrumental in balancing my professional interest and my family life all these years6
7Foreword
It is a pleasure to write a Foreword for Step by Step Temporal Bone Dissection by Dr Gauri S Belsare.
Dr Gauri S Belsare is known to me personally since the past 10 years. I have always known her to be a sincere student and an excellent teacher. She has contributed her part to the growth of Otology by setting up of a Temporal Bone Laboratory at Bharati Vidyapeeth's Medical College, Pune, 10 years ago, where she is conducting workshops three times a year, which is a great achievement for any ENT surgeon.
In my view, Temporal Bone Dissection Laboratory should be part of every postgraduate institute to improve the quality of otologic surgery so that it becomes more popular and acceptable in our country. An ENT surgeon who does not perform temporal bone dissection or does not go through literature on anatomy of temporal bone dissection cannot become a good otologist.
She has trained herself by attending multiple Otology and Lateral Skull Base Workshops in India and besides, she has had an opportunity to attend various courses by renowned names like Prof Mario Sanna (Italy), House Ear Institute, Los Angeles (USA) and Dr Bruce Ganz, Lowa (USA). She has also been an observer with Dr Robb Brig (Australia) and Dr Arun Gadre, Louisville (USA) for cochlear implant surgery.
She has been performing various otologic surgeries and also has experience of performing lateral skull base surgery under my supervision. She is the only ENT surgeon in India who has organized lateral skull base cadaveric dissection workshop for neurosurgeons.
In this book, Dr Gauri S Belsare has described steps of temporal bone dissection in great details besides elaborating on various associated clinical situations, which is a unique feature of this manual. I compliment her on tremendous efforts and highly recommend this book which can be used by ENT surgeons throughout their career.
KP Morwani ms (ent)
Head
Department of ENT and Skull Base Surgery
Dr Balabhai Nanavati Hospital
Mumbai, Maharashtra, India
Head
Department of ENT
Hiranandani Hospital (Fortis Network)
Navi Mumbai, Maharashtra, India8
9Preface
The state-of-the-art temporal bone dissection laboratory at Bharati Vidhyapeeth Hospital, Pune, was established in 2002 with combined efforts of the Department of ENT at Bharati Vidyapeeth and the Association of ENT Surgeons of Pune (Pune Otology Group).
The basic course in ear surgery with temporal bone dissection is being conducted regularly three times in a year since then. It has helped many budding otologists from India and abroad to train themselves and to improve their surgical skills in basic ear surgeries.
Thorough knowledge of temporal bone anatomy achieved through repeated temporal bone dissections can help in learning advance ear surgeries and to learn new approaches. This dissection manual will help the candidates as a quick reference during the dissection course as well as when they practice in their own setups.
I express gratitude to the management of Bharati Vidyapeeth for their immense support for this activity especially Dr Shivaji Rao Kadam Vice-Chancellor, Bharati Vidyapeeth and Dr DN Karandikar, DMER, Bharati Vidyapeeth. I am thankful to Dr Rajeev Yande, for his encouragement as well as his great contribution towards establishment of the laboratory and his help in conducting the courses. I am grateful to Dr VM Thakur (Ex-Head of the Department of ENT), Dr Maitri Kaushik, Dr Dehadray, Dr Vikram Oak and Dr Annapurna, for their help in conducting the courses.
The encouragement and guidance given by Dr KP Morwani, Mumbai, needs special mention as he has been a constant source of inspiration from establishment of the laboratory to the conduction of the courses as well as for my continued interest in skull base surgery.
I am grateful to my family members for their support and help.
Gauri S Belsare
13Introduction
The anatomy of temporal bone is complex. The three-dimensional orientation of the temporal bone and the vital structures within and around it, can be mastered through repeated temporal bone dissections.
In addition to the routine middle ear and mastoid surgical procedures, various inner ear surgical procedures, facial nerve procedures and skull base surgeries can be practiced during the dissection. Simulating experience in the laboratory using operating microscope, drill and fine micro-ear instruments definitely helps to improve the surgical skills. This is possible because, apart from some variations in the cellularity of mastoid, level of dura and sinus and dehiscences of facial canal, the anatomy of temporal bone remains almost constant.
Temporal bone dissection carried out in fresh cadaveric bones, gives a feel of live surgery. This is especially true for the middle ear procedures. Injection of dyes in internal carotid artery and internal jugular vein can highlight the color play of arterial and venous blood during the dissection.