Facial Recess

The facial recess is bordered superiorly by the fossa incudis, medially by the facial nerve, and laterally by the chorda tympani (Fig. 13-5). It occasionally allows the extension of middle ear disease into the mastoid other than from the antrum. Opening the facial recess provides additional mastoid aeration. In cochlear implantation the electrode is inserted into the cochlea through the facial recess.

The surgeon may begin drilling along an imaginary line between the digastric ridge and the horizontal SCC. The fossa incudis is a consistent and reliable landmark for identifying the level of the facial recess. Understanding that the facial nerve is most vulnerable at its second genu and at its proximal descending portion, light strokes of the bur are used at this area. The microscope is turned up in power, and copious irrigating fluid (preferably warmed to body temperature to maximize conduction to the nerve monitor) is used to flood the facial recess. It allows clear and constant visualization of the operating field and minimizes thermal injury to the facial nerve from the high-speed drill. Generally

Posterior canal Digastric

Posterior canal Digastric

Mastoid The Facial Canal

FIGURE 13-5 Approach to facial recess in the right mastoid. SPR, suprapyramidal recess; CTN, chorda tympani nerve; VII, facial nerve; SMF, stylomastoid foramen; SSC, superior semicircular canal; HSC, horizontal semicircular canal; PSC, posterior semicircular canal; B, buttress (bridge); MFD, middle fossa dura; PFD, posterior fossa dura.

FIGURE 13-5 Approach to facial recess in the right mastoid. SPR, suprapyramidal recess; CTN, chorda tympani nerve; VII, facial nerve; SMF, stylomastoid foramen; SSC, superior semicircular canal; HSC, horizontal semicircular canal; PSC, posterior semicircular canal; B, buttress (bridge); MFD, middle fossa dura; PFD, posterior fossa dura.

a diamond bur is used to work around the nerve to allow slow but more precise thinning of the fallopian canal. A thin layer should be preserved over the facial nerve if no nerve work is intended.

Inferiorly, the nerve is skeletonized distally toward the mastoid tip to locate the take-off of the chorda tympani nerve. After it is detected, the chorda is followed into the middle ear, taking care not to disrupt the annular ridge laterally. The widest portion of the facial recess rarely exceeds 3 mm. It is necessary to use a smaller bur at this point.

With the facial recess widely opened, middle ear structures can be clearly identified. The incudosta-pedial joint, the capitulum of the stapes, the stape-dial tendon, the round window, and the cochleariform process can be observed and checked for disease involvement.

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  • BRIGITTE
    What is a facial recess approach to the right ear?
    1 year ago

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