Zygomatic root approach

• Published in: Acta oto-laryngologica Vol. 129; no. 7; pp. 793 - 800
• Main Author: Ulug, Tuncay
• Format: Journal Article
• Language: English
• Published: Stockholm Informa UK Ltd 01.01.2009; Taylor & Francis; Informa
• Subjects: Biological and medical sciences; Child; Child, Preschool; Cranial Fossa, Middle - diagnostic imaging; Cranial Fossa, Middle - surgery; Decompression, Surgical - methods; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Facial Nerve - diagnostic imaging; Facial Nerve - surgery; Facial Nerve Injuries - diagnostic imaging; Facial Nerve Injuries - surgery; facial palsy; Facial Paralysis - diagnostic imaging; Facial Paralysis - surgery; Female; Geniculate Ganglion - diagnostic imaging; Geniculate Ganglion - surgery; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Injuries of the limb. Injuries of the spine; Male; Mastoid - diagnostic imaging; Mastoid - surgery; Medical sciences; Microsurgery - methods; Middle cranial fossa approach; Minimally Invasive Surgical Procedures - methods; Non tumoral diseases; Otorhinolaryngology. Stomatology; primary cholesteatoma; Prospective Studies; Retrospective Studies; Skull Fractures - diagnostic imaging; Skull Fractures - surgery; superior semicircular canal dehiscence; Temporal Bone - diagnostic imaging; Temporal Bone - injuries; temporal bone fractures; Tomography, X-Ray Computed; transmastoid approach; Traumas. Diseases due to physical agents; Tumors; Zygoma - diagnostic imaging; Zygoma - surgery; zygomatic root; Motor system disorder; Medium fossa; Diseases of the osteoarticular system; primary cholesteatoma; Fracture; ENT; Zygomatic arch; ENT disease; Tumor; Neurological disorder; facial palsy; Nervous system diseases; Temporal bone; Facial paralysis; Facial nerve; temporal bone fractures; Middle cranial fossa approach; Middle cranial fossa; Trauma; Tooth root; Cranial nerve disease; Cholesteatoma; Semicircular canal; Dehiscence; zygomatic root; superior semicircular canal dehiscence; transmastoid approach
• ISSN: 0001-6489; 1651-2251
• DOI: 10.1080/00016480802412805

Conclusions. The zygomatic root (ZR) approach provides improved intraoperative exposure of the key areas around the geniculate ganglion without a craniotomy, combining the advantages of middle cranial fossa (MCF) and transmastoid extralabyrinthine (TMEL) approaches. The ZR approach may be useful in cases of traumatic facial palsy, Bell's palsy, iatrogenic facial palsy, superior semicircular canal dehiscence and primary cholesteatoma. Objectives. To describe and evaluate the new ZR approach technique in the treatment of traumatic intratemporal facial nerve injuries. Patients and methods. This is a prospective clinical study of three consecutive procedures performed between July 2007 and January 2008, and a detailed discription of the surgical technique. The setting is a tertiary referral center. The patients' age range was 3-7 years. Interventions were based on drilling the ZR area extensively, so that the perigeniculate area was exposed through the space created between the middle cranial fossa basal dura and skeletonized external auditory canal. The ZR approach can be performed as an isolated technique or can be combined with an inferior mastoidectomy protecting the bony bridge between. Results. Two patients had a mixed-type fracture and one patient had a transverse fracture. All three patients received a ZR combined approach. There was no cerebrospinal fluid leak, hearing loss, tympanic membrane perforation or meatal stenosis.