Education:■ M.D. Ear, Nose and Throat Surgery.
May 1992, Faculty of medicine,Cairo University Kasr Al-Ainy Medical School
■ M.S. Ear, Nose and Throat Surgery. May 1985 (very good degree), faculty of medicine,Cairo University Kasr Al-Ainy Medical School
■ M B & Bch Nov. 1981 (very good degree), faculty ofmedicine, Cairo University Kasr Al-Ainy MedicalSchool
Posts:■ Senior Consultant at ENT department, Sabah and MTC
hospitals, Ministry of Health (MOH), Kuwait ■ Lecturer of otorhinolaryngology, department of
surgery, faculty of medicine, Kuwait university 1996,ongoing. (Mandated from MOH).
■ X-Chairman of ENT medical council in Kuwait.December 1999 – April 2006.
■ X-Chairman of ENT department, Al-Sabah Hospital,Kuwait, July 1999 – April 2006.
■ Resident at Cairo University Medical School, ENTdepartment, Kasr Al-Ainy Hospital, Egypt,from 2nd March 1983 until 28 Feb. 1986.
■ House officer at Cairo university hospitals, Egypt,from 1st march 1982 – 28 Feb. 1983.
Licensures and activities:■ Licensed as ENT Consultant in Kuwait, Egypt and
Sudan.■ Referee of the Kuwait Medical Journal.■ Member of the Faculty of Surgery, Kuwait Institute for
Medical Specialization (KIMS) since October 1998,ongoing.
■ X-chairman of the inspection board for private hospitals,MOH, Kuwait.
■ X-Member of the operational policy follow-up teamMOH, Kuwait.
■ X-Member of the accreditation standards setup com-mittee for hospitals and primary health care centers,MOH, Kuwait.
■ Visiting professor, Khartoum university, faculty ofmedicine.
■ Director of the first temporal bone course, Kuwait,November 2005.
Publications:19 publications in national, regional and internationaljournals, 12 presentations, 8 posters and booklets.
Awards and certificates of honor:1. From KMA on the occasion of obtaining the M.D.
degree.2. From the Egyptian medical syndicate on the occasion
of obtaining the M.D. degree.3. The first prize of the 11th course in otology and oto-
neurosurgery, 5–7 Dec. 2000, hôpital Purpan,Toulouse, France.
4. From the 3rd International Conference of the GulfCooperation Council (GCC) Otorhinological, Head &Neck Societies & Associations. March 98.
5. From the Sudanese ENT association. 6. From the minister of health of Kuwait for editing the
operational policy of the ENT departments in Kuwait,May 2000.
7. From the minister of health, Kuwait, for the 3rd editionof the operational policy of the ENT departments inKuwait, Febr. 2002.
8. Support for research from the “Kuwait Foundation forAdvancement of Science” (KFAS).
9. From the faculty of surgery, Kuwait Institute for Medic alSpecialization (KIMS)
10. From the director of Sabah medical area.
Khairy Alhag Abu Shara, M.D.Senior consultant ENT, Head and NeckSurgeon, Sabah and MTC Hospitals, Kuwait
DISSECTION MANUAL FOR THETEMPORAL BONE LABORATORY
KHAIRY ALHAG ABU SHARA, M.D.Senior Consultant ENT, Head and Neck Surgeon
Sabah and MTC Hospitals, KuwaitX-Chairman of ENT Medical Council – MOH 99-06
To my mother,from whom I have learned how
sincere hard work can bean endless source of enjoyment.
To my Family,for their unlimited support
and understanding of the medical professionas well as its obligations and commitments.
Dissection Manual for the Temporal Bone Laboratory4
Acknowledgement
The growth of medico-legal problems related to surgical practicesnecessitates greater emphasis on clinical training. Lab practice oncadavers and various models is becoming increasingly popular for bothresearch and training.
The challenges of ear surgery are unique because the density ofanatomical structures in a relatively small space is unlike any otherorgan in the human body. This consequently calls for extensive lab train-ing before starting to operate in the theater—a step that should only betaken once both the trainer and trainee are satisfied with the level ofskills achieved.
For those reasons, the establishment of a temporal bone lab within theotology center is an inevitable option.
Considering the short time frame given during a temporal bone dissec-tion course – in which the participants are concerned mainly with hands-on training rather than going into further theoretical details – this manualnevertheless provides practical and concise orientation to the topic. Theauthor’s aim was not to write a textbook, but to address the actualneeds in a temporal bone lab, which is why this manual should be sup-ported by more detailed training instructions and further readings.
I hope, this booklet will be of great help to our junior candidates and tothe seniors who are planning to establish a temporal bone lab.
A special word of gratitude goes to KARL STORZ company for their kindsupport and valuable assistance in the preparation of this booklet.
Khairy Alhag Abu Shara, M.D.Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitEmail: [email protected]: 00965 9784104
Dissection Manual for the Temporal Bone Laboratory 5
Foreword
Middle ear surgery involves procedures that are among the most chal-lenging in the field of ORL, demanding a high degree of technical skill,expertise and precision. To become a proficient otologist requires goodorientation skills and thorough knowledge of numerous anatomicalstructures confined to a space amounting to less than one cubic inch.Furthermore, the introduction of the surgical micro scope, dental drill andfine instruments requires the development of precise operative tech-niques.
The introduction of high-resolution CT scanners, 1 mm cuts and MRIenables surgeons to gain a more detailed knowledge of fine anatomicalstructures, e.g., the thickness of the stapes foot plate in stapes surgery,the facial nerve anatomy, and the possibility of any associated congenit -al anomalies in cochlear implantation.
Full anatomical orientation regarding both normal and abnormal variantsis the first step to be taught in temporal bone labs. Otherwise avoidablecomplications could occur.
It has been suggested by many authors that prior to performing in-vivosurgery in an operating theater, a trainee surgeon should acquire goodknowledge of temporal bone anatomy and develop proper navigationalskills to such a degree comparable to the uncanny sense of directionthat allows us to find our way through our own bedroom in completedarkness. It takes a long time to become an ear surgeon and even moretime to gain the required level of proficiency to successfully manage dif-ficult and complicated cases. The temporal bone dissection lab pro-vides an entry point, where candidates can devote their efforts to work -ing toward this goal.
In this manual, information is given about the anatomy of the temporalbone, the various surgical procedures, that can be practiced on cadaverspecimen in the lab (including photos, adressing procedures, and con-cepts), imaging procedures, and a suggested temporal bone laboratorysetup.
Dissection Manual for the Temporal Bone Laboratory6
Dissection Manual for the Temporal Bone LaboratoryKhairy Alhag Abu Shara, M.D.
Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitX-Chairman of ENT Medical Council – MOH 99-06
Address for correspondence:Khairy Alhag Abu Shara, M.D.Senior Consultant ENT, Head and Neck SurgeonSabah and MTC Hospitals, KuwaitEmail: [email protected]: 00965 9784104
© 2007 Endo-PressTM, Tuttlingen, GermanyISBN 978-3-89756-151-9, Printed in GermanyPostfach, D-78503 TuttlingenPhone: +49 74 61 145 90Fax: +49 74 61 708 529E-mail: [email protected]
Editions in languages other than English and German are in prepara-tion. For up-to-date information, please contact Endo-PressTM
Tuttlingen, Germany, at the address mentioned above.
Printed by:Endo-PressTM Tuttlingen, GermanyBraun Druck+Medien, D-78532 Tuttlingenj, Germany
11.07-2
Anatomical schematic drawings:Mr. Andreas MückeKarl-Frank-Str. 3212587 Berlin, Germany
Most of the photographs shown inthis manual were taken by the authorduring dissection sessions in the temporal bone laboratory.
All rights reserved. No part of this publication may be translated, reprinted orreproduced, transmitted in any form or by any means, electronic or mechanical,now known or hereafter invented, including photocopying and recording, or uti-lized in any information storage or retrieval system without the prior written per-mission of the copyright holder.
Please note:Medical knowledge is constantly changing. As new researchand clinical experience broaden our knowledge, changes intreatment and drug therapy may be required. The authorsand editors of the material herein have consulted sourcesbelieved to be reliable in their efforts to provide informationthat is complete and in accordance with the standardsaccepted at the time of publication. However, in view of thepossibility of human error by the authors, editors, or pub-lisher of the work herein, or changes in medical knowledge,neither the authors, editors, publisher, nor any other partywho has been involved in the preparation of this work, canguarantee that the information contained herein is in everyrespect accurate or complete, and they cannot be heldresponsible for any errors or omissions or for the resultsobtained from use of such information. The information con-tained within this brochure is intended for use by doctorsand other health care professionals. This material is notintended for use as a basis for treatment decisions, and isnot a substitute for professional consultation and/or peer-reviewed medical literature.Some of the product names, patents, and registereddesigns referred to in this booklet are in fact registeredtrademarks or proprietary names even though specific refer-ence to this fact is not always made in the text. Therefore,the appearance of a name without designation as propri-etary is not to be construed as a representation by the pub-lisher that it is in the public domain.All rights reserved. No part of this publication may be trans-lated, reprinted or reproduced, transmitted in any form or byany means, electronic or mechanical, now known or here-after invented, includ ing photocopying and recording, or uti-lized in any informa tion storage or retrieval system withoutthe prior written permission of the copyright holder.
Dissection Manual for the Temporal Bone Laboratory 7
Table of Contents
Acknowledgement ................................................................................................................... 4
Forword...................................................................................................................................... 5
1.0 Introduction ........................................................................................................................ 8
2.0 Training Procedures............................................................................................................ 13
3.0 Endoscopic Views of the Temporal Bone ......................................................................... 24
4.0 Temporal Bone CT Images4.1 Axial CT Scans ............................................................................................................. 284.2 Coronal CT Scans ....................................................................................................... 35
5.0 Exposure of the Temporal Bone: Genuine Dissections ................................................... 39
Remember ......................................................................................................................... 42
Dissection Manual for the Temporal Bone Laboratory8
1.0 Introduction
Fig. 1Left temporal bone, lateral view with the squama sculptured asan auricle. There are two temporal bones. Each is composed offive parts: mastoid, petrous, squamous, tympanic plate andstyloid process.
Squamous portion
Petrous portion
Mandibular fossa
Zygomatic processTympanic portion
Mastoid portion
Styloid portion
Fig. 2Right temporal bone attached to the occipital bone. View of theposterior cranial fossa. The internal auditory meatus (IAM),jugular foramen and notch, sigmoid sinus, superior and inferiorpetrosal sinuses, petrous apex, clivus, and hypoglossal canalcan be seen.
Internal auditory meatus
Basisphenoid
Occipital condyle
Nerves of the jugular foramen
Sigmoid sinus
Vessels of the jugular foramen
Occipitomastoid suture
Squamous part of theoccipital bone
Basiocciput
Jugular tubercle
Hypoglossal canal
Dissection Manual for the Temporal Bone Laboratory 9
Fig. 3Right temporal bone attached to sphenoid and occipital bones.View of the middle cranial fossa. The foramina (rotundum, ovale,spinosum, and lacerum), the superior orbital fissure, internalcarotid artery, anterior clinoid process, clivus, petrous apex,cavum trigeminale, greater wing of the sphenoid, petro-sphenoid and petro-occipital suture lines are visible.
Foramen rotundum
Superior orbital fissure
Sella turcica
Foramen spinosum
Foramen ovale
Superior petrosal sulcus
Foramen lacerum
Clivus
Anterior clinoid process
Internal carotid artery
Occipital condyle
Fig. 4External view of the skull base. The jugular foramen, carotidcanal, greater wing of the sphenoid, the foramina (ovale,spinosum, lacerum), zygomatic root, mandibular fossa, styloidprocess, squamo-sphenoid suture, occipital condyle, digastricfossa, stylo-mastoid foramen, and mastoid tip are visible.
Zygomatic root
Squamo-sphenoid suture
Jugular bulb
Mandibular fossa
Tympanic plate
Mastoid tip
Stylo-mastoid foramen
Digastric fossa
Styloid process
Occipital condyle
Foramen spinosum
Carotid canal
Foramen ovale
Jugular tubercle
Dissection Manual for the Temporal Bone Laboratory10
Fig. 5Right inner ear. The three semicircular canals (SCC) are open,the lateral, the posterior and the superior with crus communeare visible. The cochlea and oval window are also exposed.
Superior SCC
Cochlea
Oval window
Lateral SCC
Common crus
Posterior SCC
Fig. 6Left inner ear. The superior and lateral SCC, facial nerve,oval and round windows, cochlea, modulus, and promontory.
Oval window
Superior SCC
Lateral SCC
Facial nerve
Remnant of promontory
Cochlea: basal turn
Modulus
Round window
Dissection Manual for the Temporal Bone Laboratory 11
Fig. 7Anatomy of the left middle ear: The incudo-stapedial joint, thestapes head and the crura, facial nerve, stapedial tendon,promontory, and tympanomeatal flap are visible.
Malleus handle andtympanomeatal flap Long incus process
Stapes head
Stapedial tendon
Lenticular incus process
Incudo-stapedial joint
Promontory
Fig. 8The auditory ossicles.1 The malleus, head, neck, lateral process, and handle.2 The incus: body, short, long, and lenticular processes. 3 The stapes: head, neck, anterior and posterior crura,
and footplate.
HeadNeck
1 Malleus
2 Incus
3 Stapes
Short process
BodyLenticular process
Long process
Head
Neck
Posterior crus
Anterior crus
Footplate
Lateral process
Handle
1
2
3
Dissection Manual for the Temporal Bone Laboratory12
Fig. 9Right side dissection. Notice the jugular bulb, carotid canal,both vertical and horizontal parts, carotico-jugular septum,and foramen for the IX cranial nerve, cochlea, oval window,facial nerve, cochleariform process, semi-canal of the tensortympani muscle, and lateral SCC.
Facial nerve(transverse segment)
Cochleariform process
Transverse partof the carotid canal
Vertical partof the carotid canal
Semi-canal of thetensor tympani muscle
Carotico-jugular foramen
Middle ear
Jugular bulb
Dissection Manual for the Temporal Bone Laboratory 13
Identify important landmarks related to different anatomic views of the temporal bone, for example:
• Zygomatic root • Petrous part of temporal bone and its apex• Mastoid tip • Cavum trigeminale • Digastric notch • Arcuate eminence• External auditory meatus • Internal auditory meatus• Squamous part of temporal bone • Cranial nerves VII, VIII, IX and X
(spaghetti-like structure)
2.0 Training Procedures
The bones should be removed from therefridgerator at least one hour before dissection.First, determine whether the bone is right or left,and secure it with a temporal bone holder in a
surgical position, as if in the operating theater.The zygomatic root is anterior, and the mastoidtip is inferior (Fig. 10a)
Fig. 10aLeft temporal bone with soft tissues.
External auditory meatus
Squama
Zygomatic root
Mastoid tip
Digastric notch
General rules• Specimen should be taken out of the
refridgerator one hour before dissection.• All needed instruments should be available.• Temporal bone should be in surgical
position.• Rapid review of the gross anatomy.• Verify operational integrity of the drill and
perform an initial function test .• Leave your bones in a labeled plastic bag.
Sanitary rules• Anti-hepatitis vaccination.• Wear gowns, gloves, overshoes, safety
glasses and face mask to prevent bone dustinhalation and entry of a bone splinter into theeye.
• Avoid injuries by using proper instruments.• Remaining bones and dust should be
handled as medical wastes.• Leave the working area clean and tidy for
the next group.
Dissection Manual for the Temporal Bone Laboratory14
Attempt soft tissue procedures, such as:• Periosteal incision and dissection• Dissection of the posterior meatal skin
down to the annulus.
1.
Drill a code number on the squama to prac-tice control of the drill handpiece, whichshould be held and used like a pencil. Neverapply undue force to avoid losing controland causing subsequent, potentially cata-strophic injury.
2.
Fig. 10bDifferent periosteal incisions and flaps.
U- shaped incision
Vertical andtransverse incisions
Transmeatal transverse andvertical skin incisions
Craniotomy flap
T- shaped incision
Obliteration flap
Sometimes the candidate cannot practice thesoft tissue work properly if formalinized speci-mens or macerated bones are used.The candidate should be familiar with the anatomyof macerated bones (Figs. 10d and 10e).
The Golden Rules of Drilling:• Hold the drill securely with a steady hand• Never perform blind drilling!• Proper burr type, size and shape.• Parallel direction• Excavate, but never penetrate.• Use suction-irrigation and prevent overheating.
Dissection Manual for the Temporal Bone Laboratory 15
Fig. 10cThe art of drilling.
Antrum External auditory meatus
Cells of the mastoid tip
Posterior meatal wall
Dural plate
Lateral SCC
Posterior tympanotomy
Sinus plate
Digastric ridge
Drill
Fig. 10dAnatomy of macerated bones. Lateral surface.
Squama
Zygomatic root
External auditory meatusMastoid
Tympanic plate
Digastric notchCarotid canal
Petrous bone
Fig. 10eAnatomy of macerated bones: Medial surface.
Arcuate eminence
Squama
Mastoid
Petrous bone
Internal auditory meatus
Dissection Manual for the Temporal Bone Laboratory16
Fig. 10fLeft myringotomy and grommet insertion.
Malleus handle andtympanomeatal flap Long incus process
Stapes head
Stapedial tendon
Lenticular incus process
Incudo-stapedial joint
Promontory
Fig. 11Left anterior tympanotomy.
Dissection Manual for the Temporal Bone Laboratory 17
Practice myringotomy and grommetinsertion (Fig. 10f).
3.
Practice anterior tympanotomy: a tympano -meatal flap is created by removal of theposterior meatal wall and exploration of themiddle ear (Figs. 11, 12a). Practice stape -dectomy and teflon piston insertion (Fig.12b)In-vitro fixation can be achieved by injectingadhesive glue around the footplate or intothe labyrinth through a “decapitated” super iorSCC at the arcuate eminence.
Check the annulus, incudo-stapedial joint, stapessuprastructures, stapedial tendon, pyramidalprocess, facial nerve, chorda tympani, malleushandle, tympanic membrane, promontory, andround window.
4.
Fig. 12aLeft anterior tympanotomy (schematic drawing).
Annulus fibrosus
Long process of incus
Posterior meatal wall
Posterior crus of stapes
Incudostapedial joint
Tympanomeatal flap
Malleus handle
Chorda tympani
Promontory
Fig. 12bLeft stapedectomy and teflon piston insertion.
Teflon piston
Long process of incus
Lenticular process of incus
Promontory
Pyramidal process
Shaft
Perform myringoplasty, in which a piece ofperiosteum is harvested and used as a graftwhich is positioned with the underlay tech-nique to repair a previously created tympanicmembrane perforation.
Dissection Manual for the Temporal Bone Laboratory18
5.
6.
Zygomatic root
External auditory meatus
Posterior meatal wall
Tip cells
Sinus plate
Antrum
Squama
Lateral SCC
Dural plate
Sinodural angle
Practice a cortical mastoidectomy (Figs.13, 14). Identify the spine of Henle, thenstart with the largest cutting burr in theMacEwen’s triangle between the inferiortemporal line, tangent to the posterior meatalwall and the spine of Henle. This triangle
serves as a landmark for localizing the mastoidantrum. Drilling should be accompanied by con-tinuous irrigation and performed parallel to theanticipated border without leaving behind anyoverhangs. Never work blindly. The antrum, whichis the largest mastoid air cell, has the lateral SCCon its floor. Cells over the dural and sinus platesare drilled, the sinodural angle is identified, andcells behind the sinus are cleared. Identify thedigastric ridge and clear the peri-facial and deepmastoid air cells. Keep the posterior bonymeatal wall intact.
Fig. 13Right cortical mastoidectomy.
Fig. 14Right cortical mastoidectomy (schematic drawing).
Lateral semicircular canal
Dural plate
External auditory meatus
Posterior meatal wall
Digastric ridge
Facial nerve
Sinus plate
Antrum
Sinodural angle
Dissection Manual for the Temporal Bone Laboratory 19
tympani, and facial nerve down to the middleear. The incudostapedial joint, promontory andround window niche should be visible.
Note: You can fill the external auditory meatuswith a colored fluid. This fluid should not leakinto the mastoid. If leakage occurs, it is anearly alarm that the annulus, tympanic mem-brane or posterior meatal wall was injured.
Incus body
Antrum
Short process of incus
Lateral SCC
Posterior meatal wal
Incudo-stapedial joint
Window of the posteriortympanotomy
Facial nerve
Fig. 16Left posterior tympanotomy (schematic drawing).
7. Perform posterior tympanotomy (Figs. 15, 16)by initially gaining access to the middle earfrom the mastoid cavity while ensuring thatthe tympanic membrane and annulusremain intact. A cortical mastoidectomy isperformed to deepen the sinodural angleand thin the posterior meatal wall. The incusbody and its short process are identified.Drilling begins with the 2 mm-diamond burrbetween the incus short process, chorda
Fig. 15Left posterior tympanotomy.
Chorda tympani
Posterior meatal wall
Promontory
Body of incus process
Incudo-stapedial joint
Dural plate
Lateral semicircular canal
Facial nerve
Round window
Sinus plate
Dissection Manual for the Temporal Bone Laboratory20
8.
Fig. 18Right saccus decompression (schematic drawing).
Fig. 17Right saccus decompression.
Perifacial cells
Endolymphatic sacopened with a sickle knife
Sigmoid sinus
Lateral SCC (de-roofed)
Antrum
Posterior SCC (de-roofed)
Identify the endolymphatic sac (Figs. 17, 18).Both lateral and posterior SCCs are exposedbut not opened. The peri-sinus cells aredrilled, and an imaginary line is passed alongthe lateral SCC, perpendicular to the poste-
rior SCC. The bone inferior to this line is thenthinned out and removed with a needle. The lateral wall of the sac is identified and incisedusing a sickle knife.
Dural plate
External auditory meatus
Posterior meatal wall
Sinus plate
Sinodural angle
Digastric ridge
Endolymphatic sac
Axis of lateralsemicircular canal
Axis of posteriorsemicircular canal
Dissection Manual for the Temporal Bone Laboratory 21
Fig. 20Right double cochleostomy.
Posteriormeatal wall
Cochleostomy
Secondcochleostomy
Window of the posterior
tympanotomy
Fig. 19Cochlear implant bed.
Corticalmastoid
Nose of theimplantdummy inthe recesscreated forelectrodes
Dummyinsertedinto theimplant site
Fig. 21Electrode hugging the modulus of the rightcochlea (counter-clockwise).
9. A cochleostomy is performed (Fig.20) afterpreparation of the cochlear implant bed(Fig. 19) and cortical mastoidectomy withposterior tympanotomy. An attempt can bemade under visual control with the cochleaopened from posterior so the electrode isconstantly under direct vision during inser-tion (Fig. 21).
Note: This step needs to be perform ed undersupervision of a trainer.
Dissection Manual for the Temporal Bone Laboratory22
10. Perform a radical mastoidectomy (Figs. 22,23) by drilling through the posterior meatalbony wall down to a level just above a linefrom the lateral SCC to the digastric ridge,removing the bridge over the attic area, as
well as the anterior and posterior buttresses. Theanterior attic is also cleared. Identify the facialnerve, semicanal of the tensor tympani muscleand the cochleariform process tendon. Try to com-plete an ossiculoplasty procedure.
Fig. 23Right radical mastoidectomy (schematic drawing).
Semi-canal of thetensor tympani muscle
Promontory
Round window
Stapes
Facial nerve
Sinus plate
Tendon of the tensortympani muscle
Cochleariform process
Dural plate
Dural plate
Lateral semicircular canal
Fig. 22Right radical mastoidectomy.
Middle ear
Lateral SCC
Zygomatic root
Stapes
Dural plate
Sinodural angleTip cells
Sinus plate
Dissection Manual for the Temporal Bone Laboratory 23
Superior SCC
Facial nerve
Lateral SCC
Posterior SCC
11. Perform a labyrinthectomy (Fig. 24, 25) byfirst identifying the domes of the three SCC.Open the canals and follow with a small dia-
mond burr to the vestibule. Preserve the anteriorpart of the lateral SCC to avoid injury to the facialnerve.
Fig. 24Left labyrinthectomy.
Fig. 25Left labyrinthectomy (schematical drawing).
Facial nerve
Posterior semicircular canalLateral semicircular canal
Superior semicircular canal
Dural plate
Stapes
Sinus plate
Dissection Manual for the Temporal Bone Laboratory24
3.0 Endoscopic Views of the Temporal Bone
Fig. 26Right tympanic membrane.
Malleus handle
Lateral malleus process
Cone of lightUmbo
Pars flaccida
Pars tensa
Fig. 27Oto-endoscopic view of the right middle ear through theEustachian tube.
Long incus process
Semicanal of thetensor tympani muscle
Middle ear
Incudo-stapedial jointTympanic membrane
Umbo
Eustachian tube
Tendon of the tensortympani muscle
Malleus handle
Dissection Manual for the Temporal Bone Laboratory 25
Fig. 28Left middle ear.
Facial nerve
Attic
Oval window
PyramidPonticulus promontorii
Sinus tympani
Subiculum promontorii
Round window
Mesotympanum
Promontory
Hypotympanic cells
Semicanal of thetensor tympani muscle
Eustachian tube
Fig. 29Right internal auditory meatus.
Superior vestibular area
Fallopian canal
Inferior vestibular area
Singular nerve
Cochlear area
Bill’s bar
Transverse crest
Dissection Manual for the Temporal Bone Laboratory26
Fig. 30Left internal auditory meatus.
Bill’s bar
Fallopian canal
Cochlear areaInferior vestibular area
Singular nerve
Superior vestibular area
Transverse crest
Fig. 31a, ba Right internal auditory meatus (de-roofed) and cochlea
opened with modiolous and spiral lamina visible.b MRI insert image provides orientation about the position of
the cochlea in (a).
Right internal auditory meatus(de-roofed)
Modiolus
Cochlea (opened)
Spiral lamina
a b
Dissection Manual for the Temporal Bone Laboratory 27
Fig. 32Endoscopic view of the right internal auditory meatus (IAM).The vestibular, cochlear and facial nerves are contained withinthe sheath of the dura mater.
Facial nerve
Vestibular nerve
Dural sleeve
Cochlear nerve
Internal auditory meatus
Jugular bulband inferiorpetrosal sinus
Dissection Manual for the Temporal Bone Laboratory28
4.0 Temporal Bone CT Images
4.1 Axial CT Scans
Axial CT sections that include 1 mm cuts withoverlap are appropriate for temporal bone visu-alization. The cuts start from the level of themastoid tip and continue up to the level of thesuperior SCC.
Some authors link the anatomical structureswith mnemonic cartoon symbols that aid inmemorizing the major structures and their char-acteristics, such as:
Mnemonicsymbols
Anatomicalstructure
Cochlearaqueduct
Basal turn ofthe cochlea
Cochlea
Common crus
Lateral SCC
Duck bill
Horn
Smile
Horns
Spot
Bucket handle
Internalauditorymeatus(IAM)
Mnemonicsymbols
Anatomicalstructure
Incus andmalleus
Attic, aditus,and antrum
Carotid artery
Vestibularaqueduct
Superior SCC
Funnel
Ice cream cone
Hour glass
Inverted L
Slit
Snake eyes
The following CT images very effectively illustratethe osteological details needed for this course
Dissection Manual for the Temporal Bone Laboratory 29
Fig. 33
Sphenoid sinus
Great wing of the sphenoid
Foramen ovale
Carotid artery (transverse)
Carotid artery (vertical)
Inferior petrosal sinus
Sphenoid body
Jugular vein
Posterior cranial fossa
Mandibular condyle
External auditory meatus
Sinus plate
Mastoid cortex
Occipito-mastoid suture
Squamo-sphenoid suture
Anterior cranial fossa
Foramen spinosum
Fig. 34
Sphenoid sinus
Great wing of the sphenoid
Foramen spinosum
Carotid artery (transverse)
Sphenoid body
Jugular vein
Petrous apex
Posterior cranial fossa
Mandibular condyle
External auditory meatus
Facial nerve
Mastoid cortex
Sigmoid sinus
Foramen ovale
Anterior cranial fossa
Try to refresh your knowledgewith the axial sections listed below.
Dissection Manual for the Temporal Bone Laboratory30
Fig. 35
Sphenoid sinus
Great wing of the sphenoid
Foramen ovale
Sphenoid body
Eustachian tube
Cochlea
Carotid artery (transverse)
Posterior cranial fossa
Middle ear
External auditory meatus
Facial nerve
Sigmoid sinus
Mandibular condyle
Foramen spinosum
Fig. 36Notice the basal turn of the cochlea, middle ear and thecochlear aqueduct.
Great wing of the sphenoid
Foramen ovale
Carotid artery (transverse)
Sphenoid body
Cochlea
Posterior cranial fossa
Petrous apex
Tympanic membraneand malleus
External auditory meatus
Facial nerve
Sigmoid sinus
Mandibular condyle
Middle ear
Dissection Manual for the Temporal Bone Laboratory 31
Fig. 37Notice the cochlea, posterior SCC, sinus tympani, semi-canalof the tensor tympani muscle, round window, facial nerve,chorda tympani, tympanic membrane, and malleus handle.
Carotid artery (transverse)
Round window
Cochlea
Ampullary end of theposterior semi-circular canal
Posterior cranial fossa
Cochlear aqueduct
Tympanic membraneand malleus
Facial nerve
Sinus tympani
Posterior semi-circular canal
Middle ear
Foramen rotundum
Fig. 38
Foramen rotundum
Semicanal of the tensortympani muscle
Carotid artery (transverse)
Posterior cranial fossa
CochleaFacial nerve
Common crus
Middle ear andauditory ossicles
Sinus tympani
Dissection Manual for the Temporal Bone Laboratory32
Fig. 39Notice the long incus process.
Carotid artery
Petrous apex
Cochlea
Semicanal of the tensortympani muscle
Posterior cranial fossa
Vestibule
Malleus
Sinus tympani
Facial nerve
Anterior and posterior crura of the stapes
Middle ear and ossicles
Long incus process
Fig. 40Notice the stapes, vestibule, common crus, and facial nerve.
Petrous apex
Internal auditory meatus
Vestibule
Cochlea
Posterior cranial fossa
Incudomallear complex
Vestibular aqueduct
Common crus
Facial nerve
Lateral semicircular canal
Dissection Manual for the Temporal Bone Laboratory 33
Fig. 41Notice the “ice cream cone” (incus and malleus) ossicular complex, vestibule, lateral SCC, facial nerve, IAM, and attic.
Greater superficialpetrosal nerve
Geniculate ganglion
Internal auditory meatus
Petrous apex
Posterior cranial fossa
Malleus head
Posterior semicircular canal
Superior semicircular canal
Mid-cranial fossa
Incus body
Fig. 42Notice the posterior and superior semicircular canals.
Mid-cranial fossa
Petrous apex
Internal auditory meatus
Greater superficialpetrosal nerve
Posterior cranial fossa
Attic
Posterior semicircular canal
Antrum
Superior semicircular canal
Aditus ad antrum
Dissection Manual for the Temporal Bone Laboratory34
Fig. 43Notice the superior SCC extending to the dome, which isequivalent to the arcuate eminence at the mid-cranial fossa.
Superior SCC
Dissection Manual for the Temporal Bone Laboratory 35
4.2 Coronal CT Scans
A series of 1 mm cuts with overlap are appropri-ate for temporal bone coronal CT imaging. Thecuts start from anterior to posterior from thelevel of the cochlea back to the level of the pos-terior SCC.
Some authors link the anatomical structureswith mnemonic cartoon symbols that aid inmemorizing the major structures and their char-acteristics, such as:
Superior SCC,lateral SCC,basal turn ofcochlean
Mnemonicsymbols
Anatomicalstructure
Transverse crest IAM
Vestibule andround window
Cochlea
Three fingers
Inverted tear drop
Snail shell
Scutum
Mnemonicsymbols
Anatomicalstructure
Malleus
Labyrinth andtympanic facialnerve seg-ments
Eustachiantube
Pyramid
Hammer
Snail eyes
Inverted triangle
Dissection Manual for the Temporal Bone Laboratory36
Fig. 44Notice the cochlea, carotid artery, Eustachian tube, middle ear,attic, digastric notch, tympanomastoid suture, and mandibularcondyle.
Petrous apex
Petro-occipital joint
Facial nerve, labyrinth portion
Attic
Cochlea
Carotid artery
Middle earDigastric notch
Eustachian tube
Mandibular condyle
Facial nerve, tympanic portion
Tegmen tympani
Annulus
Fig. 45Notice the attic, malleus head and neck, tendon of tensor tym-pani muscle, tympanic membrane, middle and external ear,Eustachian tube, petro-occipital suture, cochlea, mandibularcondyle, petrous apex, annulus, scutum, tegmen and cochleari-form process.
Petro-occipital fissure
Middle ear
Cochlea
Cochleariform process
Attic
Petrous apex
Eustachian tube
Tegmen
External ear
Tympanic membrane
Annulus
Mandibular condyle
Scutum
Malleus
Tendon of the tensortympani muscle
Mastoid air cells
Fig. 46Notice the internal auditory meatus and transverse crest, attic,malleus, scutum, tegmen, mastoid air cells, external auditorymeatus, tympanic membrane, mandibular condyle, annulus,petro-occipital suture, petrous apex and middle ear.
Petrous apex
Petro-occipital
Internal auditory meatus
Transverse crest
Attic
Middle ear
Annulus
Mastoid air cells
Tympanic membrane
Mandibular condyle
External ear
Tegmen
Malleus
Scutum
Try to refresh your knowledgewith the coronal sections listed below.
Dissection Manual for the Temporal Bone Laboratory 37
Fig. 48Notice the vestibule, round window, petromastoid suture,hypoglossal canal, and jugular bulb.
Vestibule
Petrous apex
Middle ear
Round window
Tympanic membrane
Antrum
Mastoid air cells
Tegmen tympani
External ear
Fig. 49Notice the jugular bulb, hypoglossal canal, mastoid cells, andSCC.
Superior semicircular canal
Lateral semicircular canal
Arcuate eminence
Jugular vein
Antrum
Mastoid air cells
Tegmen tympani
Facial nerve (vertical part)
Fig. 47Notice the internal auditory meatus, basal turn of the cochlea,superior (arcuate eminence) and lateral SCC, tympanic mem-brane, incus, stapes footplate, tegmen tympani, lateral semicir-cular canal, mastoid air cells, body of incus, scutum, externalear, incudo-stapedial joint, vestibule, petrous apex, petro-occipital fissure and middle ear.
Stapes footplate
Petrous apex
Vestibule
Superior semicircular canalArcuate eminence
Internal auditory meatus
Petro-occipital fissure
Basal turn of the cochlea
Middle ear
Body of incus
Tympanic membrane
Incudo-stapedial joint
External ear
Mastoid air cells
Tegmen tympani
Lateral semicircular canal
Scutum
Dissection Manual for the Temporal Bone Laboratory38
Fig. 50Notice the posterior SCC, mastoid air cells, jugular bulb,tegmen tympani, mastoid tip, lateral and superior SSCs andhypoglossal canal.
Lateral semicircular canal
Jugular vein
Posterior semicircular canal
Superior semicircular canal
Hypoglossal canal
Mastoid air cells
Tegmen tympani
Mastoid tip
Dissection Manual for the Temporal Bone Laboratory 39
Fig. 51
Eustachian tube
Facial nerve
Cochleostomy
Digastric ridge
Lateral SCC
Superior SCC
Solid angle
Posterior SCC
5.0 Exposure of the Temporal Bone: Genuine Dissections
Fig. 52
Posterior meatal wall
Short process of incus
Superior incudal ligament
Body of incus
Attic
Lateral SCC
Fossa incudis
Posterior tympanotomy
Dissection Manual for the Temporal Bone Laboratory40
Fig. 53
External auditory meatus
Incudostapedial joint
Incus
Fossa incudis
Attic
Tympanic plate
Antrum
Superior SCC
Annulus
Umbo
Facial nerve
Lateral SCC
Posterior SCC
Fig. 54
Semicanal of tensor tympani
Cochleariform process
Facial nerveTendon of the tensor
tympani muscle
Malleus handle
Tympanic membrane
Chorda tympani
Head of malleus
Body of incus
Incudostapedial joint
Superior SCC
Lateral SCC
Short process of incus
Fig. 55
Malleus
Incus
Tympanic membrane
Incudostapedial joint
Malleus handle
Anterior wall of externalauditory meatus
Promontory
Attic
Lateral SCC
Pyramidal process
Dissection Manual for the Temporal Bone Laboratory 41
Fig. 56
Körner’s septum is an internalextension of the petrosqua-
mous suture. May misleadinto a false antrum
Antrum
Fig. 57
Oval window
Promontory
Lateral SCC
Posterior SCC
Superior SCC
Facial nerve
Tegmen tympani
Sinus plate
Round window
Facial nerve
Jugular bulb
Dissection Manual for the Temporal Bone Laboratory42
☞ When is the right time to begin withtraining in the operating room?
● When both the trainer and trainee are equally satisfied about the outcome.
● When the trainee is able to identify earstructures as if within one’s own bedroomin the dark.
● After watching various live surgeries.
☞ When back to the operating room,never forget
● Morbid anatomy.● Congenital anomalies.● Continuous polishing of your skills.
Remember
Remember, that ear surgery is not foramateurs; it can end with unpleasantcomplications like facial nerve palsy, peri-lymph fistula and vertigo, fatal intracranialcomplications or hearing loss.
Dissection Manual for the Temporal Bone Laboratory 43
Dissection Manual for the Temporal Bone LaboratoryInstruments, Units, Video Systems and Accessories
Dissection Manual for the Temporal Bone Laboratory44
Please note: The temporal bone dissection laboratory should be located away from all clinical and surgical activities with sanitaryarrangements managed by the infection control officer of the hospital. The number of stations is subject to the number of participants.The main station should be equipped with a video camera and monitor for demonstration purposes. The lab should be equipped with alarge double level refrigerator for storage of the temporal bone specimens.
Checklist: Instruments for the Temporal Bone Dissection LaboratoryEach participant and main station:❑ 123207 HOLMGREEN Endaural Ear Speculum, self-retaining, outer diameter 7 mm❑ 223803 Seeker, with ball end, angled 45°, size 3, length 15.5 cm❑ 224001 HOUSE Curette, large, spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm, length 15 cm❑ 225205 Pick, 90º, length 16 cm, 0.5 mm❑ 152301 Ear Hook, without ball end, size 1, length 15.5 cm❑ 212803 LEMPERT Elevator, width 3 mm, length 19 cm❑ 213008 PLESTER Elevator, width 8 mm, length 18 cm❑ 208000 Surgical Handle, Fig. 3, length 12.5 cm, for blades 208010 – 19, 208210 – 19❑ 208015 Blades, Fig. 15, non-sterile, package of 100❑ 203710 Suction Tube, cylindrical, LUER, outer diameter 1 mm, working length 9 cm❑ 203730 Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm❑ 206500 FISCH Suction and Irrigation Tube, cylindrical, outer diameter of suction tube 3 mm,
irrigation tube 2 mm, working length 9.5 cm❑ 161000 HARTMANN Ear Forceps, alligator type, serrated, working length 8 cm❑ 223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm❑ 280120 Temporal Bone Holder, bowl-shaped, with 3 fixation screws for tensioning the
petrosal bone and with evacuation tube for irrigation liquid
Checklist: Powered Instrumentation – UNIDRIVE® ENTEach participant and main station:❑ 40 7116 01-1 UNIDRIVE® ENT
consisting of:20 7116 20-1 UNIDRIVE® ENT with KARL STORZ-SCB®,power supply 100 – 120, 230 – 240 VAC, 50/60 Hz400 A Mains Cord20 0126 30 Two-Pedal Footswitch, two stage, with proportional function20 7116 40 Silicone Tubing Set, for irrigation, sterilizable20 7116 21 Clip Set, for use with Tubing Set 20 7116 4020 0901 70 SCB Connecting Cable, length 100 cm031131-01* Single Use Tubing Set, sterile, package of 3
❑ 20 7110 32 High Performance EC Micro Motor❑ 20 7110 72 Connecting Cable, to connect EC micro motor 20 7110 32 to control unit❑ 252475 INTRA Drill Handpiece, angled, length 12.5 cm, for use with straight shaft burrs,
transmission 1:1 (40,000 rpm)❑ 260000 Standard Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15❑ 262000 Diamond Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15
Checklist : General Equipment for ParticipantsEach participant:❑ Zeiss Operating Microscope with side tube
Main station:Main station operating microscope with:❑ Camera control unit 20 2130 11❑ Camera head 20 2120 34❑ TV-Adaptor for ZEISS operating microscope 301677❑ Optical Beamsplitter 50/50, for use with Zeiss operating microscope 301513❑ C-Mount Microscope Adapter 20220040 and monitor 9415 N
Each participant and main station:❑ Suction and irrigation unit❑ Gowns❑ Gloves❑ Overshoes❑ Head caps❑ Fluid soap❑ Tissues❑ Disposable syringe
Dissection Manual for the Temporal Bone Laboratory 45
Instruments for the Temporal Bone Dissection Laboratory
123207 HOLMGREEN Endaural Ear Speculum,self-retaining, outer diameter 7 mm
212803 LEMPERT Elevator, width 3 mm,length 19 cm
213008 PLESTER Elevator, width 8 mm,length 18 cm
208000 Surgical Handle, Fig. 3, length 12.5 cm,for Blades 208010 – 19, 208210 – 19
208015 Blades, Fig. 15, non-sterile, package of 100223803 Seeker, with ball end, angled 45°, size 3,
length 15.5 cm224001 HOUSE Curette, large,
spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm,length 15 cm
225205 Pick, 90º, length 16 cm, 0.5 mm
123207 212803 213008 208000
208015
223803
223803
224001
224001
225205
225205
Dissection Manual for the Temporal Bone Laboratory46
152301
152301
Instruments for the Temporal Bone Dissection Laboratory
152301 Ear Hook, without ball end, size 1,length 15.5 cm
223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm
161000 HARTMANN Ear Forceps, alligator type,serrated, working length 8 cm
203710 Suction Tube, cylindrical, LUER,outer diameter 1 mm, working length 9 cm
203730 Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm
206500 FISCH Suction and Irrigation Tube, cylindrical, outer diameter suction tube 3 mm,gelieferti irrigation tube 2 mm,working length 9.5 cm
280120 Temporal Bone Holder, bowl-shaped,with 3 fixation screws for tensioning thepetrosal bone and with evacuation tube forirrigation liquid
223500
223500
8 cm
161000
161000
203710
203710
9 cm 203730
203730
11 cm
206500
206500
9,5 cm
280120
Dissection Manual for the Temporal Bone Laboratory 47
UNIDRIVE® ENTThe high-end multifunction system for excellenthandling and convenience in the OR
One unit – six functions
• Shaver S7ystem for surgery of the paranasal sinuses and anterior skull base
• Sinus Burr• Drill• STAMMBERGER-SACHSE Intranasal Drill• Micro Saw• Dermatome
Special features:
• With touch screen• Color display• Choice between several display languages• Functions displayed in words• Clearly defined operating elements• Set values of the last session are stored• Automatic error message via text display
Dissection Manual for the Temporal Bone Laboratory48
UNIDRIVE® ENT
Special features and benefits
Constant motor speed• Microprocessor-controlled motor speed• Preselected parameters are maintained during drilling• Continuously adjustable speed of rotation• Maximum speed of rotation can be preset
Integrated irrigation pump• Microprocessor-controlled flow rate• Quick and easy connection of the tubing set• Flow rate can be controlled from the sterile area via footswitch• Flow rate adjustable from 6–125 ml/min
2 motor outputs• Simultaneous connection of 2 motors• Active output can be selected from the sterile area via footswitch
Saves time
• 2 motors can be connected simultaneously � no plugging or unplugging during the operation
• Automatic display of error messages� no time-consuming error tracing in the operating room
• Exact reading and adjustment of motor speed• Preselected parameters can be stored
� set-point values for motor speed and flow rate do not need to be readjusted with each new procedure• Quick and easy connection of the tubing set to the pump
Relieves OR personnel
• The time for preparation prior to surgery is considerably reduced by standardization• Irrigation flow rate and motor speed adjustable via footswitch• Easy to use due to clearly structured design and optimized function selection• Personnel can use the time saved for other tasks• User can control multiple functions from the sterile area via footswitch
Saves money
• Only one unit required to perform six functions• Most of the available shaver blades, burrs and drills are reuseable
� enables perfect hygienic reprocessing• EC micro motor is compatible with various INTRA drill handpieces
Dissection Manual for the Temporal Bone Laboratory 49
Mode Handpiece No. Motorspeed(max.) rpm
Touch Screen: 6.4" / 300 cd/m2
Weight: 6.1 kg
Certified to: IEC 60-1 CE acc. to MDD
Selectabledisplay English, French, German, Spanish,languages: Italian, Portuguese, Greek, Turkish
UNIDRIVE® ENT
Shaver modeOperation mode: oscillatingMax. rev. (rpm): in conjunction with Micro Shaver Handpiece 40 7110 35 3,000*
in conjunction with Paranasal Sinus Shaver Handpiece 40 711039 7,000*in conjunction with DrillCut-X Shaver Handpiece 40 711040 7,000*
Sinus Burr modeOperation mode: rotatingMax. rev. (rpm): in conjunction with DrillCut-X Shaver Handpiece 407110 40 12,000
Drilling modeOperation mode: counter-clockwise or clockwiseMax. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 40,000
and Connecting Cable 207110 72
Micro Saw modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 711032 20,000
and Connecting Cable 207110 72
Intranasal Drill modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 711032 60,000
and Connecting Cable 207110 72
Dermatome modeMax. rev. (rpm): in conjunction with EC Micro Motor 20 7110 32 8,000
and Connecting Cable 207110 72
* Approx. 3000 rpm is recommended as this is the most efficient suction/performance ratio.
Power supply: 100-120, 230-240 VAC, 50/60 Hz
Dimensions: 304 x 164 x 263 mm(w x h x d)
Two outputs for parallel connection of two motors
Integrated irrigation pumpFlow rate: 6-125 ml/min, adjustable in 8 steps
Technical specifications:
Dissection Manual for the Temporal Bone Laboratory50
UNIDRIVE® ENT
20 7116 20-1
40 7116 01-1 UNIDRIVE® ENTconsisting of:20 7116 20-1 UNIDRIVE® ENT with KARL STORZ
Communication Bus System ®,power supply: 100 – 240 VAC, 50/60 Hz
400 A Mains Cord20 0126 30 Two-Pedal Footswitch, two-stage,
with proportional function20 7116 40 Silicone Tubing Set, for irrigation, sterilizable20 7116 21 Clip-Set, for use with tubing set 20 7116 4020 0901 70 SCB Connecting Cable, length 100 cm031131-01* Disposable tubing set, sterile
* mtp medical technical promotion gmbh, Take-Off Gewerbepark 46, D-78579 Neuhausen ob Eck, Germany
Dissection Manual for the Temporal Bone Laboratory 51
Two-Pedal Footswitch
20 0126 30 20 7116 40
U N I T S I D E
P A T I E N T S I D E
UNIDRIVE® ENT
Silicone Tubing Set
Shaver Blade, straight
41305 DN
Shaver Blade, curved
41201 KN
41202 KN
Sinus Burr
253000 - 253300
Dermatome
254000 - 254300
Micro Saw
Shaver Blade, straight
Shaver Blade, curved
40201 KN
40302 KN
252475 - 252495
660000
INTRA Drill Handle
Intranasal Drill
EC Motorwith Connecting Cable
20 7110 3220 7110 72
STAMMBERGER-CASTELNUOVODrillCut-X Shaver Handpiecewith integrat ed suction / irrigationchannel and longer shaver blade,with connecting cable
40 7110 40
Micro Shaver Handpiecestraight, with integrated EC-MicroMotor and Connecting Cable
40 7110 35
STAMMBERGER, Paranasal SinusShaver Handpiece90° angle, with connecting cable
40 7110 3920 7110 70
UNIDRIVE® ENTSystem Components
Dissection Manual for the Temporal Bone Laboratory52
252475 INTRA Drill Handpiece, angled,length 12.5 cm,for use with straight shaft burrs,transmission 1:1 (40,000 rpm)252475
INTRA Drill Handpieces
BurrsStraight Shaft Burrs, length 7 cm
260000 Standard Straight Shaft Burr, stainless,sizes 006 – 070, length 7 cm, set of 15
262000 Diamond Straight Shaft Burr, stainless,sizes 006 – 070, length 7 cm, set of 15
SizeDetail Dia. mm
Standard
for singleuse, sterile,
set of 5sterilizable
for singleuse, sterile,
set of 5sterilizable
TungstenCarbide
TransverseTungstenCarbide
014 1.4
018 1.8
023 2.3
027 2.7
031 3.1
035 3.5
040 4
045 4.5
050 5
060 6
–
–
260023 D
–
260031 D
–
260040 D
–
260050 D
260060 D
261014
261018
261023
261027
261031
261035
261040
261045
261050
261060
261123
–
261131
–
261140
–
261150
261160
DiamondDiamond,
coarse
–
007 0.7 – – – – –
008 0.8 – 261008 – – –
010 1 – 261010 –
261114
–
– –
–
–
006 0.6 – 261006 – – –
–
262023 D
–
262031 D
–
262040 D
–
262050 D
262060 D
262223
262227
262231
262235
262240
262245
262250
262260
070 7 –
260014
260018
260023
260027
260031
260035
260040
260045
260050
260060
260007
260008
260010
260006
260070 261070 – –
262014
262007
262008
262010
262006
262018
262023
262027
262031
262035
262040
262045
262050
262060
262070 262270
7 cm
Dissection Manual for the Temporal Bone Laboratory 53
20 2120 30 / 20 2121 30
TELECAM® One-Chip Camera Head
20 2120 34 / 20 2121 34
TELECAM® C-MOUNT One-Chip Camera Head
TELECAM®
One-Chip Camera Head20 2120 30 PAL
20 2121 30 NTSC
color systems PAL/NTSC, with integrated Parfocal ZoomLens, f = 25 – 50 mm (2x), 2 freely programmable camerahead buttons
20 2120 34 PAL
20 2121 34 NTSC
color systems PAL/NTSC, 2 freely programmable camerahead buttons
TELECAM® C-MOUNTOne-Chip Camera Head
For use with TELECAM® SL II Camera Control Unit 20 2130 11U
TELECAM® SL IICamera Heads
TELECAM® SL IICamera Control Unit
n
20 2130 20
20 2130 11U TELECAM® SL II Camera Control Unitcolor systems PAL/NTSC, with integrated digitalImage Processing Moduleconsisting of:20 2130 20 TELECAM® SL II Camera
Control Unit400 A Mains Cord20 2001 30U Keyboard, with US-english
character set2x 20 2210 70 Connecting Cable,
for controlling peripheral devices,length 180 cm
536 MK BNC/BNC Video Cable,length 180 cm
547 S S-Video (Y/C) Connecting Cable,length 180 cm
20 0400 82 DV Cable, 6 pin to 4 pin,length 500 cm
Specifications:
- Composite signal atBNC socket
- S-Video signal to 4 pinMini DIN socket (2x)
- DV signal to 6 pin DV socket
Video Output
Keyboard input for titlegenerator and camerafunctions to 5 pin DINsocket
Input
3.5 mm stereo jack plug(ACC 1, ACC 2)
Control Output
- Dimensions:305 x 88 x 254 mm (w x h x d)
- Weight:2.7 kg
Control Unit (CCU)
100-240 VAC, 50/60 Hz
Power Supply
IEC 601-1, 601-2-18,CSA 22.2 No. 601,UL 2601, and CE accor-ding to MDD, protectionclass 1/BF
Certified to:
Dissection Manual for the Temporal Bone Laboratory54
Video Accessories for Operating Microscopes
Example for direct C-MOUNT adaption:KARL STORZ Endovision® TELECAM® MicroscopeCamera Head
In addition to using the KARL STORZ Endovision®
camera systems with endoscopes, all KARL STORZ cameras can be connected to other systems, such asmicroscopes, colposcopes, and slit lamps. The adap -tation requires a standardized C-MOUNT connectionon the specific optical system.
This connection can be made both directly via the standardized C-MOUNT connection or indirectly via special quick-adaptors.
Both alternatives have specific advantages:
Direct Adaptation
A direct connection between camera and microscopehas the advantage that no special adaptor systems arenecessary any longer. The direct C-MOUNT connec-tion is safe, stable, and does not reduce quality. Such acon nec tion can be made, for example, with the TELE-CAM® C-MOUNT Camera Head 20 2120 34/20 2121 34or the TRICAM® C-MOUNT Camera Head 20 2210 34/20 2211 34 in conjunction with a C-MOUNT micro-scope adaptor.
Indirect Adaptation
An indirect adaptation between the KARL STORZ Endovision® camera systems and other optical sys-tems, for example, a microscope or colposcope with C-MOUNT connection, may be accomplished with specialquick-adaptors. These quick-adaptors ensure the con-nection between the standardized endoscope couplingand the C-MOUNT of the optical system. The advan-tage of this solution is that the camera can be pluggeddirectly into the optical system with the endoscopecoupling, without time-consuming threading action.Such a quick- adaptation is possible with allKARL STORZ Endovision® cameras.
Dissection Manual for the Temporal Bone Laboratory 55
Video Accessories for Operating MicroscopesAdaptor for Direct and Indirect C-MOUNT Adaptation
Camera Heads for quick coupling of Endovision®
camera with C-MOUNT Adaptor 2010 Z:Indirect C-MOUNT Adaptation
Camera Heads for use with TV Adaptor 301677:Direct C-MOUNT Adaptation
20 2120 3020 2121 30
20 2120 3420 2121 34
20 2200 40C-MOUNT
Microscope Adaptor
2010 Z
301677 TV-Adaptor, for ZEISS operating microscopeor colposcope, f = 85 mm, for use withOptical Beamsplitter 301513 and C-MOUNTAdaptor 2010 Z or TELECAM® C-MOUNTOne-Chip Camera Head20 2120 34/20 2121 34
20 2200 40 C-Mount Microscope Adaptor for use withKARL STORZ Endovision TRICAM® C CameraHead 20221034/20221134
2010 Z C-MOUNT Adaptor, allows quickcoupling of Endovision® camera e. g.with operating microscopes (the camera’s coupling device is mountedon the 2010 Z adaptor which fits to anoperating microscope’s C-MOUNT ring)
301513 Optical Beamsplitter 50/50,for use with ZEISS operating micro -scope or colposcope
301513
301677
Dissection Manual for the Temporal Bone Laboratory56
KARL STORZ AIDA™ compact II combines all the required functions for integrated and precisedocumentation of endoscopic procedures and open surgeries in a single system.
Data Acquisition
AIDA compact II records still images, video sequences and spokencomments of findings and intraoperative procedures directly from thesterile area. Recordings are activated via touch screen, voice control,footswitch or camera head buttons.
Live display of camera images on the touch screen enables immediatemonitoring and selection of the recorded data.
Flexible Review
Before final archiving, the saved data can be viewed or listened to onthe review screen. Data no longer required can be simply deleted.
Individual images, video and audio sequences can be renamed andgiven more meaningful names. A pre-defined selection list with key-words simplifies and speeds up data entry. Furthermore, a commentfield is available for entering relevant details of an intervention.
A voice entry of the case report can yet be recorded while viewing video and image files.
Automated Data Archiving
Once a treatment is completed, AIDA compact II automatically stores thedata on a DVD or CD-ROM, creates a standard report and prints it as anoverview if required.
Multisession and Multipatient
Efficient data archiving is assured as several treatments can be savedon one DVD, CD-ROM or on an USB stick.
AIDA compact II: Automatic creation of standard reports
AIDA compact II: Review screen
AIDA compact II:Efficient archiving
The Compact Documentation Solution
AIDA compact II: Voice control
Dissection Manual for the Temporal Bone Laboratory 57
Special Features:● Digital storage of still images, video sequences and audio files● Digital alternative to video printer, video recorder and dictating machine● Sterile, ergonomic operation via touch screen, voice control, camera head buttons
and/or footswitch● Efficient archiving on DVD, CD-ROM or USB stick, multisession and multipatient● Network storage is possible● Optional connection to PACS, RIS and HIS● Automatic creation of standard reports● Computers and monitors for use in the OR area certified according to EN 60601-1● Compatible with KARL STORZ Communication Bus (SCB) and OR1™ connect series
● PAL ● NTSC
● S-Video (Y/C)● Composite
● JPG● BMP
● MJPEG● MPEG1● MPEG2
● WAV ● DVD+R● DVD+RW● DVD-R● DVD-RW● CD-R● CD-RW● USB Stick
Video Systems Signal Inputs Image Formats Video Formats Audio Formats Storage Media
Specifications:
consisting of:20 0960 20 KARL STORZ AIDA™ control,
with integrated DVD/CD writer20 040377 Frame Grabber Board,
with digital I/Os20 0403 78 Slot Bracket, for digital I/Os20 0902 34U PS/2 Compact Keyboard,
US version, with cover20 0404 02-12 KARL STORZ AIDATM compact II
Software, with voice control andsoftware protection
20 0402 75 KARL STORZ USB Stick, 512 MB2 x 20 2210 70 Connecting Cable20 0901 38 Headset20 0903 76 Headset Extension Cable,
length 10 m547 S S-Video (Y/C) Connecting Cable,
length 180 cm400 A Mains Cord400 B Mains Cord, US version
20 0406 01U KARL STORZ AIDA™ compact II SystemDocumentation system for digital archiving of image,video and audio files in the OR,power supply: 100/240 VAC, 50/60 Hz
Dissection Manual for the Temporal Bone Laboratory58
20200032 KARL STORZ Special Beamsplitter, for use with IMAGE1™, TRICAM® and TELECAM® camera heads, for simultaneousviewing by endoscope and monitor screen. The camera headconnector is 120º deflected and can instantly be swiveled tothe desired position.
KARL STORZ ENDOVISION TRICAM® SL II with ® – autoclavableDigital Three-Chip Video Camera – Color Systems PAL, NTSC
20 2210 40 KARL STORZ Endovision TRICAM®, three-chip camera,color system PAL, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT.
20 2211 40 KARL STORZ Endovision TRICAM®, three-chip camera,color system NTSC, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT.
20 223011U1 TRICAM® SL II Camera Control Unit color system PAL/NTSC, with integrated KARL STORZ Communication Bus System ® and integrated ImageProcessing Module; power supply: 100–240 VAC, 50/60 Hz;set, ready for use; without camera head
20 2120 40 KARL STORZ Endovision TELECAM®, one-chip camera,color system PAL, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT
20 2121 40 KARL STORZ Endovision TELECAM®, one-chip camera,color system NTSC, with integrated Parfocal Zoom Lens,f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons,camera head autoclavable,including sterilisation tray 39301 ACT
20 2130 11U TELECAM® SL II Camera Control Unit, color system PAL/NTSC, with integrated Image ProcessingModule; power supply: 100–240 VAC, 50/60 Hz;set, ready for use; without camera head
KARL STORZ ENDOVISION TELECAM® SL II – autoclavableDigital 1-Chip Video Camera – Color Systems PAL, NTSC
Camera Control Unit
Camera Control Unit
Dissection Manual for the Temporal Bone Laboratory 59
KARL STORZ TM DVD-M with SmartscreenTM
Advanced Image and Data Archieving System
Special Features:● Digital storage of still images,
video sequenc es and audio files● Digital alternative to video printers,
video recorders and dictaphone● Easy and intuitive handling via touch screen,
camera head buttons or footswitch● Compact design● Efficient archiving on DVD-R, DVD+R,
CD-R, USB Stick, multisession andmultipatient
● SDI, S-video (Y/C) and compositevideo inputs
● Network storage is possible● All video signals are through-patchable to
the video monitor● Print-out of still images via ink jet printer
possible● Compatible with KARL STORZ Communication
Bus (SCB) and OR1™ connect series
20 2045 01-140 KARL STORZ AIDA™ DVD-M with SmartscreenTM,color system: PAL, NTSCpower supply: 100–240 VAC, 50/60 Hz
consisting of:20 2045 20-140 KARL STORZ AIDA™ DVD-M, with integrated
DVD/CD writer and integrated touch screen400 A Mains Cord400 B Mains Cord, US version536 MK BNC/BNC Video Cable, length 180 cm547 S S-Video (Y/C) Connecting Cable, length 180 cm2 x 20 0400 83 Adaptor, BNC–Cinch20 0400 84 Serial Connecting Cable, length 20 cm20 0400 85 DVI Connecting Cable, length 20 cm20 0400 88 USB-Extension Cable, length 7.5 cm
Dissection Manual for the Temporal Bone Laboratory60
Cold Light Fountains and Accessories
Cold Light Fountain HALOGEN 250 twin
20 1133 01 Cold Light Fountain HALOGEN 250 twin,power supply:100/120/230/240 VAC, 50/60 Hz,consisting of:400 A Mains Cord
495 NL Fiber Optic Light Cable, diameter 3.5 mm, length 180 cm
495 NA Same, length 230 cm
495 ND Same, length 300 cm
20134001 Cold Light Fountain XENON NOVA® 175power supply:100–125 VAC/220–240 VAC, 50/60 Hzconsisting of:400 A Mains Cord
20132026 Xenon-Spare-Lamp,only, 175 watt, 15 volt
Cold Light Fountain XENON NOVA® 175
Dissection Manual for the Temporal Bone Laboratory 61
Mobile Videocart
29003 NA Mobile Videocart, consisting of:29003 NAG Basic Mobile Cart, rides on
4 antistatic double-casters, 2 equipped with locking brakes, 1 shelf fixed, 1 shelf with mainsswitch, 1 shelf inclinable,1 drawer unit with lock, 1 push bar,with large lumen cable channelsintegrated in both columns, 1 set of non-sliding stands,1 camera mount
29003 PB Power Box with electrical supply terminal strip with 12 plugs,12 equipotential plugs
Dimensions:Mobile Cart:700 mm x 1280 mm x 686 mm (w x h x d)shelf: 630 mm x 480 mm (w x d)caster diameter: 125 mm
TFT-Flat Screen MonitorsMultinorm Liquid Crystal Display, PAL and NTSC with automatic switch-over
9415 NN / 9419 NN
9415 NNB / 9419 NNB
29003 NA
9415 NNB 15" KARL STORZ TFT Flat Screen,Wall-mounted with VESA 100 mounting,color systems PAL/NTSC, resolution max.1024 x 768, video inputs: (XGA), SDI,Composite, S-Video, RGBS/VGA, brightness430 cd/m2, contrast 500:1,power supply 100 – 240 VAC, 50/60 Hzconsisting of:9415 NNG 15" TFT Flat Screen9419 PS External 24 VDC Power Supply400 A Mains Cord2x 536 MP BNC/BNC Video Cable,
length 240 cm547 SL S-Video (Y/C) Connecting Cable,
length 350 cm20 0403 72 SVGA Connecting Cable,
length 200 cmInstructions for use on CD-ROM
9415 NN Same, desktop model, with pedestal9419 NNB 19" KARL STORZ TFT Flat Screen EndoVue
Desktop, color systems PAL/NTSC, resolutionmax. 1280 x 1024 (SXGA), video inputs: SDI,Composite, S-Video and RGBS/VGA, brightness450 cd/m2, contrast 650:1, power supply 100 – 240 VAC, 50/60 Hzconsisting of:9419 NNG 19" TFT Flat Screen9419 PS External 24VDC Power Supply400 A Mains Cord2x 536 MP BNC/BNC Video Cable,
length 240 cm547 SL S-Video (Y/C) Connecting Cable,
length 350 cm20 0403 72 SVGA Connecting Cable,
length 200 cmInstructions for use on CD-ROM
9419 NN Same, desktop model, with pedestal
Dissection Manual for the Temporal Bone Laboratory62
Notes:
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