Executive Editor: Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, Co-author: A Di Ieva

Skull base & Cranial vault

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Glossary

Transmatoid approach
Transmatoid approach for facial nerve decompression enlarge

Incision

A postauricular incision is commonly used to access the mastoid. The incision is taken through the skin, subcutaneous tissues, and down to the periosteum.


Transmatoid approach for facial nerve decompression enlarge

The periosteum is then incised in a T-shaped manner, and the mastoid bone is exposed.


Transmatoid approach for facial nerve decompression enlarge

Exposure of the facial nerve

The mastoid cortex is drilled off in a triangular fashion with the superior limb of the triangle paralleling the tegmen. The anterior limb of the triangle parallels the posterior wall of the external auditory canal.


Transmatoid approach for facial nerve decompression enlarge

With the antrum fully exposed, the outline of the facial nerve, which is completely encased in bone, is found just anterior to the outline of the horizontal semicircular canal. The nerve is exposed by carefully thinning the bone with a diamond burr using constant irrigation for cooling. Once the bone is thin enough, the nerve is completely exposed by lifting the remaining bone using a pick or another instrument.

v1.0 2011-05-14