Severe to Profound Sensorineural Hearing Loss Clinical Trial
Official title:
Radiological Classification of the Vertical Segment of Facial Nerve in Cochlear Implant Surgery
Cortical mastoidectomy and posterior tympanotomy is a classic approach for cochlear implant. Intimate knowledge of the relevant surgical anatomy of the temporal bone and facial recess is important to safely perform the posterior tympanotomy. Anatomical variation of facial nerve such as lateral or anterior position of vertical segment of facial nerve, will render this approach challenging. In this research, investigators proposed a Radiological Classification system of the position of vertical segment of facial nerve in relation to the lateral semicircular canal to predict difficult cases with narrow facial recess.
Cochlear implantation done by mastoidectomy, posterior tympanotomy and round window membrane
insertion or cochleostomy, if we have to. In cases with very laterally placed vertical
segment of the facial nerve a trans- mastoid trans- attic approach used with trans canal
monitoring as an alternative approach. Position of the vertical segment of the facial nerve
(VFN) determined by coronal view HRCT of temporal bone, bone window of 0.6 mm thickness by
using the cut posterior to the internal auditory canal at the level of lateral semicircular
canal (LSCC) and then drawing a line parallel to the bony canal of the VFN and another
parallel line on the outer bony wall of lateral semicircular canal (LSCC), and comparing
level of both. The location of the facial nerve classified into normal if the FN is medial,
same level or lateral to LSCC . Investigators referred the laterally placed FN (LPFN) when
the whole vertical segment of facial nerve is lateral to LSCC. In addition, distance between
VFN and LSCC was measured in cases of laterally placed FN.
Investigators proposed a radiological classification system of the mastoid segment of facial
nerve to predict round window niche accessibility through posterior tympanotomy
pre-operatively by using coronal view computed tomography scan of temporal bone. Facial
nerve position classified into 3 types in relation to LSCC:
1. TYPE I Medial to LSCC
2. TYPE II Same level of LSCC
3. TYPE III Laterally placed to LSCC III a) Less than 2mm III b) More than 2mm
;
Time Perspective: Retrospective