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Glomus Tympanicum

Revision surgery. Subtotal petrosectomy

1. Planning the incision. Retraction of the retroauricular skin due to former mastoidectomy. 2. Incision. Periosteal flap. The cavity of the former mastoidectomy is seen.
3. Refinement of the mastoidectomy. Epitympanotomy.. 4. Completion of the epitympanotomy. The body of the incus is seen.
5. Skeletonization of the sigmoid sinus. New bone formation is seen on the sinus. 6. Searching for the digastric ridge.
7. The region of origin of the digastric muscle is seen. 8. Trying to locate the jugular bulb.
9. The blue color of the jugular bulb begins to appear. 10. Drilling Bill’s island.
11. The operation continuous through the meatus. The tympanic bone is removed. 12. View of the tumor in the hypotympanum.
13. Continuing the removal of the tympanic bone. 14. Gradual detachment of the tumor from the hypotympanum.
15. Continuing the detachment of the tumor and the mucosa. 16. While the tumor is being dissected, a small remnant is left behind, anteriorly and inferiorly.
17. The remnant is almost completely separated from the bulk of the tumor. 18. Drilling towards the jugular bulb. In front of the suction tip appears the figure of the internal carotid.
19. Mobilization of the tumor and removal with the suction. 20. Removal of the tumor remnant.
21. The continuation of the drilling reveals another remnant which is also removed. 22. The removal of bone from the hypotympanum leads to the disclosure of the dura of the posterior cranial fossa.
23. Elevation of the tympanic membrane. Due to adhesions, the mucosa of the promontory is also detached revealing cochlea. 24. Separation of the incudostapedial joint to explore the oval window.
25. Removal of the adhesive mucosa. 26. Receiving temporal fascia and muscle graft.
27. Covering the hypotympanic cavity with the compound graft. 28. Packing with absorbable pledgets.
29. Suturing the periostium.