The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach

• Published in: Clinical otolaryngology Vol. 42; no. 2; pp. 268 - 274
• Main Authors: Pauna, H.F., Monsanto, R.C., Schachern, P.A., Costa, S.S., Kwon, G., Paparella, M.M., Cureoglu, S.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases - pathology; Bone Diseases - surgery; Cadaver; Carotid arteries; Carotid Arteries - pathology; Child; Cholesteatoma, Middle Ear - pathology; Cholesteatoma, Middle Ear - surgery; Chronic Disease; Ear diseases; Endoscopy; Female; Humans; Male; Middle Aged; Otitis Media - pathology; Otitis Media - surgery; Surgery; Temporal Bone - pathology
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.12712

Objective
Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals.
Design
Comparative human temporal bone study.
Setting
Otopathology laboratory.
Participants
We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma and then compared those two groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease.
Main outcome measures
We analysed the middle ear, carotid artery canal and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy.
Results
We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear‐diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease.
Conclusion
The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery.