My name is Neil Patel, and this is a

video demonstrating facial

nerve decompression after a

traumatic temporal bone fracture.

This patient presented with house

and great six facial paralysis

following a skiing injury

roughly one week prior.

Electro diagnostic testing showed

greater than 90 percent degeneration

of the affected side

compared to the contralateral side

on evoked DMP or

testing.

Therefore, facial nerve

decompression was considered.

Preoperative CT imaging

demonstrated a longitudinal

temporal bone fracture involving

the genetic ganglion and sparing

the capsule.

Here you can see the edge of the

fracture on the mastoid cortex,

some fluid in the middle ear space.

Contiguity of the

Malula joint

and the fracture extending through

the Nicollet ganglion.

This photograph of a categoric

dissection shows the approximate

size and position of the temporal

craniotomy used for this procedure,

the craniotomy should be centered on

the external auditory canal or

center, just a.

to it to provide adequate

exposure of the pitcher's apex

interrogatory canal Janicki

Ganglion labyrinthian segment.

And then here we can

see the dura over the left temporal

lobe and the lateral edge

of the craniotomy.

We begin by elevating the temporal

Durah from a posterior to anterior

direction, we proceed

in this direction in an effort

to avoid a stretch injury

on the facial nerve by traction

on the greater superficial

nerve.

Initial landmarks include

the argument Éminence Peatross rich

medially and the

greater superficial Petrosian Nerve

or Gaspin Anteriorly.

As this case involved primarily

facial nerve dissection.

We will focus on the spine

and location of the Janicki ganglion

once the retractor is placed on the

Peatross ridge and

secured at the edge of the

craniotomy.

We use a press nerve

stimulator probe to localize the

position of the facial nerve engine

ganglion.

Using a three

millimeter diamond burner,

the phone over the

Internet to ganglion is

carefully removed.

We begin distally along

the Gaspin and proceed proximally,

though

some would begin at the

internal auditory canal and

proceed laterally.

Once the kespin is identified,

the Janicki ganglion can

be identified proximally and

the bone can be carefully removed

to decompress a.

In this case, there was some

inflammatory material

and hyper vascularity

of the tissue around the genitalia

ganglion consistent with a fracture

extending through it.

Once this bone is removed, you can

see both the labyrinthine

and genetic ganglion segments

of the facial nerve that will be

shown later in this video.

The bone lateral to the

ganglion is quite safe

as the cochlea is

deep and medial and

the internal auditory canal is

far medial as well.

This shows the facial nerve

segments, including the labyrinthine

Ginette Gullett and Tympanic segment

as it goes into the middle ear.

Once the labyrinthine segment is

decompressed to the internal

auditory canal dura.

We consider the decompression to be

complete. The key points of this

surgical approach include the

following.

The craniotomy should be centered on

the external auditory canal or

slightly anterior.

The House urban middle

class of Attracta, if used,

should be positioned on the true

Peatross Ridge,

the greater superficial Patroclus

nerve should be identified early in

the case anteriorly, either

visually or, if possible,

using electrical stimulation.

One should be careful to avoid

drilling immediately, medial and

deep to the

spine and

gangland to avoid injury to the

cochlea or internal carotid artery

in the bony decompression should be

ideally one hundred and eighty

degrees around the

labyrinthine segment, clinical

ganglion and proximal tympanic

segments of the facial nerve.