Since 1974 a creative and efficient global niche player in the field of medical publishing

Manual of Temporal Bone Dissection

edited by: M. Barbara

Price: € 50.00 / US $ 62.50

Add to cart

Publication details: Book. 2002. ix and 70 pages. Publication date: 2002-09-10. 57 full color illustrations. Spiral binding.
17x21 cm (6.7x8.3).

ISBN: 978-90-6299-190-7 (ISBN 10: 90-6299-190-4; Kugler Publications)

Also available as ebook



When the Programme of the Permanent Educational Center in Otology at the University of Rome 'La Sapienza' started its First Basic Course on the Temporal Bone in 1996, a long-standing dream of both my teacher, Professor Roberto Filipo, and myself was realised: to create a reference point for all colleagues who, in mid-southern Italy, wished to make a start in, or to improve their knowledge of, otology and otosurgery.

The presence of a prestigious foreign guest of honour at each course, the use of advanced technology and, last but not least, the informal set-up of the courses expressly desired by Professor Filipo, have been the winning weapons for the ever greater diffusion of our Center in Italy as well as abroad.

Therefore, in the present manual, it was natural to bring together all the teaching and advice that are offered to participants during the laboratory sessions, in a formula that combines pure anatomy with surgical applications. Although simple and certainly not exhaustive, this manual has required a huge amount of effort, and its realisation has only been possible thanks to:
Professor Roberto Filipo, my teacher, for all his advice and stimulating criticism;

Professor Robert Jackler, from the University of San Francisco (UCSF), who followed my work with his particular expertise;
Mr John Ballantyne, who revised the English version of the manual with his renowned professionalism;
Drs Aleandro Harguindey, Daniele Bernardeschi and Francesco Ronchetti for their constant dedication and tirelessness;
Dr Francesca Auriti for enriching the iconography;
and, most of all, my beloved Simonetta for her support.

Maurizio Barbara



The temporal bone is an anatomical jewel box of extraordinary complexity. Both the minuscule scale of its vital structures and their convoluted three-dimensional relationships make microsurgery of this region one of the most technically demanding of all operative endeavours. Unravelling the mysteries of temporal bone anatomy is the foremost challenge faced by every otologist. The goal of achieving perfect knowledge and facility will never be achieved. No matter how experienced a surgeon becomes, ongoing study of the finer points of temporal bone anatomy (observed both in the operating room and dissection laboratory) serves to maintain and improve his or her skill. 

Dr Barbara has produced a highly useful Manual of Temporal Bone Dissection to guide exploration of the temporal bone. Its stepwise approach will prove useful for both the novice otologist and the experienced surgeon seeking to refresh his or her knowledge. Its orientation upon specific surgical procedures, rather than pure anatomy, enhances its utility for the practising surgeon. This written resource is an essential element of the three components needed for a high quality surgical dissection course: a lucid manual (such as that authored by Dr Barbara), informative didactic sessions, and anatomical dissection proctored by expert microsurgeons. The team at 'La Sapienza' are to be congratulated for their efforts in producing an outstanding educational programme.

Robert K. Jackler, MD
San Francisco
July, 2002

Table of Contents

Table of Contents




Lateral (transmastoid) approach

Phase 1: Removal of the mastoid cortex
Phase 2: Opening of the superficial mastoid cell system
Phase 3: Opening of the deep mastoid cell system and antrotomy
Phase 4: Skeletonisation of the sigmoid sinus, opening of the retrofacial and medial tip cells, and exposure of the jugular bulb
Phase 5: Posterior and anterior epitympanectomy
Phase 6: Posterior tympanotomy (facial recess)
Phase 7: Lowering of the posterior wall of the external auditory canal
Phase 8: Classical radical mastoidectomy
Phase 9: Opening of the petrous apex
Phase 10: Cochleostomy and cochlear visualisation
Phase 11: Identification and skeletonisation of the vertical intrapetrous tract of the internal carotid artery, jugular bulb (subfacial approach) and petrous apex
Phase 12: Facial nerve decompression (second and third portions)
Phase 13: Identification of the endolymphatic sac
Phase 14: Isolation of the labyrinthine block
Phase 15: Labyrinthectomy and identification of the intraosseous endolymphatic sac and duct
Phase 16: Opening of the vestibule
Phase 17: Identification of the labyrinthine segment of the facial nerve
Phase 18: Identification and opening of the internal auditory canal

Supratemporal or middle fossa approach

Phase 19: Opening of the epitympanic cavity and of the petrous apex cells
Phase 20: Identification of the facial nerve and geniculate ganglion
Phase 21: Exposure of the internal auditory canal
Phase 22: Isolation of the cochlea

Posterior cranial fossa approach

Phase 23: Identification of the internal auditory canal



Surgical applications



Book reviews


This is a delightful and comprehensive presentation of the anatomy of the temporal bone. The author set out an easy to follow guide to the anatomy and relationships of the individual structures within the temporal bone. This is presented from a surgical bias and is full of helpful hints for the surgeon, ie from the most basic sitting position in front of the microscope, to the use of burrs and other instruments.
Each section is well labelled and dearly arranged, the manual facilitates a comprehensive tour through the temporal bone with clear reference to the salient anatomical landmarks and how to identify these structures. The author uses abbreviations, which are dear and referenced throughout the text. Unfortunately the print quality does not always do justice to the photographs. I think this is an excellent manual for both junior and experienced surgeons alike and is easy to follow.

Victoria MM Ward, FRCSI FRCS(Oto),
Specialist Registrar Otolaryngology.

Kugler Publications
Postal address:
P.O. Box 20538
1001 NM Amsterdam
The Netherlands
Tel: +31 20 68 45 700