Middle Ear and Mastoid Microsurgery 2nd Edition PDF

Middle Ear and Mastoid Microsurgery 2nd Edition PDF



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Preface

The first edition of Middle Ear and Mastoid Microsurgery contains large numbers of figures and surgical photographs taken with film-based cameras in a step-by-step manner that successfully demonstrated the surgical philosophy of the Gruppo Otologico; it is recognized as one of the best textbooks in this field. During the 8 years since its publication, we have continued to improve our techniques and therapeutic strategies through more than one thousand operations a year. That period is most certainly long enough to have enjoyed the fruits of technological advancement. Many people urged us to update the contents of the book and record and formalize the advances in our clinical activity.
The development of digital cameras enables us to obtain more detailed and informative surgical pictures, even in severe conditions. Remarkable advances in the technology of cochlear implantation allow reliable solutions for profound sensorineural hearing loss. Over time we have increased our clinical activity relating to this surgery, and we have become one of the most important centers of this field. The reader can find herein very useful wisdom based on accumulated experiences including difficult cases. Considerable changes have also been made in the chapter on paraganglioma (Chapter 15), where our modification to Fisch’s classification is shown. Newly added representative cases are arranged in accordance with the classification, and readers can find reasonable solutions for this difficult pathology. With appropriate management of bleeding and adequate exposure, Class A and B paragangliomas can be treated as a category of middle ear surgery, and unnecessary embolization can be avoided. We have also rewritten the chapter on hemipetrosectomy followed by middle ear obliteration (Chapter 18). We recognize that the technique is very useful for treating troublesome situations such as intractable otorrhea in dead ears and severe pathologies widely infiltrating the middle ear. We now perform this surgery more than before. On the other hand, even in the era of sophisticated medical engineering such as navigation systems and radiological imaging, full knowledge of the three-dimensional anatomy of the temporal bone remains of prime importance. To facilitate understanding of the three-dimensional relationships between important structures, Chapter 1 on anatomy is supplemented by interpretation of computed tomography of a normal temporal bone.
One of the main focuses of this book is to demonstrate the surgical techniques required to reap stable results without complications. We believe that clear systematic photographs greatly help readers to understand the principles and system of the surgery. At the same time, we realize that the information we can provide is not sufficient for young doctors in particular. Middle ear surgeons have to work on very fine, fragile structures in a very small area using fine-edge instruments and a high-speed drill. Delicate and stable manipulation is required, and experienced surgeons are aware of small but important signs such as bleeding from particular points, changes of color, and the particular sound of drilling to guide surgery appropriately. Since nothing is easy in middle ear surgery, vigorous self-training and study with concurrent effort to accumulate clinical experience are required. A full range of knowledge of three-dimensional anatomy is a minimum requisite for performing safe surgery, but it can be learned only from repetitive work in temporal bone dissection laboratories. Surgical training in a step-by-step manner under the supervision of an experienced surgeon is a desirable solution.
One should also understand that middle ear surgery is not merely a chain of discrete techniques but is a part of the therapeutic strategy starting from diagnosis and ending in follow-up. For some patients, a conservative attitude may be appropriate for the time being. Surgery should be given to suitable patients in an appropriate way after considering multiple factors such as the patient’s wishes, age, and general condition, the grade and natural history of the disease, and the status of the contralateral ear. In some cases, referral to experienced surgeons may be the right answer. Such a situation sometimes conflicts with a surgeon’s desire to gain experience and skill, but it is important to always keep in mind that the surgeon must plan the surgery not for himself but for the patient.
We believe that the best way to learn is to teach. We have learned a lot through writing this book. We hope that this book will guide young doctors in the right direction, and help experienced doctors to refine their knowledge and to enjoy a positive feedback.
We sincerely thank our families for their continuous warm support. Many thanks go to our co-workers Giuseppe De Donato, Enrico Piccirillo, Antonio Caruso, Giuseppe Di Trapani, Seung-Ho Shin, Lorenzo Lauda, and Filippo Di Lella, who participated in preparing this book. The senior author, Mario Sanna, would like to express special thanks to some great teachers—Carlo Zini, Jim Sheehy, and William House. Co-author Hiroshi Sunose thanks his colleague Fumie Kaneko for his tremendous assistance. All the authors would like to acknowledge Stephan Konnry of Thieme Publishers for his collaboration and great help.


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