Glomus Jugulare - Steps of ITF type-A approach
ITF Type - A
Fig.1 Post auricular incision from temporal region to cricoid.
Fig.2 Skin flap was raised superficial to temporalis and sternomastoid muscles. Anteriorly based myoperiosteal flap was raised over mastoid (for blind closure).
Fig.3 EAC is divided at the bony and cartilagenous junction. Skin was dissected off the cartilage (for blind closure).
Fig.4 Elevated skin of the cartilagenous canal was everted and closed (first layer of blind sac).
Fig.5 Anteriorly based myoperiosteal layer was rotated (arrow) and sutured to the cartilage of the canal (as a second layer of blind sac closure)
Fig.6 Neck is dissected and ECA, ICA, IJV and cranial nerves VII, X, XI & XII are exposed.
Fig.7 Subtotal petrosectomy done. Facial nerve is decompressed from geniculate ganglion to its bifurcation in the parotid gland.
Fig.8 Decompressed facial nerve is rerouted anteriorly to expose the area of jugular bulb.
Fig.9 After complete excision of a glomus jugulatre. Tumour was found between ICA (yellow arrow head), jugular bulb (JB) and cochlea. Yellow arrow – rerouted facial nerve. C1 – Tip of C1 transverse process. IJV – internal jugular vein.
Fig.10 MR angio shows no blood flow on the side of tumour (yellow arrow). Tumour can grow inside the lumen of jugular bulb and occlude it completely.
Fig.11 Picture shows tumour inside IJV.
Fig.12 Tumour had been excised along with jugular bulb after extraluminally occluding the sigmoid sinus (green arrow). Yellow arrow – rerouted facial nerve. C1 – Tip of C1 transverse process.
Fig.13 Closure. Dead space is filled with free fat.
Fig.14 Closure. Temporalis muscle is rotated and sutured to sternomastoid muscle.
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)