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Dehiscent high jugular bulb: a pitfall in middle ear surgery
Bor-Rong Huang1, Chih-Hung Wang, Yi-Ho Young
1Department of Otolaryngology, Chung-Shan Hospital, Taipei, Taiwan, Republic of China.
Summary
High jugular bulb (HJB) dehiscence is a rare finding during middle ear surgery. This study shows that with careful management, HJB is not a contraindication for surgery, reducing operative risks.
Area of Science:
- Otolaryngology
- Neurosurgery
- Surgical Anatomy
Background:
- Dehiscence of the high jugular bulb (HJB) is an uncommon anatomical variation.
- It can pose a surgical challenge during middle ear procedures.
- Identifying and managing HJB is crucial to prevent intraoperative complications.
Purpose of the Study:
- To report the authors' experience with managing dehiscent high jugular bulb during middle ear surgery.
- To emphasize the importance of recognizing this anomaly to minimize surgical risks.
Main Methods:
- A retrospective review of 1,657 patients undergoing 1,857 middle ear surgeries between 1982 and 2002.
- Ten cases (0.5%) of dehiscent HJB were identified.
- Pre- and post-operative otoscopic examination, radiography, and audiometry were performed.
Main Results:
- Dehiscent HJB was found in ears with adhesive otitis media and chronic otitis media with cholesteatoma.
- Active bleeding occurred in 20% of cases upon flap elevation, managed with compression and gelfoam.
- The remaining HJB were reinforced with cartilage, fascia, or perichondrium, allowing successful completion of surgery without complications.
Conclusions:
- Dehiscent high jugular bulb is not a contraindication for middle ear surgery.
- Awareness and appropriate management strategies can significantly reduce operative risks associated with HJB.
