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The suprapyramidal fossa: a 3-dimensional reconstructive and surgical study.

Yanqing Fang1, Peidong Dai, Bing Chen

  • 1Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, People's Republic of China.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|October 12, 2011
PubMed
Summary

The suprapyramidal fossa (SF) is present in 68.3% of ears and can serve as a key landmark for identifying the facial nerve (FN) during otosurgery. Its consistent positional relationship with the FN canal is crucial for surgical navigation.

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Area of Science:

  • Otolaryngology
  • Surgical Anatomy
  • Medical Imaging

Background:

  • The suprapyramidal fossa (SF) is an anatomical structure in the middle ear.
  • Its precise location, prevalence, and morphology are not fully understood.
  • Accurate identification of anatomical landmarks is critical in otosurgery, particularly for the facial nerve (FN).

Purpose of the Study:

  • To define the anatomical position, occurrence rate, and configuration of the suprapyramidal fossa (SF).
  • To evaluate the utility of the SF as a landmark for the facial nerve (FN) during otosurgery.
  • To assess the diagnostic accuracy of high-resolution computed tomography (HRCT) in identifying the SF.

Main Methods:

  • Surgical observation of the SF in 300 ears with chronic otitis media.
  • 3-dimensional reconstruction of the SF and surrounding structures using high-resolution computed tomography (HRCT) data.
  • Analysis of the positional relationship between the SF and the facial nerve canal (FNC).

Main Results:

  • The SF was observed in 68.3% of surgical cases.
  • The SF is located posteriorly in the facial recess, adjacent to the pyramidal segment of the FN canal.
  • Observed configurations included rounded, curved-rod, and irregular shapes, with varying frequencies.
  • HRCT demonstrated a sensitivity of 79.0% and specificity of 88.4% for SF detection.

Conclusions:

  • The presence and configuration of the SF are variable.
  • A consistent positional relationship exists between the SF and the second genu of the FNC when the SF is present.
  • The SF can be a valuable anatomical landmark for identifying the FN during otosurgery.
  • HRCT has limitations in detecting atypical SFs.