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Is the human round window really round? An anatomic study with surgical implications.

Francesca Atturo1, Maurizio Barbara, Helge Rask-Andersen

  • 1*Department of Neurology, Mental Health and Sensory Organs, Otorhinolaryngologic Unit, Medicine and Psychology, Sapienza, Rome, Italy; and †Department of Surgical Sciences, Head and Neck Surgery, Section of Otolaryngology, Uppsala University Hospital, Uppsala, Sweden.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|March 11, 2014
PubMed
Summary

The human round window (RW) is rarely round, often ovoid or skewed, influencing surgical approaches. Understanding these anatomical variations is crucial for effective surgical strategies and implant design in the middle ear.

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Area of Science:

  • Anatomy
  • Otology
  • Surgical Neuroscience

Background:

  • The precise shape of the human round window (RW) has been debated since its initial description.
  • Recent advancements in surgical techniques highlight the importance of understanding RW anatomy.
  • This study investigates the size and shape variations of the human RW using microdissected temporal bones.

Purpose of the Study:

  • To document the anatomical variations in size and shape of the human round window.
  • To assess how these variations may impact surgical access and the design of implants targeting the RW.

Main Methods:

  • Analysis of an archival collection of microdissected human temporal bones.
  • Delineation and photography of the RW rim from the labyrinthine aspect.
  • Topographical assessment of the RW's shape and dimensions.

Main Results:

  • The human RW is typically ovoid, orthogonal, skewed, or saddle-shaped, rarely perfectly round.
  • RW membrane morphology varies, with distinct anteroinferior and posterosuperior components.
  • Measurements revealed mean longest diameter of 1.90 mm, smallest diameter of 1.54 mm, and mean area of 2.08 mm², with significant individual variation.
  • A distinct anterior crista fenestrae structure, termed a "doorstep," may impede access to the scala tympani.

Conclusions:

  • The diverse anatomical features of the human RW necessitate consideration during surgical planning.
  • Understanding these variations is essential for optimizing surgical approaches and developing effective implants for RW interventions.