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Encountering a high jugular bulb during ear surgery.

R Fox1, R Nash1, T Tatla1

  • 1Northwick Park Hospital , Harrow , the UK.

Annals of the Royal College of Surgeons of England
|September 24, 2016
PubMed
Summary

High-riding jugular bulbs, a rare ear surgery complication, can cause severe bleeding if inadvertently opened. This case highlights the importance of recognizing jugular bulb variations during tympanomeatal flap elevation in myringoplasty.

Keywords:
HemostasisJugular veinMyringoplasty

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Anatomy

Background:

  • Jugular bulb abnormalities are uncommon but recognized complications in ear surgery.
  • A high-riding jugular bulb, occurring in 10-15% of patients, presents anatomical challenges within the temporal bone.
  • Inadvertent opening of the jugular bulb can lead to significant venous hemorrhage.

Observation:

  • A 52-year-old female patient presented with a central tympanic membrane perforation.
  • The patient underwent an elective endaural myringoplasty.
  • Brisk bleeding was encountered during the elevation of the tympanomeatal flap.

Findings:

  • The bleeding was attributed to an intraoperatively identified high-riding jugular bulb.
  • This anatomical variation posed a surgical risk during the myringoplasty procedure.
  • Careful flap elevation is crucial to avoid inadvertent injury to the jugular bulb.

Implications:

  • Highlights the necessity of pre-operative awareness and intra-operative vigilance for jugular bulb variations in ear surgery.
  • Emphasizes the potential for severe hemorrhage and the need for meticulous surgical technique.
  • Suggests that imaging may be beneficial in cases with suspected anatomical anomalies prior to ear surgery.