The preoperative temporal bone CT: a mnemonic for reducing surgical risk

Otologic surgery provides safe and effective treatment for a variety of ear and skull base pathologies. However, even routine procedures are not without risk of serious surgical complications. Ear surgery requires sub-millimeter tolerances near a variety of critical structures in a complex anatomic region. As such, preoperative computed tomography (CT) can be helpful to surgeons and radiologists for identifying anatomic variants that can influence surgical technique, and which may predispose patients to surgical complications. However, the analysis and reporting of temporal bone CT is not always detailed, consistent, or comprehensive. The purpose of this narrative review is to illustrate important landmarks and anatomic variants on the preoperative temporal bone CT, with special attention towards features important in otologic surgery and that may impact surgical risk. These critical landmarks and variants can be recalled using the mnemonic "Making Miracles Involves Focused Vision," which provides an educational framework for the major regions that should be systematically reviewed in the imaging report: mastoid, middle ear, inner ear, facial nerve, and vascular anatomy.