(A866) The Preoperative Temporal Bone CT: A Systematic Approach for Identifying Variants and Preventing Complications

Introduction: Otologic surgery treats various ear and skull base pathologies but carries risks of serious complications due to the need for sub-millimeter precision in a complex anatomic region. Preoperative temporal bone computed tomography (CT) is valuable for identifying anatomic variants that influence surgical approach, though its analysis and reporting are often inconsistent.

Methods: This study synthesizes imaging findings, literature, and expert experience to propose the mnemonic "Making Miracles Involves Focused Vision," a systematic framework for analyzing the mastoid, middle ear, inner ear, facial nerve, and vascular structures, improving temporal bone CT reporting and optimizing surgical outcomes.

Results: Our review identified clinically significant anatomical variations and pathologies. Mastoid findings such as pneumatization patterns are associated with conditions like chronic otitis media and mastoiditis. Tegmen defects and thinning, which increase the risk of cerebrospinal fluid leaks, are notable in cholesteatoma surgery. Elderly patients or those with sclerotic mastoids may also present with low-lying tegmen. Middle ear findings, including ossicular chain erosion, stapes fixation, and oval window stenosis, highlight the need for tailored surgical approaches to preserve hearing. Inner ear anomalies, such as semicircular canal dehiscence, Michel aplasia, and labyrinthitis ossificans, complicate procedures like cochlear implantation. Variations in the facial nerve, including dehiscence and medial deviation, present nerve injury risks during mastoid and middle ear surgeries. Vascular anomalies, such as high-riding jugular bulbs and aberrant carotid arteries, present additional challenges due to their proximity to the surgical field.

Conclusions: By systematically evaluating temporal bone CTs with the "Making Miracles Involves Focused Vision" framework, surgeons can identify critical landmarks and anatomical variations, enabling tailored strategies that enhance surgical planning, safety, and outcomes.