TYMPANOMASTOID SURGERY

Diseases of the middle ear and their surgical treatment1 may result in injury to local structures of which the most serious are facial nerve, labyrinth, dura and bloodvessels2 [full text].  Such operative complications are not de facto evidence of substandard surgical technique, but they must be disclosed for informed consent. 

For facial nerve injury, substandard surgical technique may include 1) failure proactively to identify all anatomical landmarks including 2) the facial nerve, and 3) drilling perpendicular rather than parallel to the nerve.  Intra-operative electrical stimulation of the facial nerve can confirm or refute its intactness.  If the nerve is inadvertently cut, immediate grafting is indicated.  Facial nerve injury causes weakness of the muscles of the face. 

Labyrinthine injury is usually the result of 1) inadvertently opening a semicircular canal or the cochlea during drilling, or 2) trauma to the stapes while manipulating it surgically. Injury to the labyrinth causes deafness and/or dizziness.   

Copyright 2009 Electronic Handbook of Legal Medicine