{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:12:53Z","timestamp":1790845973324,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for the learning and training of the young oto-surgeon in order to perform middle ear surgery, which includes the management of inflammatory pathology, hearing rehabilitation, and also cognitive decline prevention surgery. The primary objective of this study was to identify common mistakes and critical passages during the initial steps of temporal bone dissection, specifically cortical mastoidectomy and posterior tympanotomy. Methods: A survey among 100 ENT residents was conducted, gathering insights into the most prevalent errors encountered during their training to uncover the most challenging aspects faced by novice surgeons during these procedures. Results: The most common mistakes included opening the dura of the middle cranial fossa (MCF), injury of the sigmoid sinus (SS), chorda tympani (CT), and facial nerve (FN) injury while performing the posterior tympanotomy. The most important critical steps to prevent mistakes are related to the absence of wide exposure during cortical mastoidectomy and the consequent impossibility of identifying the landmarks of the facial recess before performing posterior tympanotomy. Injury of these structures was more common in younger surgeons and in the ones who performed less than five temporal bone dissection courses. Conclusions: Numerous temporal bone dissections on cadavers are mandatory for ENT residents looking forward to performing middle ear surgery.<\/jats:p>","DOI":"10.3390\/jpm14040349","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T13:39:56Z","timestamp":1711546796000},"page":"349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Critical Steps and Common Mistakes during Temporal Bone Dissection: A Survey among Residents and a Step-by-Step Guide Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Giovanni","family":"Motta","sequence":"first","affiliation":[{"name":"ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2443-9133","authenticated-orcid":false,"given":"Eva Aurora","family":"Massimilla","sequence":"additional","affiliation":[{"name":"ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4312-4711","authenticated-orcid":false,"given":"Salvatore","family":"Allosso","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology-Head and Neck Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-1552","authenticated-orcid":false,"given":"Massimo","family":"Mesolella","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology-Head and Neck Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"De Luca","sequence":"additional","affiliation":[{"name":"Head and Neck Department, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7176-3652","authenticated-orcid":false,"given":"Domenico","family":"Testa","sequence":"additional","affiliation":[{"name":"ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Motta","sequence":"additional","affiliation":[{"name":"ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s12070-019-01692-0","article-title":"Herald Cell: The Gateway to Posterior Tympanotomy-A cadaveric Study","volume":"71","author":"Singh","year":"2019","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"935","DOI":"10.3109\/00016489.2013.797602","article-title":"Cochlear implantation surgery in patients with narrow facial recess","volume":"133","author":"Wang","year":"2013","journal-title":"Acta Otolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.anl.2017.05.020","article-title":"Posterior canal wall reposition for management of cholesteatoma: Technique and results","volume":"45","author":"Mobashir","year":"2018","journal-title":"Auris Nasus Larynx"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.amjoto.2015.01.006","article-title":"Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas","volume":"36","author":"Patnaik","year":"2015","journal-title":"Am. J. Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0030-6665(05)70153-5","article-title":"Complications and their management in tympanomastoid surgery","volume":"32","author":"Mancini","year":"1999","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00106-006-1527-z","article-title":"Acute complications during middle ear surgery: Part 1: Problems during tympanoplasty\u2014What to do?","volume":"55","author":"Schwager","year":"2007","journal-title":"HNO"},{"key":"ref_7","unstructured":"Matos Cruz, A.J., Hohman, M.H., and De Jesus, O. (2024). Facial Nerve Repair, Stat Pearls."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103304","DOI":"10.1016\/j.amjoto.2021.103304","article-title":"The posterior ligament of the incus (\u201cwhite dot\u201d): A reliable surgical landmark for the facial recess","volume":"43","author":"McMillan","year":"2022","journal-title":"Am. J. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s12070-021-02512-0","article-title":"Dimensions of the Posterior Tympanotomy and Round Window Visibility Through the Facial Recess: Cadaveric Temporal Bone Study Using a Novel Digital Microscope","volume":"74","author":"Samuel","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1017\/S0022215100059892","article-title":"A re-examination of Macewen\u2019s triangle as a surface marking for the mastoid antrum","volume":"76","author":"Pickard","year":"1962","journal-title":"J. Laryngol. Otol."},{"key":"ref_11","first-page":"8316B","article-title":"Variability of the temporal bone surface\u2019s topography: Implications for otologic surgery","volume":"8316","author":"Lecoeur","year":"2012","journal-title":"Proc. SPIE Int. Soc. Opt. Eng."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1017\/S0022215109004484","article-title":"History of instruments used for mastoidectomy","volume":"123","author":"Mudry","year":"2009","journal-title":"J. Laryngol. Otol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1097\/MAO.0000000000001532","article-title":"Anatomical Relationship of the Middle Cranial Fossa Dura to Surface Landmarks of the Temporal Bone","volume":"38","author":"Alhussaini","year":"2017","journal-title":"Otol. Neurotol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5152\/iao.2020.7748","article-title":"Grading of the Position of the Mastoid Tegmen in Human Temporal Bones: A Surgeon\u2019s Perspective","volume":"16","author":"Singh","year":"2020","journal-title":"J. Int. Avd. Otol."},{"key":"ref_15","first-page":"e62653","article-title":"An integrated (Microscopic\/Endoscopic) Dissection Ear Surgery Course","volume":"178","author":"Fermi","year":"2012","journal-title":"J. Vis. Exp."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1002\/lio2.844","article-title":"The parietal notch (Brammer\u2019s point): Accuracy of a surface landmark for temporal bone surgery","volume":"7","author":"Castle","year":"2022","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sanna, M. (2006). The Temporal Bone: A Manual for Dissection and Surgical Approaches, Thieme Medical Publishers.","DOI":"10.1055\/b-0034-59678"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Francis, H.W., and Niparko, J.K. (2016). Temporal Bone Dissection Guide, Thieme Medical Publishers.","DOI":"10.1055\/b-0036-135664"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/BF00179948","article-title":"Anatomical relationship between position of the sigmoid sinus and regional mastoid pneumatization","volume":"253","author":"Aslan","year":"1996","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_20","first-page":"e27068","article-title":"Pneumatization Pattern and Status of the Mastoid Antrum in Chronic Otitis Media: A Review","volume":"14","author":"Khan","year":"2022","journal-title":"Cureus"},{"key":"ref_21","first-page":"e31070","article-title":"Significance of K\u00f6rner\u2019s Septum in Relation to Occurrence of Squamous Chronic Otitis Media","volume":"14","author":"Murali","year":"2022","journal-title":"Cureus"},{"key":"ref_22","first-page":"304","article-title":"Clinical Importance of the Korner\u2019s septum","volume":"18","author":"Kemaloglu","year":"1997","journal-title":"Am. J. Otol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.5603\/FM.a2019.0079","article-title":"K\u00f6rner\u2019s septum (petrosquamosal lamina): The anatomical variant or clinical problem?","volume":"79","author":"Przewozny","year":"2020","journal-title":"Folia Morphol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5152\/iao.2022.21167","article-title":"Evaluation of the Relationship Between Facial Nerve and Lateral Semicircular Canal in the Posterior Tympanotomy Approach","volume":"18","author":"Yilmaz","year":"2022","journal-title":"J. Int. Adv. Otol."},{"key":"ref_25","first-page":"125","article-title":"Ossicular erosion in patients requiring surgery for cholesteatoma","volume":"24","author":"Mohammadi","year":"2012","journal-title":"Iran J. Otorhinolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/1098-2353(2000)13:4<251::AID-CA4>3.0.CO;2-E","article-title":"Topographical relationships among the facial nerve, chorda tympani nerve and round window with special reference to the approach route for cochlear implant surgery","volume":"13","author":"Haramoto","year":"2000","journal-title":"Clin. Anat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00276-015-1606-5","article-title":"Posterior tympanotomy is a riskier procedure in chronic otitis media than in a normal mastoid: A high-resolution computered tomography study","volume":"38","author":"Kim","year":"2016","journal-title":"Surg. Radiol. Anat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.anl.2020.05.002","article-title":"Facial Nerve Course in the temporal bone: Anatomical relationship between the tympanic and mastoid portions for safe ear surgery","volume":"47","author":"Ozaki","year":"2020","journal-title":"Auris Nasus Larynx"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1080\/00016489.2018.1504168","article-title":"A new technique to find the facial nerve and recess by using the short process of the incus and the spine of Henle as landmarks: Incus-spine angle","volume":"138","author":"Yilmazer","year":"2018","journal-title":"Acta Otolaryngol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1001\/archotol.1988.01860170064020","article-title":"Surgical dimensions of the facial recess in adults and in children","volume":"114","author":"Bielamowicz","year":"1988","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"103370","DOI":"10.1016\/j.amjoto.2021.103370","article-title":"Ossiculoplasty in incudostapedial joint defects: Audiologic outcomes of three type of partial ossicular prostheses in retrospective clinical study 1995\u20132015","volume":"43","author":"Massimilla","year":"2022","journal-title":"Am. J. Otolaryngol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jamaneurol.2022.4155","article-title":"Hearing Aids and Cochlear Implants in the Prevention of Cognitive Decline and Dementia-Breaking Through the Silence","volume":"80","author":"Denham","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1009087","DOI":"10.3389\/fneur.2022.1009087","article-title":"Can cochlear implantation prevent cognitive decline in the long-term follow-up?","volume":"13","author":"Kamin","year":"2022","journal-title":"Front. Neurol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/4\/349\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:19:14Z","timestamp":1760105954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/4\/349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,27]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jpm14040349"],"URL":"https:\/\/doi.org\/10.3390\/jpm14040349","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,27]]}}}