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Subtotal Petrosectomy

Fisch and Mattox[24] described a subtotal petrosectomy in combination with removal of the otic capsule to gain full exposure of the petrous apex. This technique offers the advantage of direct exposure from the carotid artery to the sigmoid sinus in an anteroposterior direction and exposure from the hypotympanum to the middle fossa dura in an inferosuperior direction. The contents of the IAC are left undisturbed, and the facial nerve does not require transposition, making possible complete removal of benign lesions of the petrous apex, including cystic structures with their lining matrix. This increased exposure results in total sensorineural hearing loss with the removal of the otic capsule.
  1.    A postauricular incision is made down to the temporalis fascia superiorly and through the periosteum posteriorly and inferiorly. A second incision is made along the temporal line through the temporalis muscle, the auricle is reflected anteriorly, and the cartilaginous canal is …