Proximity of carotid canal wall to tympanic membrane: A human temporal bone study

Objective: The objective was to examine the possible risk of injury to the internal carotid artery during procedures in the middle ear, including myringotomy. Study Design: Histopathological morphometric study of human temporal bones. Methods: One hundred forty-two human temporal bone specimens obtained from 92 individuals without any known ear disease were prepared for light microscopic study. Using 83 bones that were available for measurement, the thickness of the carotid canal wall (CCW), which is the medial wall of the bony portion of the eustachian tube, was measured. Using 15 bones selected for three-dimensional measurement, the closest distance from CCW to the anterior tympanic annulus was measured. Using all 142 temporal bone specimens, the CCW was examined to detect the presence of partial dehiscence. In one case, the images of CCW dehiscence and its surrounding structures were reconstructed by a personal computer. Results: The thickness of the CCW was 0.00 to 0.73 mm (average thickness, 0.24 mm [±0.12 mm]). The distance from the CCW to the anterior tympanic annulus was 1.8 to 8.1 mm (average distance, 4.9 [±1.7 mm]). Dehiscence of CCW was observed in 7 (49%) of 142 temporal bone specimens. The reconstructed image showed that the posterior half of the dehiscence of CCW could be seen from the external ear canal. Conclusions: The CCW was found to be extremely thin or even dehiscent in some cases, rendering the internal carotid artery vulnerable during transtympanic procedures. The study's findings emphasized the need for judicious care when operating in the anterior mesotympanum.