The purpose of this paper is to report some variations in technique developed in the course of over 200 fenestrations performed since April, 1947.
In comparing the appearance of ears successfully operated on with that of those that had fibrous or bony closures, I was struck by the frequent presence of a distinct downward dip of Shrapnell's area from the malleolar folds to the region of the facial nerve in the former (Fig. 2) and the absence of this dip in the latter (Fig. 1). When these observations are correlated with anatomical considerations, it appears that a factor in closure could have been failure of apposition of the tympanomeatal flap to, or contracture from, the inferior margin of the fenestra. Since the distance between the facial canal and the inferior edge of the fenestra novovalis is only 1 mm., it can be appreciated that apposition here is not a matter
HARBERT F. Some Aspects of Fenestration. AMA Arch Otolaryngol. 1956;63(4):347–350. doi:10.1001/archotol.1956.03830100005002