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[Applied anatomy study related to implants in the temporal bone region].

OBJECTIVE: To study the bone anatomic structure of the temporal bone region and provide reference in implant surgery in this region. METHODS: Manual quantitative measurements of the bone structure were performed in 73 skull specimens (38 from male and 35 from female). RESULTS: In the area of 8:00-11:00 (right ear) and 16-22 mm from center of the external auditory canal in the temporal bone region, the minimum bone thickness is as follows: 11:00: 6.77 mm in male, 5.18 mm in female; 10:00: 8.60 mm in male, 6.77 mm in female; 9:00: 9.85 mm in male, 7.30 mm in female; 8:00: 14.50 mm in male, 10.80 mm in female. CONCLUSION: (1) In the temporal bone region, the area of 8:00-11:00 (right ear) and 16-22 mm from center of the external auditory canal offers sufficient bone for implants. The length of implants should be as follows: 11:00: 4-5 mm in male, 3-4 mm in female; 10:00: 4-7 mm in male, 4-5 mm in female; 9:00: 4-8 mm in male, 4-6 mm in female; 8:00: 4-12 mm in male, 4-8 mm in female. (2) Towards the external auditory canal and from 12:00 to 11:00, 10:00 to 8:00, the bone became thicker, so, if no ample bone is available in the initial site, the location should be shifted anti-clockwise in right side (clockwise in left side) and closer to the external auditory canal. (3) The differences between male and female are statistically significant in the temporal bone region, so they should be treated distinguishingly during the clinical practices.

Ear Canal↗

[3-D morphological study of the temporal bone].

OBJECTIVE: To establish the 3-D(three-dimensional) morphological study of the temporal bone by means of computer graphic techniques. METHODS: The serial sections of the temporal bone were processed by the technique of computer-aided 3-D reconstruction. The 3-D images of the multi-structures in the temporal bone were displayed on the monitor. The 3-D parameters of these structures were measured by a special software. The stereo-images of the structures in the temporal bone were obtained by stereoscopy and stereo-pairs. RESULTS: Most structures of the temporal bone were reconstructed in 37 instances for the different purpose of study. Each set of the stereo-pair corresponding to the structures in the temporal bones and many 3-D parameters were obtained. The complex spatial relationship among the reconstructed structures such as the facial nerve, endolymphatic sac, posterior tympanum and posterior ampullary nerve was revealed and the mechanic model of the ossicular chain was set up. According to these results, the surgical approach of the posterior ampullary nerve transection was designed and simulated on the graphic computer. CONCLUSION: The technique of computer-aided 3-D reconstruction provides a new tool for the study of the temporal bone. It is also helpful for the designs and simulations of the surgical approaches. The results of this study contribute to developmout of a new branch of pathology of the temporal bone and a primary 3-D morphological study of the temporal bone.

Ear, Middle↗

Invasion patterns of advanced temporal bone malignancies.

Primary malignancies of the temporal bone may originate in the external auditory canal, the middle ear, the endolymphatic sac, or the eustachian tube. The surgical treatment of advanced tumors in these regions is strictly dependent upon the radiographic delineation of disease extent and the tumor relationship to adjacent neurovascular structures. Twenty-six cases of stage III or IV squamous cell carcinoma of the temporal bone were retrospectively reviewed to correlate preoperative clinicoradiographic analysis with intraoperative findings. The following patterns of tumor invasion were identified: (a) superior erosion through the tegmen tympani into the middle cranial fossa; (b) anterior extension into the glenoid fossa and infratemporal space; (c) inferior growth through the hypotympanum and jugular foramen; (d) posterior involvement of the mastoid air cells; and (e) medial involvement of the middle ear and carotid canal. While otic capsule erosion was uncommon, several of these patients did present with lower cranial nerve palsies. Complex surgical procedures exist for the en bloc resection of advanced temporal bone cancers. Appropriate operative planning must be based upon a knowledge of potential patterns of tumor extension and meticulous radiographic assessment.

Aged↗

Imaging of pediatric temporal bone abnormalities.

Disorders involving the temporal bone in children may be associated with considerable morbidity. Hearing loss occurring during childhood may impair cognitive development and should therefore be diagnosed and treated as soon as possible. Thin section high resolution CT and MR imaging of the temporal bone provide critical information about a variety of developmental, inflammatory, traumatic, and neoplastic disorders, and are used for diagnostic purposes and to help determine therapeutic options.

Adolescent↗

Bilateral longitudinal temporal bone fractures: a retrospective review of seventeen cases.

The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reivewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty-nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.

Facial Paralysis↗

Anomalies of the auditory organ in Potter's syndrome. Histopathological findings in the temporal bone.

Histopathological findings in the temporal bone are described in a newborn infant, diagnosed as having Potter's syndrome. The infant has severely malformed low-set ears bilaterally and a small lower jaw; autopsy findings showed bilateral renal agenesis and pulmonary hypoplasia. The temporal bone indicated the deformities of the inner ear, classified as Mondini-type, complicated by extensive deformities to the external ear and middle ear, including absence of auditory ossicles, atresia of the oval window, abnormal course of the facial nerve, and hypoplastic external auditory canal. The cochlear membranous labyrinth showed nearly normal form in the upper turn, but severe hypoplasia in the basal turn, which was an unusual cochlear anomaly.

Abnormalities, Multiple↗

Temporal bone radiography using the orthopantomograph.

Temporal bone radiographs obtained with an Orthopantomograph were compared with conventional radiographs. In acoustic neurinoma, cholesteatoma, otitis media, and middle fossa tumors, both methods demonstrated the abnormalities well. In two cases with lesions extending beyond the range of conventional projections, the broad orthopantomographic coverage was very valuable. Mastoid air cells, the mastoid process, petrous ridge, and internal auditory meatus were well demonstrated by both techniques. Orthopantomography was found to be superior in the demonstration of the petrous apex, while the superior semicircular canal was better demonstrated on the conventional views. Bilateral symmetry was particularly good and because of fewer films, radiation exposure was considerably less with orthopantomography. For many applications, orthopantomography is an adequate convenient substitute for conventional methods of examining the temporal bones.

Adolescent↗

[A general review on the procedures in a human temporal bone laboratory].

Structures of the human ear are usually inaccessible during life for examination of pathologic changes of the underlying disease, which is only possible with postmortem studies of the human temporal bone. Human temporal bone laboratories serve as a unique source of material for research in this respect. They enable comparison between histologic findings of temporal bone sections and the ear pathologies documented prior to death, as well as comparison of diseased ears with any selected temporal bone specimens, both of which provide invaluable knowledge to be shared among researchers and other laboratories. This article aims to provide insight into the functions of temporal bone laboratories and to familiarize the reader with histopathologic studies conducted therein.

Humans↗

Temporal bone pathology in drowning.

The temporal bones of a 2-year-old child who had drowned were examined histopathologically. The abnormalities were limited to the submucosa and lumen of the tympanomastoid space. Abnormalities included severe edema, vascular congestion, and focal ecchymosis without inflammation in the submucosa and hemorrhage into the tympanomastoid air space. To determine the incidence of tympanomastoid hemorrhage in autopsy material, 258 temporal bones were reviewed, and 11 were found to have free blood in the tympanomastoid space. When specimens from victims of skull fractures, cerebrovascular accidents, and leukemia were excluded from the 11, the only specimen remaining was found to be that from a drowning victim. Tympanomastoid hemorrhage in the absence of otitis media, head trauma, cerebrovascular accident, or a bleeding diathesis appears to be strong supporting evidence for death by drowning.

Child, Preschool↗

Utricular and saccular volumetry in human temporal bones.

Using serially sectioned human temporal bones, endolymphatic volumes of utriculus and sacculus were measured with the aid of a computer. The mean of the utricular volume was 8.187 mm3, and the saccular volume, 2.096 mm3. The former was 3.9 X the latter. The surface area of the macula utriculi was 3.271 mm2, and the macula sacculi was 2.188 mm2. The former was 1.5 X the latter. The study using pathologic temporal bones (Meniere's disease, otosclerosis, and otitis media chronica) showed that the utricular volume could indeed increase, and the saccular membrane was found to be more fragile than the utricular membrane in those diseased conditions.

Child, Preschool↗

Pediatric temporal bone fractures.

Twenty-seven temporal bone fractures in 25 pediatric patients were evaluated over a 6-year period. The diagnosis was confirmed with otoscopy and high-resolution computed tomography scans (HRCT). Three-dimensional reconstruction of high-resolution computed tomography scans were used to aid in the diagnosis. The most common fracture was an oblique fracture which is oriented in an axial or horizontal plane with the temporal bone. Facial nerve paralysis was found in 6 of our patients, which is less than the expected incidence when compared to adults. Hearing loss was found in 24 patients, the most common of which was conductive hearing loss, which had a higher incidence than expected when compared with adults.

Accidental Falls↗

High-resolution CT of temporal bone trauma.

Computed tomographic (CT) findings in 18 patients with temporal bone trauma were reviewed. Eight patients suffered longitudinal fractures of the petrous bone, which were associated with ossicular dislocation in two patients. Transverse fractures were detected in six patients, with a contralateral mastoid fracture in one patient. In four patients, the fractures were restricted to the mastoid region. Of the 14 patients in whom adequate neurologic evaluation was available, seven had a permanent facial nerve or hearing deficit while five suffered at least a transient neurologic deficit related to the temporal bone trauma. Routine head CT (10 mm sections) demonstrated only eight of 19 petrous bone injuries. Clues to such injury included opacification of the mastoid air cells (10 patients), sphenoid sinus (11 patients), external canal and middle ear air space (10 patients), and local pneumocephalus (five patients). Evidence of brain trauma or extraaxial hematoma was seen in 12 patients. In 13 cases, high-resolution CT was also performed, demonstrating temporal bone injuries in all. This latter technique allows rapid and detailed evaluation of temporal bone trauma. Reports of radiographic evaluation of temporal bone trauma tend to deal with a somewhat skewed population, selected on the basis of clinical symptomatology. In a major trauma center equipped with high-resolution CT, it was found that temporal bone fractures may be seen incidentally, or in patients in whom symptomatology related to temporal fracture is obscured by much more serious neurologic compromise.

Adolescent↗

Severe middle ear anomaly with underdeveloped facial nerve. A temporal bone histopathologic case report.

The temporal bone histopathologic condition of a 9-year-old patient with unilateral congenital facial palsy and an auricular anomaly is described. The major pathologic findings were an extremely underdeveloped facial nerve, abnormal course of the facial nerve, an abnormally large middle ear artery that was suspected to be a persistent stapedial artery, absence of a pneumatized tympanic cavity, a severe ossicular anomaly, and an enlarged Eustachian tube. We believe that this child had a severe type of developmental anomaly of the middle ear, possibly caused by changes that occurred in early embryonal life. We reviewed the literature for similar cases in which the facial nerve is anomalous. We present a classification of such anomalies in the temporal bone in this case and in eight others and discuss the clinical implications of such anomalies.

Adolescent↗

"Ossifying" hemangiomas of the temporal bone: evaluation with CT.

Hemangiomas of the temporal bone that affect the facial nerve are more frequent than previously suspected. Six patients with slowly progressive or recurrent facial paralysis were evaluated with computed tomography. In each case, a lesion was demonstrated that enlarged the facial nerve canal and contained intratumoral spicules of bone. Typically the temporal bone was expanded by a lesion with an indistinct margin. Demonstration of the typical radiologic findings, especially the intratumoral bone spicules, makes hemangioma a much more likely diagnosis than schwannoma.

Adult↗

Histopathologic features of the temporal bone in usher syndrome type I.

Temporal bones of 2 patients with Usher syndrome type I were examined using light microscopy. In both patients, findings from histopathologic examination of the cochlea were characterized by degeneration of the organ of Corti, which was most marked in the basal turn, atrophy of the stria vascularis, and a decrease in the number of spiral ganglion cells. The cochlear nerve appeared to be diminished. The sensory epithelium of the saccular and utricular maculae of patient 1 was normal for age. The left temporal bone of patient 2, classified as Usher syndrome genetic subtype USH1D or USH1F, demonstrated the typical signs of severe cochleosaccular degeneration. Present cases and cases from the literature were reviewed in search of an explanation for the above-described differences in histologic findings.

Aged↗

Unusual complications of temporal bone fractures.

Eighty-two temporal bone fractures were diagnosed in 75 patients with high-resolution computed tomographic scanning. Excluding six gunshot injuries, 55 (72%) of the fractures were oblique, 11 (15%) were longitudinal, and ten (13%) were transverse. Facial paresis or paralysis occurred in 45 patients (60%), hemotympanum occurred in 67 (89%), and cerebrospinal fluid otorrhea occurred in 19 (25%). Among 66 patients in whom audiometry was performed, 20 (30%) had conductive hearing loss, nine (14%) had sensorineural loss, and 36 (55%) had mixed hearing loss. Vestibular symptoms were present in 23 patients (30%). Other unusual complications of temporal bone fractures were observed: bilateral abducens paralysis, three patients (4%); unilateral abducens paralysis, two (2.67%); trigeminal paralysis, one (1.33%); and aseptic sigmoid sinus thrombosis, one (1.33%).

Abducens Nerve Injury↗

Hearing loss and temporal bone structure in achondroplasia.

Characteristic temporal bone changes have recently been defined by high resolution CT in nine patients with achondroplasia (Cobb et al., Am J Neuroradiol 9:1195, 1988). These included narrowing of the skull base and "towering" petrous ridges resulting in abnormal orientation of the inner and middle ear structures. In order to determine whether these morphologic changes are the cause of the hearing deficit in achondroplasia, audiometric studies and ENT evaluation were performed in eight of the nine patients. All had a history of frequent otitis media and four had experienced tympanic membrane tube insertion. Three patients had significant sensorineural hearing loss, two had conductive hearing loss and one patient had combined hearing loss. None of the temporal bone morphologic changes were found to be correlated with the degree of either sensorineural or conductive hearing loss. Fusion of the ossicular chain was not present in any of our cases. Appropriate treatment of frequent acute otitis media and early awareness of middle ear effusions and conductive hearing loss in children with achondroplasia may be of great importance in preventing permanent hearing loss.

Achondroplasia↗