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PubMed1990

Radiation injury to the temporal bone.

Osteoradionecrosis of the temporal bone is an unusual sequela of radiation therapy to the head and neck. Symptoms occur many years after the radiation is administered, and progression of the disease is insidious. Hearing loss (sensorineural, conductive, or mixed), otalgia, otorrhea, and even gross tissue extrusion herald this condition. Later, intracranial complications such as meningitis, temporal lobe or cerebellar abscess, and cranial neuropathies may occur. Reported here are five cases of this rare malady representing varying degrees of the disease process. They include a case of radiation-induced necrosis of the tympanic ring with persistent squamous debris in the external auditory canal and middle ear. Another case demonstrates the progression of radiation otitis media to mastoiditis with bony sequestration. Further progression of the disease process is seen in a third case that evolved into multiple cranial neuropathies from skull base destruction. Treatment includes systemic antibiotics, local wound care, and debridement in cases of localized tissue involvement. More extensive debridement with removal of sequestrations, abscess drainage, reconstruction with vascularized tissue from regional flaps, and mastoid obliteration may be warranted for severe cases. Hyperbaric oxygen therapy has provided limited benefit.

Adult↗
PubMed1988

Three-dimensional reconstruction of the temporal bone from histologic sections.

To increase understanding of the stereoscopic anatomy of the temporal bone, we have developed a computer system for three-dimensional reconstruction of the temporal bone from human histologic sections. The results were satisfactory for reconstructing details of complicated temporal bone structures. This system is equipped with such functions that it is possible to observe the reconstructed structures from an arbitrary direction, and to investigate their internal aspects by cutting and drilling. Three-dimensional reconstruction by this method is useful not only in understanding the fundamental anatomy and stereoscopic relationship of various parts of the temporal bone, but also in simulating temporal bone surgery on reconstructed three-dimensional images.

Humans↗
PubMed1986

Nursing management of the patient with total en bloc resection of the temporal bone.

En bloc resection of the temporal bone is an extensive and complicated surgical procedure for removal of malignancies of the ear and temporal bone. The lengthy surgical procedure (18 to 36 hours) and the resultant functional disabilities and cosmetic deformities create special nursing management concerns. Preoperative preparation, carotid artery occlusion, and postoperative nursing management are discussed. Communication and psychological issues for the patient and family are presented.

Combined Modality Therapy↗
PubMed1978

Temporal bone resection for cancer.

Fifteen patients with cancer involving the temporal bone have been considered for radical surgical treatment by partial resection of the temporal bone during the past 12 years. All but one had undergone previous treatment by local surgery and/or irradiation. Two patients proved to be inoperable at surgical exploration. Three types of partial resection of the temporal bone and described to encompass disease involving the concha, the mastoid and squamous areas of the temporal bone, the ear canal, the middle ear, and the parotid gland. Closure of the surgical defect has been achieved in five cases using the residual pinna, in four cases with scalp flaps, and in five cases with a deltopectoral flap. Complications have been surprisingly few, with only one postoperative death. In one case communicating hydrocephalus persisted until death from residual disease many months later. Minor repair failure occurred in two patients. No attempt has been made to restore facial nerve function by grafting procedures. Long-term survival has been disappointing; however, it is considered that such radical surgery remains justified in selected cases for relief of the pain and disfigurement caused by chronic ulcerating neoplastic disease.

Aged↗
PubMed1999

Does otosclerosis occur only in the temporal bone?

HYPOTHESIS: Otosclerosis does not occur outside the temporal bone. BACKGROUND: The widely accepted assumption that otosclerosis is confined to the temporal bone has never been tested. It is important to investigate this issue, particularly because of evidence that otosclerosis may be a systemic (genetic) disease that could affect other bones. METHODS: Biopsies from 9 to 11 skeletal sites were obtained from 2 patients with clinical otosclerosis. Two hundred forty-one nontemporal bone sections were examined by light microscopy. RESULTS: No nontemporal skeletal bone section showed histologic evidence of otosclerosis. The data indicate, with 95% confidence, that the true prevalence of otosclerosis in the extratemporal skeleton of the 2 patients examined was < 3%. CONCLUSIONS: These findings suggest that otosclerosis is unlikely to occur outside the temporal bone. Factors unique to the otic capsule that may predispose it to otosclerosis are lack of bone remodeling and the presence of globuli interossei.

Adult↗
PubMed1990

Histological examination of the temporal bone in medicolegal cases of asphyxia.

Histological findings of the temporal bone in 23 autopsy cases of various asphyxial fatalities were studied. The temporal bones of 12 cases who died of tumors including mammary cancer, gastric cancer, myxoma of heart and craniopharyngioma, the bones of 3 cases of heart attack and the bones of 17 cases who died of various poisoning (barbiturate, amphetamine, paraquat and alcohol) were used as controls. In drowning, the primary finding was hemorrhage in the mastoid air cells of the bilateral temporal bones. In cases of strangulation by ligature, hemorrhage and edema of the cochlear duct in the inner ear as well as hemorrhage in the mastoid air cells were demonstrated bilaterally. In contrast, congestion and edema in the mastoid air cells and inner ear were found in cases of manual strangulation but there was no hemorrhage. From these results, the histological examination of the temporal bone is useful as an adjunct procedure for diagnosing the cause of asphyxia. Differentiation between drowning, strangulation by ligature and manual strangulation may be possible by observing hemorrhages or their absence in the mastoid air cells and inner ear.

Adolescent↗
PubMed1989

Temporal bone laboratory training for stapedectomy.

Practice in the Temporal Bone laboratory is a fundamental part of Otological training. Performing a stapedectomy on a normal temporal bone is handicapped by the mobility of the footplate. We describe a simple method of producing stapes footplate fixation in a normal temporal bone so that the operative conditions found in otosclerosis are more closely simulated.

Humans↗
PubMed2003

Quantitative analysis of Neanderthal temporal bone morphology using three-dimensional geometric morphometrics.

The temporal bone is the location of several traits thought to differentiate Neanderthals from modern humans, including some proposed Neanderthal-derived traits. Most of these, however, are difficult to measure and are usually described qualitatively. This study applied the techniques of geometric morphometrics to the complex morphology of the temporal bone, in order to quantify the differences observed between Neanderthal and modern human anatomy. Two hundred and seventy modern human crania were measured, representing 9 populations of 30 individuals each, and spanning the extremes of the modern human geographical range. Twelve Neanderthal specimens, as well as Reilingen, Kabwe, Skhul 5, Qafzeh 9, and 4 Late Paleolithic European specimens, were included in the fossil sample. The data were collected in the form of three-dimensional (3-D) landmark coordinates, and specimen configurations were superimposed using generalized Procrustes analysis. The fitted coordinates were then analyzed by an array of multivariate statistical methods, including principal components analysis, canonical variates analysis, and Mahalanobis D(2). The temporal bone landmark analysis was very successful in separating Neanderthals from modern humans. Neanderthals were separated from modern humans in both the principal components and canonical variates analyses. They were much further in Mahalanobis distances from all modern human populations than any two modern human groups were from each other. Most of the previously described temporal bone traits contributed to this separation.

Animals↗
PubMed2003

[Histiocytosis X of temporal bone in a 5 year old boy].

Histiocytosis X or Langerhans cell histiocytosis (LCH) is a disease including three less distinctive and overlapping conditions called eosinophilic granuloma (EG), Hand-Schüller-Christian (HSC) disease and Letterer-Siwe (LS) disease. A high index of suspicion is required to diagnose histiocytosis, especially when an ear disease is refractory to medical treatment. The authors present a case report of histiocytosis X in a 5-year-old boy with ear involvement. Bone destruction involved temporal bone and zygomatic process. The role of imaging diagnosis in evaluation of lesion extent with special consideration of CT is presented.

Diagnosis, Differential↗
PubMed2000

Temporal bone histopathology in connexin 26-related hearing loss.

OBJECTIVE: Mutations in GJB2, a gene that encodes a gap junction protein, Connexin 26 (Cx26), are responsible for approximately one third of sporadic severe-to-profound or profound congenital deafness and half of severe-to-profound or profound autosomal recessive nonsyndromic hearing loss (ARNSHL). Mouse mutants homozygous for knockouts of this gene are nonviable, precluding histopathologic studies of the associated inner ear pathology in this animal model. Therefore, we studied archival temporal bone sections to identify temporal bone donors with Cx26-related deafness. STUDY DESIGN: Temporal bone donors with a history of congenital severe-to-profound or profound deafness were identified in the registry of the Temporal Bone Library at the University of Iowa. Histological findings were interpreted in a blinded fashion. DNA extracted from two celloidin-embedded mid-modiolar sections from each temporal bone was screened for the 35delG Cx26 mutation. The entire coding region of Cx26 was screened for other deafness-causing mutations if the 35delG mutation was detected. RESULTS: Of five temporal bone donors with congenital severe-to-profound deafness, one donor was found to have Cx26-related deafness. This individual was a Cx26 compound heterozygote, carrying the 35delG mutation and a noncomplementary Cx26 missense mutation on the opposing allele. Microscopic evaluation of this temporal bone showed no neural degeneration, a good population of spiral ganglion cells, near-total degeneration of hair cells in the organ of Corti, a detached and rolled-up tectorial membrane, agenesis of the stria vascularis, and a large cyst in the scala media in the region of the stria vascularis. CONCLUSION: This study is the first to report the temporal bone histopathology associated with Cx26-related deafness. Preservation of neurons in the spiral ganglion suggests that long-term successful habilitation with cochlear implants may be possible in persons with severe-to-profound or profound Cx26-related deafness.

Adult↗
PubMed2006

Computed tomographic anatomy of the canine temporal bone.

This study aims to identify and describe structures of the temporal bone in normal dogs that can be depicted using computed tomography (CT). Five normal dogs of different breeds and both sexes ranging from 0.5 to 8 years were used as the study material. CT images of 2 mm thickness without abnormalities in the temporal bone were reviewed and analysed in bone and soft tissue settings. All images were compared with corresponding E 12 plastic-embedded cross sections of 3 mm thickness, which were acquired from anatomic cross sections of frozen beagles. The sections were provided from the Department of Pathobiology (Institute of Anatomy). CT is able to image all relevant bony structures within the temporal bone. Concerning soft tissue structures, CT allows their localization by using bony markers, i.e. the internal acustic meatus for the cranial nerves VII and VIII or the canals for the internal carotid artery and the temporal sinus. The provided reference images are meant to improve orientation within the complex anatomy of the temporal bone. On condition that slice thickness is equal to or smaller than 2 mm and bony setting is supplied, CT is able to visualize all relevant structures within the temporal bone. However, in clinical settings the combined look on air, liquids and bone as well as the contrast enhancement of soft tissues might prefer magnetic resonance imaging to CT.

Animals↗
PubMed1983

Osteogenic sarcoma of the temporal bone.

A case of osteogenic sarcoma of the temporal bone is reported. Most probably the sarcoma was induced by previous irradiation. The patient was treated by a wide temporal bone resection, but the tumour recurred three months after operation. The possibility of late-induced osteosarcoma of the temporal bone must be kept in mind when planning the irradiation of tumours of the nasopharynx.

Aged↗
PubMed1988

[How best to present the radiological picture of the temporal bone today?].

The detailed evaluation of anatomy and pathology of the temporal bone requires imaging modalities that are superior to plain x-ray films. Conventional polytomography has today largely been replaced by high-resolution CT. High-resolution CT provides excellent demonstration of the delicate bony structures and provides superior information about the soft tissues. The axial 1 mm scans of a complete temporal bone examination can be reformated in any number of planes. These reconstructions display the temporal bone in various projections. This theoretically well-founded procedure of individual processing has proven to be highly practical in more than 1000 examinations of the skull base. High-resolution CT with image reconstruction is the diagnostic method of choice for the evaluation of the skull base and especially the temporal bone, as the complex anatomy is best demonstrated by this technique. Six axial computed tomographic scans are demonstrated in detail. The special value of multiplanar reconstructions is illustrated by reconstructions in the coronal, sagittal and longitudinal plane.

Cochlea↗
PubMed2001

Prevalence of otosclerosis in an unselected series of temporal bones.

BACKGROUND: Histologic otosclerosis is a disease process without clinical symptoms or manifestations that can be discovered only by sectioning of the temporal bone at autopsy. Clinical otosclerosis is otosclerosis at a site where it causes conductive hearing loss by interfering with the motion of the stapes or of the round window membrane. Various authors have studied the prevalence of histologic otosclerosis on laboratory collections of temporal bones. Some 12% to 15% of temporal bones with histologic otosclerosis have demonstrated stapedial fixation. Using these figures for calculating the prevalence of clinical otosclerosis gives an extrapolated clinical prevalence of 0.99% to 1.2%. This does not correlate well with the clinical data on otosclerotic families, from which a clinical prevalence of 0.3% has been estimated. OBJECTIVE: To study the prevalence of histologic otosclerosis in an unselected series of temporal bones. STUDY DESIGN: During a 1-year period, 118 consecutive pairs of temporal bones of deceased patients at a tertiary care center were collected to determine the prevalence of otosclerosis. Although histology remains the gold standard for evaluation of otosclerosis, the gross observation of temporal bone slices combined with microradiography was used to screen for otosclerotic lesions more rapidly and with a lower cost/benefit ratio. The temporal bones, which were suspected of having otosclerosis with these techniques, were further analyzed by conventional histology. RESULTS: 2.5% of the 236 temporal bones (or 3.4% of patients) studied demonstrated histologic otosclerosis. CONCLUSIONS: Although the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30% to 0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by hearing loss or other otologic diseases.

Adolescent↗
PubMed1995

How I do it: an improved temporal bone holder.

Although some form of temporal bone holder is in use in virtually all ENT postgraduate teaching departments, a paucity of information in the literature may cause problems in selecting the most appropriate model to those responsible for equipping temporal bone laboratories. The bone holder which we describe is based on existing designs but incorporates a built-in irrigation system which offers considerable advantages to the unassisted operator.

Humans↗
PubMed1976

Metastatic disease of the temporal bone.

This paper discusses metastatic disease of the temporal bone, and illustrates its discussion with a case history. The incidence, signs, symptoms, and treatment generally recorded are discussed. The histopathology of such lesions, as well as a documentation of those organ systems most likely to provide temporal bone metastatic spread, is noted. As the primary neoplasias of the temporal bone, metastatic disease may coexist with or mimic chronic otitis media. It is the wary surgeon who carefully analyzed his patient, the history, the intensity of recognizing neoplasia with or without associated chronic otitis media.

Diagnosis, Differential↗
PubMed1979

Eosinophilic granuloma in the temporal bone.

Eosinophilic granuloma is an uncommon granulomatous disease which can affect the temporal bone. Although initially silent, the disease may erode the mastoid cortex, destroy the tegmen and extend into the cranial vault, as well as erode the semicircular canals or cochlea. These lesions almost always become infected and can be confused with chronic otomastoiditis. Equally important, temporal bone involvement may represent only one manifestation of a multifocal disease. Between 1940 and 1978, 19 cases of eosinophilic granuloma involving the temporal bone have been recorded in the Armed Forces Institute of Pathology Registry. Most recently, a 24-year-old white boatswain's mate was sent to the National Naval Medical Center for treatment of unifocal disease which originated in his right mastoid bone. He subsequently underwent modified radical mastoidectomy and received 2500 R cobalt therapy to the temporal bone following surgery. His case history is detailed and the problem of eosinophilic granuloma in the temporal bone is reviewed in depth.

Adult↗