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PubMedDate not supplied

[Computerized tomography: features of roentgeno-anatomy of the temporal bone].

Normal X-ray and computed-tomography anatomy of the temporal bone are presented. It is indicated that computed tomography has certain advantages over routine X-ray methods because it allows simultaneous visualization of bone structures and soft tissues of the temporal bone. The anatomical picture of every compartment of the tympanic cavity as seen in CT and visual features of different structures of the temporal bone as related to the tomographic section plane are described in detail. In addition to the clinical advantages, CT is superior to standard X-ray methods in terms of radiation safety of the lens. CT data help to understand correctly the nature of pathological formations in the temporal bone and to apply adequate and effective therapeutic measures.

Ear, Middle↗

PubMed2004

Pediatric temporal bone fractures in a rural population.

OBJECTIVE: To examine pediatric temporal bone fractures in a rural population. STUDY DESIGN AND SETTING: A retrospective chart review of pediatric temporal bone fractures between January 1, 1996, and December 31, 2000, at a rural academic medical center. RESULTS: A total of 108 patients were identified. Common etiologies include falls, bicycle-related injuries, and motor vehicle accidents. Animal-related injuries were identified primarily in patients under 5. Facial nerve injuries were noted in 7%, hearing loss in 16%, additional skull base fractures in 65%, and intracranial injuries in 75%. CONCLUSIONS: Temporal bone fracture etiology in the rural pediatric population is associated with age. Young children may suffer fractures secondary to animal-related accidents. Patterns of injury differ little between rural and urban settings. SIGNIFICANCE: Animal-related accidents may be a significant cause of temporal bone trauma in rural young children. Our data remain unique in that we report additional skull base fractures as well as intracranial injuries in this population.

Accidental Falls↗

PubMedDate not supplied

The vestibular aqueduct in patients with Meniere's disease. A temporal bone histopathological investigation.

Meniere's disease (idiopathic endolymphatic hydrops) was studied in human temporal bone histology sections. Measurements were made of the area, length, width, angle, position, and external aperture of the vestibular aqueduct in 27 temporal bones of individuals with this disease. These measurements were compared with measurements of the same parameters in 88 normal temporal bones. It was found that small vestibular aqueducts were more often observed in the temporal bones of patients with Meniere's disease than in temporal bones from individuals without this disorder. The difference in size of the vestibular aqueduct in bones with hydrops and normal bones was statistically significant.

Adult↗

PubMed1991

Cholesterol cysts of the temporal bone: diagnosis and treatment.

Cholesterol cyst (or granuloma) of the temporal bone, a recognized clinical entity distinct from cholesteatoma, is more common than previously thought. Apparently it is caused by obstruction of previously pneumatized temporal bone air cells. Surgical cure is achieved by drainage and reestablishment of normal pneumatization. This paper reviews 14 cholesterol cysts of the temporal bone, emphasizing the importance of preoperative imaging and surgical approach. Use of magnetic resonance imaging differentiates cholesterol cysts from cholesteatoma or other neoplasms. Computed tomography delineates the location of the lesion and defines temporal bone anatomy essential to surgical approach. The two studies together allow the surgeon to properly plan drainage, as in the case of a cholesterol cyst, versus excision or exteriorization, as in the case of cholesteatoma. The infralabyrinthine approach to a petrous apex cholesterol cyst is the procedure of choice when hearing preservation is desired.

Adolescent↗

PubMed2001

Temporal bone fracture and its complications.

OBJECTIVE: To explore the characteristics and treatment of temporal bone fractures and injuries in the medial-inner ear. METHODS: The clinical data of 48 cases of temporal bone fractures admitted to our hospital from January 1989 to November 1999 were retrospectively analyzed. RESULTS: Forty-eight patients with temporal bone fractures accounted for 17.00% of the homochronous craniofacial fractures. Of the 48 cases, temporal bone fractures induced by traffic accidents accounted for 66.67%, capillary fractures for 93.75%, medial inner ear injuries or craniocerebral injuries for 77.08% and hearing loss or tinnitus for 48.00%. The cerebrospinal fluid (CSF) otorrhea and facioplegia accounted for 36.70% and 3.00%, respectively, in the longitudinal fractures, while they were 25.00% and 37.50%, respectively, in the transversal fractures. Primary emergent operations were performed on 46 cases and neurosurgery accounted for 46.00%. Secondary procedures accounted for 16.70%. As a result, 43 cases survived (89.58%) and 5 died (10.41%). CONCLUSIONS: Traffic injury is the first high-dangerous factor for temporal bone fractures, which are often complicated with medial-inner ear or craniocerebral injury. The CSF otorrhea is common in the longitudinal fractures and facioplegia is common in the transversal fractures. The key step is to rescue the life, keep the airway unobstructed and maintain the circulation in the primary emergency treatment.

Adolescent↗

PubMed1990

Ancient temporal bone osteopathology.

Few isolated specimens or series of temporal bone abnormalities from antiquity are reported from North America. Infections were in the past and are today the most common otologic problems. Differentiating infectious disease residua from other causes of osteopathology has proven difficult for some not conversant with disease pathophysiology. During clinical experience spanning five decades and research involving several thousand aboriginal skeletons, data relating to temporal bone disease were accumulated. As a didactic exercise, findings in 18 illustrative temporal bones encountered during research are presented and discussed briefly.

Adult↗

PubMed1977

Microsurgical anatomy and dissection of the temporal bone.

The topographic and internal anatomy of the temporal bone is reviewed with emphasis on the relationships important to the suboccipital, middle fossa and translabyrinthine surgical approaches to the internal auditory canal. The equipment and materials needed for temporal bone dissection in the laboratory are reviewed. A stepwise method of dissection for each of the three surgical approaches to the internal acoustic meatus is outlined for both the dry and wet temporal bone.

Humans↗

PubMedDate not supplied

Autoimmune sensorineural hearing loss: a human temporal bone study.

PURPOSE: To describe histopathologic findings in temporal bones of a patient whose clinical history suggests a sensorineural hearing loss (SNHL) of autoimmune origin. MATERIALS AND METHODS: Temporal bones from a patient with a history of ulcerative colitis, leukemia, and SNHL were examined by light microscopy. RESULTS: Histopathologic findings included: (1) organs of Corti missing or absent in all cochlear turns; (2) cells decreased in spiral ganglia, and lymphocytic infiltration; (3) absence of portions of the spiral prominence; (4) endolymphatic hydrops in basal, middle, and apical cochlear turns and in the saccule and utricle; (5) fibrosis and osteoneogenesis of a scala tympani of the basal turn of the cochlea, the posterior semicircular canal, and the canal of Cotugno; (6) fibrosis of the vestibular aqueduct and endolymphatic sac; and (7) lymphocytes in the endolymphatic sac, perisaccular area, inferior cochlear vein, and Rosenthal's canal. CONCLUSION: Histopathologic findings in the temporal bones of this patient with ulcerative colitis, sensorineural hearing loss, and vestibular symptoms closely parallel those in a previously reported animal study of autoimmunity and suggest the possibility of a SNHL of autoimmune origin.

Adolescent↗

PubMed1997

[En bloc resection of the temporal bone for middle ear carcinoma extending to the cranial base].

En bloc resection of the temporal bone for squamous cell carcinoma of the middle ear was performed by the postauricular transtemporal and retromastoid approaches. The patient was a 70-year-old woman whose tumor extended to the middle and posterior cranial fossae. Temporal and retromastoid craniotomies were carried out, then the temporal dura and the cerebellar dura, and the transverse and sigmoid sinuses were exposed. The temporal dura and the cerebellar dura were opened, and the transverse sinus was ligated at the junction with the sigmoid sinus. After that, the tentorial dura was incised, the incision extending anteriorly to the middle cranial fossa and transecting the superior petrosal sinus. Consequently, a wide view into the middle and the posterior cranial fossae was obtained. In the posterior fossa, cranial nerves VII and VIII were divided. On the other hand, nerves IX, X and XI were preserved at the dural incision on the posterior surface of the temporal bone. Subsequently, in the area of the carotid canal, the temporal bone was drilled toward the medial side of the internal auditory canal and also posteriorly down to the jugular bulb. At this stage, the temporal bone and the soft tissue attachments, such as the middle and posterior cranial fossa dura, and the sigmoid sinus, were separated from the pyramidal apex and the clivus. The dural defect was repaired with a free pericranial graft. A rectus abdominis muscle flap was transferred to reconstruct the defect of the skull base resulting from the temporal bone resection. Postoperative complications like CSF leakage, meningitis and lower cranial nerve damage, were not seen after the treatment. The patient has shown no evidence of recurrence for the 28 months since the surgical treatment, and has not complained of any problems with swallowing or conducting conversations in daily life. With the contribution of recent developments in skull base and reconstruction surgery, more aggressive en bloc resection of the temporal bone can be carried out on patients with advanced middle ear carcinoma. These developments will also make it possible for patients whose prognosis was previously thought to be poor to have a chance for a cure.

Aged↗

PubMed1992

Selection of surgical approaches for meningiomas affecting the temporal bone.

The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long-term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine in 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa in two patients (4%), and retrolabyrinthine in one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred in 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures involved. Patients must be realistically counseled about the surgical morbidity and long-term outcome associated with each approach.

Facial Nerve↗

PubMed2005

[Imaging of the temporal bone. An overview].

Diseases of the temporal bone should be diagnosed by high resolution computed tomography (CT) and magnetic resonance imaging (MRI). Because of the excellent imaging of bony structures, CT is the method of choice for diagnosing pathologies of the external auditory channel, middle ear, and mastoid. Imaging of trauma is performed with CT. For examining the labyrinth system and interior auditory channel, MRI is the method of choice. This article gives an overview of the anatomy of the temporal bone and describes the most important pathologies.

Diagnosis, Differential↗

PubMed1975

Osteoradionecrosis of the temporal bone.

A series of twenty-nine cases of osteoradionecrosis of the temporal bone is described. Two patterns occur: a localized involvement of the tympanic plate which resolves after the spontaneous separation of a sequestrum of bone, and a more diffuse necrosis of the temporal bone with a high risk of involvement of adjacent structures, in particular the brain, labyrinth and facial nerve and to a lesser extent the temporomandibular joint and the parotid gland. Localized osteonecrosis occurs more commonly when the temporal bone is in the periphery of an irradiated field whereas irradiation aimed primarily at the temporal bone is more likely to be followed by diffuse disease. The use of megavoltage irradiation has not led to the disappearance of the complication which may occur as much as twenty years after the completion of the course of radiotherapy.

Adult↗

PubMed1997

[Chondroblastoma of the temporal bone. Apropos of a case].

A case of temporal bone chrondroblastoma is reported. The presenting symptom was a serious otitis. The finding on physical examination was partial facial palsy. The tumor was removed through a middle fossa approach. Chondroblastoma is a rare tumor that represents 1% of all primary bone tumors. In the temporal bone only 34 cases have been reported. The histologic diagnostic should be difficult. Radical excision is suggested regarding its tendency to recur.

Adult↗

PubMed1990

Radiation therapy for paragangliomas of the temporal bone.

Treatment of paragangliomas of the temporal bone (glomus jugulare and glomus tympanicum tumors) is controversial, with both surgery and radiation therapy having their advocates. This paper discusses the experience at the University of Arizona Health Sciences Center in treating 10 cases of this uncommon tumor between 1971 and 1988. Seven of 10 cases were initially treated using irradiation and achieved complete tumor control for a mean of 67 months (range = 23-107 months). Two patients, one treated surgically and the other by embolization, had recurrences and were salvaged by radiation, and neither has recurred. The final patient is disease-free 9 months after embolization and surgery. There have been no serious sequelae of treatment. We conclude that moderate-dose irradiation can safely control most temporal bone paragangliomas.

Female↗

PubMed1995

Temporal bone fractures.

The diagnosis and monitoring of patients presenting to an emergency department with blunt temporal bone fracture and complications requiring acute management were reviewed for a four-month period. Of 104 trauma patients with closed head injury, 15 patients were diagnosed with temporal bone fracture, 12 of whom survived their injuries. Four patients developed cerebrospinal fluid (CSF) otorrhea and two patients developed facial nerve paralysis; all patients had resolution of complications with conservative management. Significant shortcomings in the initial evaluation and monitoring of patients with temporal bone fracture were identified. Specific and thorough facial nerve examinations were not initially conducted on temporal bone fracture patients and subsequent inpatient monitoring for facial nerve paralysis and CSF otorrhea was incomplete. The outcome of temporal bone fracture is discussed. This article reminds the emergency physician of the importance of initial diagnosis and documentation of temporal bone fractures.

Cerebrospinal Fluid Otorrhea↗

PubMed2003

[Computer-aided surface area measurement of temporal bone pneumatization: histological sections].

Contention exists on the development of pneumatization of temporal bone. Many techniques to measure the volume of pneumatization have been reported, but no techniques for direct surface area measurement. We measured the surface area and volume of human mastoid air cells. Eight normal temporal bones removed at autopsy were analyzed and fixed in formalin fixative, decalcified, and embedded in celloidin, sectioned at 25 microns and stained with H-E for histological examination. Total surface area and the volume of human mastoid air cells were measured using a personal computer. The surface area of pneumatic spaces for the 8 temporal bone specimens ranged from 36.1 cm2 to 163.0 cm2 (mean +/- SD: 89.1 +/- 34.0 cm2). The volume of pneumatic spaces for the 8 specimens ranged from 1.53 ml to 6.03 ml (mean +/- SD: 4.12 +/- 0.97 ml). The surface area of temporal bone pneumatic spaces we determined could serve as useful basic data for determining the physiology of ventilation for the temporal bone and the function of mastoid cells.

Aged↗

PubMed1987

The temporal bone anomaly in CHARGE association.

Examination of the temporal bones from a patient with the CHARGE association revealed an unusual form of dysplasia. Mondini dysplasia of the pars inferior with complete absence of the pars superior was observed in both temporal bones. A review of the literature revealed four previous descriptions of this unique anomaly in patients whose clinical picture resembled the required components of CHARGE. On this basis, it is suggested that this anomaly represents a specific form of labyrinthine dysplasia which may be called the CHARGE dysplasia of the temporal bone.

Abnormalities, Multiple↗

PubMed1987

Volumetric analysis of the tympanic isthmus in human temporal bones.

A volumetric study on the tympanic isthmus and its relationship to temporal bone pneumatization was conducted in 110 serially sectioned temporal bones with and without middle ear pathology. With a microcomputer and digitizing tablet, the area of the tympanic isthmus and the degree of pneumatization in sample sections were calculated. Nonpathologic temporal bones showed a significant correlation between the volume of the tympanic isthmus and the degree of pneumatization. The narrowest area of the tympanic isthmus and the degree of pneumatization were also highly correlated. The result indicated a definite inhibition of pneumatization due to chronic middle ear infection when compared with nonpathologic temporal bones.

Aged↗