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Temporal bone trauma has numerous manifestations, many of which are detectable by current imaging techniques. Our discussion of temporal bone trauma is subdivided into fractures and pseudofractures, fistulous communication, hearing loss, and facial nerve involvement.
Temporal bone hemangiomas are rare tumors that require a high degree of clinical suspicion on the part of the otolaryngologist to be diagnosed early. The purpose of this report is to present 10 histologically confirmed cases of hemangiomas located within the temporal bone treated at the Gruppo Otologico of Piacenza-Rome, Italy. A short review of the literature is also presented. The symptomatology of these extraneural vascular tumors depends on their location. Tumors located within the internal auditory canal present mainly with hearing loss, while a facial nerve deficit is the predominant symptom in geniculate ganglion tumors. The treatment modality is also dependent on the location of the tumor, as well as the clinical features and tumor size. The final facial nerve outcome is directly affected by the duration of the facial nerve deficit, and so the treatment should not be delayed once the diagnosis is made.
Temporal bone fractures represent a frequent source of morbidity and are often associated with fatal injuries in the head trauma patient. The initial care of these patients may be the responsibility of the emergency room physician or the neurosurgeon. The treatment of temporal bone fractures is often postponed because more pressing injuries may exist. However, it should be stressed that an otolaryngologist be consulted as soon as feasible because future rehabilitation is dependent on the initial examination.
Five temporal bones were serially sectioned and studied concerning spread of erythrocytes and blood-derived precipitate in patients who died from subarachnoid hemorrhage. Erythrocytes followed the natural pathways--the cochlear aqueduct, the cochlear, vestibular, facial and glossopharyngeal nerves, and were demonstrable in the inner ear fluid spaces. The temporal bone marrow spaces were also filled with erythrocytes, particularly in the hypotympanal area. In the microimmunoelectrophoresis, no specific precipitation lines formed between the anti-CSF serum from rabbits and middle ear exudate from human ears with acute otitis media. Although, in animals, middle ear spaces have been shown to be connected to the middle ear space this does not seem to apply to human ears, and CSF fluid components are not involved in the formation of middle ear exudate.
Temporal bone pathology is described in a 37-year-old man who had acute, bilateral, profound sensorineural hearing loss without improvement 4 months before death. The patient had suffered from low complement nephritis, for which he had received prednisolone therapy. Autopsy revealed malignant lymphoma with non-Hodgkin's type, membranous proliferative glomerulonephritis and necrotizing vasculitis of middle and small arteries. In the temporal bone study, pathological changes were limited to the cochlear region. The vestibular structure showed no detectable pathological changes. The changes included total absence of the organ of Corti, atrophy and/or disappearance of the stria vascularis in the upper turns, collapse of Reissner's membrane in the middle turn, and new bone formation in the apical turn.
OBJECTIVE AND IMPORTANCE: Aneurysmal bone cysts (ABC) are benign bone neoplasms which typically involve the spine and long bones. We present a rare case of an ABC in the temporal bone with significant cerebellar compression. CLINICAL PRESENTATION: The patient was a young boy who presented with several weeks of left posterior auricular pain. Computed tomography, magnetic resonance imaging and angiogram showed an expansile bone neoplasm involving the left petrous temporal bone. INTERVENTION: A retrosigmoid-transmastoid craniectomy was performed, and total removal of the bone lesion was achieved. The pathological examination revealed the diagnosis of ABC. CONCLUSION: The postoperative course was uneventful, and the imaging studies demonstrated total removal of the neoplasm. This case represents the imaging and surgical management of a rare ABC in the temporal bone. This diagnosis should be considered in the differential of bone neoplasms in this region.
The temporal bone appears to be affected by metastatic tumors in rather characteristic clinical presentations. More effective cancer treatments have interrupted the course of the disease, allowing more time for metastatic spread. This has increased the importance of prompt diagnosis in a group of diseases that may mimic external auditory canal or middle ear infections. In this paper, we review the distinctive patterns of involvement and presentation of metastatic tumors of the temporal bone, with emphasis on measures that should be taken to ensure early diagnosis.
Three temporal bones were serially sectioned to study the postoperative fate of the meatally based postauricular musculoperiosteal flap. In all three ears, the flap sealed off the middle ear effectively from the mastoid cavity and in one, with resected canal wall, formed a new soft posterior wall with good meatus. All flaps contained viable muscle, fat, collagen, reticulin, and elastin, and were richly vascularized. In two flaps, small granulating foci of infection were noted. In two temporal bones, from a child with hypogammaglobulinemia, small cholesterol cysts formed behind the falp during the delayed healing of the mastoid wounds.
Prior to embedding a human temporal bone in methylmethacrylate the plane of sectioning is determined through CT-scanning. A new technique of micro-slicing, plastic embedding and semithin sectioning of undecalcified human temporal bone is described.
Temporal bone encephalocele (TBE) has become less common as the incidence of chronic mastoid infection and surgery for this condition has decreased. Due to its declining incidence, the diagnosis of TBE may be delayed and result in the development of serious complications such as cerebrospinal fluid leak, meningitis, epidural or subdural abscess. Six cases of large (>1 cm) TBE of diverse etiology are described. Two patients had suffered previous temporal bone fractures, two had had prior mastoidectomy, and two patients had long-standing chronic mastoiditis. Two patients had undergone prior unsuccessful transmastoid repair. All patients underwent successful tegmen-dural repair with autogenous fascia, bone, and/or cartilage, primarily via a combined mastoid-middle fossa approach. Accurate dural closure and support of intacranial contents are imperative to prevent recurrence. We find that permanent repair can best be performed with a combined mastoid middle cranial fassa approach.
A technique for single stage total en bloc resection of the temporal bone and intratemporal carotid artery with immediate reconstruction has been described. This formidable procedure requires the collaborative efforts of neurotologic skull base surgeons, neurosurgeons, and head and neck surgeons. Two patients have undergone this procedure; one with squamous cell carcinoma and one with extensive basal cell carcinoma. The quality of life following this procedure is adequate and the cosmetic deformity can be minimized. Longer follow-up is necessary to determine the value and overall impact of this approach to cancer of the temporal bone on disease free interval and patient survival. Further experience with the technical aspects of this procedure should reduce the operating time, blood loss, and resultant morbidity.
Aneurysmal bone cyst (ABC) of the temporal bone is rare. The nature of the underlying disorder that converted into the ABC might, however, be difficult to ascertain on imaging as well as on histopathology. The unusual CT and MRI findings in a case of ABC of the temporal bone are presented. This had transdural intracerebral spread with a large component of solid enhancing matrix but no peripheral calcific rim. The patient was an adult of 45 years with a history of headache for more than 1 year.
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We present an unusual case of a temporal bone and skull base tumor in a ten-year-old child. The patient presented with unilateral hearing loss and headaches. Radiologic, surgical, and histologic findings were consistent with an aneurysmal bone cyst. This is the first report on this rare entity to document its appearance in the temporal bone and skull base using magnetic resonance imaging. Treatment consisted of surgical removal, cranioplasty, and reconstruction of the external auditory canal.
Fibrous dysplasia is an uncommon benign disorder of unknown etiology. Rarely, it presents isolated in the temporal bone. We present three cases of monostotic fibrous dysplasia that involved the entire temporal bone.
In a study done at the Geisinger Medical Center in 1976, the results of treatment of 30 cases of glomus tumors involving the ear were reviewed. All 8 cases of glomus tympanicum were controlled with surgery and all of the cases of glomus jugulare treated with high voltage radiotherapy were controlled for from 2 to 12 years. Currently, the length of control extends to 15 years and there have been no late recurrences. Three additional cases showing unusual features of glomus jugulare are presented.