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PubMed1999

Temporal bone pathology findings due to drowning.

It has been reported that anoxia due to near-drowning or near-suffocation causes brain damage but not inner ear damage. On the other hand, it has been shown that brain death causes both brain damage and inner ear damage. However, studies of temporal bone pathology resulting from sudden death due to drowning are few. We studied temporal bone pathology in six cases of individuals who died of accidents due to drowning. In all temporal bones examined, we found extensive congestion petechiae and haemorrhage in the vessels in the mucosal layers of the middle ear and mastoid air cells, as well as in the vessels around the facial nerve and carotid canal. In the inner ear, there was no abnormality in Corti's organ or the vestibular organs, except in one case who died in the bath. Our findings suggest that petechiae haemorrhage or congestion in the vessels of the mucosal layer and the vessels themselves of the middle ear occurs upon acute death due to drowning.

Adolescent↗
PubMed1985

The microslicing method in the study of temporal bone changes in the perinatal period: an interim report.

The microslicing method was used to study the temporal bones of 49 perinatal deaths in the gross. X ray of the temporal bones was an important part of the investigation. The principle pathological changes were clearly observed. They were: acute otitis media in two cases; an anterior crural deformity of the stapes in four infants and haemorrhage of the apex of the fundus of the internal auditory meatus in 12. Primitive mesenchymal tissue was frequently seen in the infants of younger gestational age, but had largely disappeared by term.

Ear Diseases↗
PubMedDate not supplied

Dimensional anatomy of the vestibular aqueduct and the endolymphatic sac (rugose portion) in human temporal bones. Statistical analysis of 79 bones.

The purpose of this study was to investigate the anatomy of the vestibular aqueduct (VA) and rugose portion (RP) of the endolymphatic sac. Serial horizontal sections of 79 normal temporal bones of individuals aged 20 to 102 years were used. Medial view graphic reconstruction of the VA was performed for each specimen to determine the area, length, angle and position of the VA. The relationship between the width of the VA and the area of the VA, and the relationship between the degree of development of the VA and the degree of development of the temporal bone (periaqueductal pneumatization and the otic capsule in the periaqueductal region) were also investigated. Measurements of the RP were also made and further histological study of the RP was performed on 30 selected specimens. We found that 1) the VA in adult temporal bone varies in size and can be classified as hypoplastic, normoplastic, or hyperplastic; 2) many of the VAs in each group have similar sizes, although they vary in length, angle, or position; 3) all or most of the RP was located within the VA in all but one specimen, which had a hypoplastic VA (in this specimen more than half of the entire RP extended into the posterior cranial fossa); 4) the histology of the RP was characteristic in each type of VA; and 5) the degree of development of the VA seems to correlate with the degree of development of the otic capsule in the periaqueductal region.

Adult↗
PubMed1994

Monostotic fibrous dysplasia of the temporal bone with associated lymphadenopathy.

Fibrous dysplasia of the temporal bone is a very unusual condition and its association with an abnormal lymph node has not been previously reported. Although it is benign condition causing conductive deafness, cholesteatoma may develop insidiously as illustrated by this case. We recommend regular long term follow up and surgical exploration if a changing clinical picture suggests the possibility of complications.

Child↗
PubMed1995

Congenital cholesteatoma of the temporal bone: MR findings and comparison with CT.

PURPOSE: To describe the MR findings of temporal bone congenital cholesteatoma and MR usefulness in preoperative diagnosis and follow-up, in comparison with CT. METHODS: Seven patients underwent CT and MR studies for facial palsy (n = 3), deafness (n = 3), vertigo (n = 1), tinnitus (n = 1), and otalgia (n = 1). Three patients had for congenital cholesteatoma previously undergone surgery. One of them was free of symptoms and referred for follow-up. Final diagnosis was obtained from surgical data in all the cases but one. RESULTS: Congenital cholesteatoma signal intensity was low or intermediate on T1-weighted images and high on T2-weighted images in all the cases. MR was useful in diagnosis in six cases, helping to differentiate congenital cholesteatoma from other nonenhancing tumors. When temporal bone wall erosion was observed with CT (n = 6), MR ruled out intracranial extension in five cases; in one case, MR found an associated epidermoid cyst of the cerebellopontine angle not identified with CT. However, CT assessed relationships with labyrinthine structures more easily. CONCLUSION: MR and CT are complementary in initial diagnosis and follow-up.

Adolescent↗
PubMed2006

[Facial paralysis after temporal bone trauma].

OBJECTIVES: To evaluate functional outcome in 64 cases of facial paralysis following temporal bone fracture and discuss decisive arguments leading either to medical treatment or surgical management. METHODS: Sixty-four patients suffering from post-traumatic facial paralysis were managed between 1995 and 2003: 38 (59%) were given medical treatment and 26 (41%) underwent surgery. A combined middle fossa and transmastoid approach was mostly used (58%). Electrophysiological testing and CT scan results were the main points of the decision algorithm. RESULTS: Electroneuromyography seems to be the most accurate exploration for guiding treatment. Good results (grades I to II on the House and Brackmann scale) were obtained in 63% of cases after medical management and in 39% of cases after surgical treatment. Grades III or IV were obtained in 13% of medically-treated patients and 42% of surgically-treated patients. CONCLUSION: Management of facial paralysis following temporal bone fracture in accordance with electrophysiological testing (evoked EMG) together with CT scan findings enabled accurate indications for surgical treatment. A good grade I or II result can be expected after medical management. A grade III is at best reached after nerve anastomosis.

Adolescent↗
PubMed2000

Virtual temporal bone dissection simulation.

We have developed a working prototype system for the virtual simulation of temporal bone dissection. The system offers a paradigm from traditional practices by integrating technological advances to provide a safer and more cost effective way to learn fundamental techniques used in temporal bone surgeries. We present our methods to provide a real-time interactive volumetric system that obviates the need for physical materials in initial training, and provides a more accessible way for residents to practice and to increase exposure to pathological variance. Finally, we discuss ways to extend this work to more advanced resident training, presurgical planning, and surgical documentation.

Aged↗
PubMed2004

Cellular changes of Reissner's membrane in Meniere's disease: human temporal bone study.

OBJECTIVE: To study the cellular characteristics of Reissner's membrane (RM) in temporal bones (TBs) from patients with endolymphatic hydrops with symptoms of Meniere's disease (EH/+MD) and TBs with endolymphatic hydrops without symptoms of Meniere's disease (EH/-MD) in an effort to understand the role of endolymphatic hydrops in MD symptoms. STUDY DESIGN: Comparative study of human TB histopathology. METHODS AND MATERIALS: Epithelial and mesothelial cellularity of RM from control TBs, TBs from patients with EH/+MD, and TBs from patients with EH/-MD were compared. The cellularity of epithelial and mesothelial cell nuclei (defined as number of cells/100 microm width of RM) were counted along the width of RM. The width of RM was measured from the vestibular crest of the spiral ligament to the limbus spiralis. RESULTS: The cellular densities of epithelial cells in the basal and middle turns of RM were significantly higher in the EH/+MD and EH/-MD groups compared with "controls." There was no difference in epithelial cellularity between EH/+MD and EH/-MD. There was a decrease in the number of mesothelial cells of RM in the basal turn in EH/+MD and EH/-MD groups (statistically significant only in EH/+MD group) when compared with controls. The number of mesothelial cells of RM in the middle turn in EH/+MD and EH/-MD groups were significantly decreased compared with normals. DISCUSSION: Similar findings in cellularity of RM in temporal bones with EH/+MD and EH/-MD suggest that pathophysiologic mechanisms other than hydrops may be responsible for symptoms in Meniere's disease.

Adolescent↗
PubMed1984

Cockayne syndrome--an audiologic and temporal bone analysis.

Cockayne's syndrome is a triad of dwarfism, retinal atrophy, and deafness. Over thirty cases have been presented in the literature. We have examined and audiometrically tested three patients (ages 13 to 17) with confirmed Cockayne's syndrome and have analyzed the temporal bones of another who died at age 24. To our knowledge this is the first reported temporal bone analysis of a patient with Cockayne's syndrome. Audiograms revealed bilateral symmetric sensorineural hearing loss that was greatest in the high frequencies. Temporal bone examinations revealed inner and outer hair cell losses in the basal turn of the cochlea with corresponding neuron losses in the spiral ganglion. We have found that the clinical and histopathologic features resemble those of presbycusis and conclude that this corresponds well with the generalized, rapid, premature aging process characteristic of this disease.

Adolescent↗
PubMedDate not supplied

Paget's disease of the temporal bone.

Osteitis deformans Paget is a fairly common, heritable, sometimes progressive disease of bone which affects primarily the axial skeleton and may lead to deformity and weakness. It affects 3% of the population over forty years of age and males more frequently than females. The skull and temporal bones become involved in about two-thirds of the patients. Progressive involvement of the temporal bones may lead to alteration of position, increase in size and change of architecture of the petrous pyramid, external canal, middle ear and inner ear capsule. These changes in turn may produce impairment of hearing (about 30-50% of cases) and vestibular function (20-25%). The clinical, radiological, and pathological manifestations of Paget's disease of the temporal bone are discussed in detail and explained with photomicrographs. Examples of tumor formations and vascular changes are presented.

Age Factors↗
PubMed2003

Giant-cell reparative granuloma of the temporal bone: a case report and review of the literature.

Giant-cell reparative granuloma (GCRG) is an unusual, non-neoplastic fibrous lesion that most often arises in the mandible and maxilla. GCRG of the temporal bone is exceedingly rare. To the best of our knowledge, only 17 cases have been previously reported in the international medical literature. Although no case of metastasis has been reported, this malignancy can be locally aggressive, and it often recurs following incomplete excision. We report the case of a young woman with a very large GCRG of the right temporal bone. We discuss the clinical picture, differential diagnosis, histologic evaluation, appearance on computed tomography and magnetic resonance imaging, and treatment options. We also review the cases of temporal bone GCRG that have been reported in the literature so far.

Adolescent↗
PubMed1979

Infratemporal fossa approach to lesions in the temporal bone and base of the skull.

An infratemporal fossa approach for extensive tumors of the temporal bone, clivus, and parasellar and parasphenoid regions features permanent anterior transposition of the facial nerve, resection of the mandibular condyle, and mobilization of the zygoma and lateral orbital rim. Obliteration of the pneumatic spaces of the temporal bone with permanent occlusion of the Eustachian tube and blindsack closure of the external auditory canal avoids the danger of postoperative infection and leads to primary wound healing in the shortest time. Three cases demonstrate selective utilization of the infratemporal fossa approach. Short-term results and complications were observed in 51 patients.

Adult↗
PubMed2003

Plastination and computerized 3D reconstruction of the temporal bone.

The purpose of this study was to generate a computerized 3D reconstruction of the temporal bone and intratemporal structures. A plastination technique was used to obtain equidistant serial thin sections of 1.2 mm thickness and, on an SGI workstation, a Contour-Marching Cubes algorithm was selected to reconstruct the temporal bone and intratemporal structures in three dimensions. All reconstructed structures can be represented individually or jointly and rotated in any plane. Any diameter and angle of a structure can be conveniently measured. The capability of reconstructing individual and combined images of intratemporal structures, viewing them from all surgical angles, and accurately measuring their spatial relationships gives skull base and otologic surgeons important guidance. The reconstructed model can also be used for resident education, rehearsal of an unfamiliar surgery, and for developing a new surgical approach.

Carotid Arteries↗
PubMed1997

Current perspective on temporal bone trauma.

The improved survival of patients sustaining massive head injuries has increased the number of temporal bone fractures being managed by otolaryngologists and neurosurgeons. We performed a prospective analysis of 35 patients with head injury with temporal bone trauma. The major emphasis of this study was to investigate the incidence, management, and outcome of facial nerve injury in such patients and to evaluate the importance of electrodiagnostics in the surgical management of the facial nerve. The results of this study indicate an incidence of fracture type, hearing loss, and facial nerve paralysis similar to that already recorded in the literature. This study underscores the importance of evoked electromyography, or electroneuronography, in assessing facial nerve function. Electroneuronography provided the indications for surgical intervention for facial paralysis. All patients having surgery for facial paralysis as determined by electroneuronographic findings had pathology of the facial nerve.

Decompression, Surgical↗
PubMed2006

Primary Ewing sarcoma of the petrous temporal bone: an exceptional cause of facial palsy and deafness in a nursling.

BACKGROUND: Primary Ewing sarcoma affecting the skull base in general and the petrous bone in particular is extremely rare with only 4 reports of Ewing sarcoma arising in the petrous temporal bone in the international medical literature. METHODS: The authors report for the first time a case of a primary Ewing sarcoma of the petrous temporal bone in a 5-month-old nursling, which became apparent with a complete peripheral facial palsy and ipsilateral surdity. RESULTS: The neoformation was treated by systemic chemotherapy and radiation of the tumor region. The diagnostic steps, therapy, and development of the child are described in detail; the literature concerning Ewing sarcoma originating from the skull in general and from the petrous temporal bone in particular is reviewed. CONCLUSIONS: The highlights of this case are an extremely uncommon location, an unusual age of presentation, as well as a unique set of symptoms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Facial paralysis in longitudinal temporal bone fractures: a review of 26 cases.

The management of facial nerve injury resulting from temporal bone fracture continues to be a topic of discussion. The indications for surgery as well as the proper timing and extent of surgical exploration are the principal questions debated. This study reviews a large series of patients (26), treated for facial paralysis following a longitudinal temporal bone fracture. The most frequent site of injury was the area of the geniculate ganglion. The injury to the facial nerve was often severe. We recommend early exploration in these cases when electrical studies indicate a severe injury. In most cases a combined mastoid and middle fossa approach is required.

Adolescent↗
PubMed2006

Tuberculous otitis in infants: temporal bone histopathology and clinical extrapolation.

HYPOTHESIS: The study of infant temporal bones with tuberculosis (TB) of the middle ear and mastoid could provide information to assist with clinical diagnosis in this population. BACKGROUND: The TB pandemic has become a critical global public health problem. With the rising incidence of the disease, otolaryngologists might encounter an increased frequency of otologic TB. Pediatric temporal bone reports of TB are rare. METHODS: Light microscopic examination was performed on both temporal bones from an infant who died as a result of miliary TB. RESULTS: The tympanic membranes were thickened with dilated blood vessels, yet were intact without perforations. Purulence, granulation tissue, and classic tubercles were observed in the middle ears and mastoids. Serous labyrinthitis and inflammatory cells surrounding the Cranial Nerve VIII in the internal auditory canal were observed in the inner ear. CONCLUSIONS: The histological findings suggest that a clinical presentation of infantile tuberculous otitis media and mastoiditis could be a patient with otoscopic findings consistent with common otitis media with an intact tympanic membrane, likely in conjunction with inner ear symptoms. Lacking the classic finding of multiple tympanic membrane perforations, tuberculous otitis might be underappreciated in this population.

Ear, Inner↗
PubMedDate not supplied

A case of subdural hematoma and temporal bone fracture as complications of chiropractic manipulation.

We present a case of subdural hematoma and temporal bone fracture as a complication of chiropractic manipulation. Subdural hematoma in the elderly may follow insignificant, often forgotten, trauma and may develop slowly and progress. Our patient presented with a complaint of headache three days after forceful chiropractic manipulation, but denied any history of trauma. Computed tomography confirmed the presence of a subdural hematoma and a temporal bone fracture and the patient underwent successful surgical treatment. Our experience identifies a previously unreported mechanism of injury in patients with subdural hematoma presenting to the emergency department with a complaint of headache.

Aged↗