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PubMedDate not supplied

High-resolution computed tomography of temporal bone: Part IV: Coronal postoperative anatomy.

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200 micro isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this, the fourth part, and the third part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same coronal (article IV) and axial (article III) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.

Cochlear Implantation↗
PubMed2003

Supraarticular, supramastoid and suprameatal crests on the outer surface of the temporal bone and the relation between them.

Supraarticular, supramastoid and suprameatal crests on the outer surface of the squamous part of the temporal bone are of clinical importance as they are accepted as landmarks for some surgical approaches relating to the temporomandibular joint, the middle cranial fossa and mastoid air cells, respectively. Because of the surgical importance of the crests, their incidence and the relations between them were studied on a total of 442 (250 male, 192 female) dry skulls. In addition, three-dimensional (3D) surface renderings of the squamous part of the temporal bone were created from routine axial computed tomographic (CT) images in four cadaver specimens to demonstrate the surface anatomy. Suprameatal crests were observed commonly as a trace type on the male dry skulls (51.2%), though no such crest was seen on most of the female skulls (54.4%). Supramastoid crests were commonly observed as a small crest on male dry skulls (46.6%), but as a trace type on female dry skulls (52.05%). Supraarticular crests were commonly seen as a trace type on both male (58.6%) and female (70.6%) dry skulls. In the light of the above data, it can be concluded that the crests on the male dry skulls were stronger than those on the female skulls. The angles between the crests were also examined. It was observed that the angle between the supraarticular and supramastoid crests was larger in male dry skulls compared with the female dry skulls. On the other hand, no gender difference was observed when the angle between the suprameatal and supraarticular crests was examined.

Female↗
PubMed1996

A human temporal bone study of changes in the basilar membrane of the apical turn in endolymphatic hydrops.

We observed that some temporal bones with endolymphatic hydrops (EH) showed varying degrees of basalward displacement (towards the scala tympani) of the basilar membrane (BM) in the apical turn of the cochlea. In some, the BM was adherent to the bony wall of the scala tympani (i.e., the interscalar septum). Such mechanical distortion of the BM could conceivably alter cochlear mechanics and lead to sensorineural hearing loss. The results of a systematic evaluation of 234 temporal bones to characterize, quantify and determine the functional significance of this observation are presented. Four groups of bones were evaluated: normal (N = 78), presbycusis (N = 96), Ménière's disease (N = 23), and EH secondary to labyrinthitis (N = 37). The incidence of extreme displacement of the BM in the apical turn such that it adhered to the interscalar septum was 52% in Ménière's disease, 57% in EH secondary to labyrinthitis, 10% in presbycusis, and 1% in normals. These differences were significant and could not be explained on the basis of age, sex, postmortem time, or artifact of technique or processing. Displacement of the BM was not observed in other turns of the cochlea. Its pathogenesis is not known, but may be related to atrophy of the spiral ligament. It is likely that such BM displacement results in sensorineural hearing loss. However, our data and theoretical analyses both indicate that such a loss will be restricted to frequencies below 100 Hz and that this pathologic change alone is not likely to cause appreciable hearing loss at clinically tested frequencies of 250 HZ and higher. Hence, even though this pathologic finding is common in endolymphatic hydrops, it cannot explain the low-frequency hearing lost observed in Ménière's disease.

Adult↗
PubMed1994

Efficacy of surgical treatments for squamous cell carcinoma of the temporal bone: a literature review.

A review of all publications dealing with surgical treatment for squamous cell carcinomas of the temporal bone was performed. No randomized or nonrandomized control studies were identified. All studies were case series without control subjects. Twenty-six of 96 publications, which contained information on 144 patients, were analyzed. Several inferences are suggested by the available evidence; however, these areas should be investigated by properly designed randomized clinical trials: (1) patients with carcinoma that is confined to the external auditory canal have similar survival, regardless of whether mastoidectomy, lateral temporal bone resection (TBR), or subtotal TBR is performed: the addition of radiation therapy to lateral TBR does not appear to improve survival; (2) when disease extends into the middle ear, survival of patients treated with subtotal TBR appeared to be improved over those treated with lateral TBR or mastoidectomy: it remains uncertain if the addition of radiation therapy to mastoidectomy improves survival; (3) the value of surgical resection when carcinoma extends to involve the petrous apex remains unclear; (4) resection of involved dura mater does not appear to improve survival; however, incomplete data regarding margins of resection were reported; and (5) determination of the value of resection of involved brain parenchyma or internal carotid artery will require further study.

Brain Neoplasms↗
PubMed2001

Papillary tumor of the temporal bone.

Papillary tumors of the middle and inner ear have been interpreted histogenetically in many ways. In 1989 Heffner proposed the endolymphatic sac epithelium as a possible origin. These rare tumors are clinically aggressive and can cause extensive temporal bone destruction. Because of this behavior, endolymphatic sac tumors (ELST) were classified as low-grade adenocarcinomas, although metastasis has not yet been documented. Two papillary neoplasms of the temporal bone are presented, which we believe are examples of adenomatous tumors arising from the epithelium of the endolymphatic sac. One was associated with a pituitary adenoma. A third case of a papillary middle ear neoplasm is described that shows histologic features similar to the other two, but it was located in the tympanum and had no connection to the endolymphatic sac. This report focuses on clinical, radiologic, and histologic findings of papillary tumors of the temporal bone with additional emphasis on modern concepts of histogenesis and aspects of differential diagnosis.

Journal Article↗
PubMed1999

Hemangiopericytoma and temporal bone.

Hemangiopericytoma is a vascular tumor arising from the pericyts. The tumor involves usually the muskuloskeletal system and the skin. A hemangiopericytoma of the temporal bone is an extremely rare lesion. This paper describes a case of hemangiopericytoma located in temporal bone, its radiologic diagnosis and its therapeutic options as well.

Adult↗
PubMed2004

Temporal bone pathology in hydrocephalus: changes in the inner ear due to increased intracranial pressure.

Changes in the inner ear due to increased intracranial pressure have not yet been clearly defined. We present a postmortem temporal bone study of child with hydrocephalus. The temporal bone was from a 2-year-old female with IVth ventricle ependymoblastoma. In the basal turn of the cochlea, degeneration of the organ of Corti and the nerve ganglion was observed. In the top and middle turn, structures were intact. The utricle and saccule were well preserved. We propose that changes in the inner ear due to increased intracranial pressure begin in the base of the cochlea, and extend to the apex in decreasing degree.

Brain Neoplasms↗
PubMed1994

[3D-CT of the temporal bone area with high-speed processing].

Three-dimentional (3D)-CT was introduced to represent abnormal findings in the temporal bone area utilizing a SOMATOM DRH CT scanner with accessory 3D reconstruction software and an exclusive high-speed 3D processing system, VOXEL FLINGER. In a patient with eosinophilic granuloma, a defect in the squamous part of the temporal bone was demonstrated suggesting exposure of the dura mater during surgery. In a patient with a normal ear, well-developed mastoid cavity, a part of the handle and the head of the malleus, the incudomalleal joint, the short limb, body and a part of the long limb of the incus and the round window niche were demonstrated. In a case of chronic otitis media, poorly developed mastoid cavity and a possible defect of the tip of the long limb of the incus were demonstrated, in contrast to the patient with the normal ear. 3D-CT yields objective and solid images which are useful for diagnosis, treatment planning and explanation of the pathology to patients and their family. To obtain convincing 3D images, physicians themselves have to choose exact rotation angles. It is not adequate to reconstruct original CT data using a CT computer with accessory 3D software whose processing capability is not good enough for this purpose. The conclusion is as follows: 1) it is necessary and effective to transfer original CT data into the memory of the exclusive high-speed 3D processing system and 2) process the data by the voxel memory method to establish a clinically valuable 3D-CT imaging system.

Adult↗
PubMed1981

Osseointegrated titanium implants in the temporal bone. A clinical study on bone-anchored hearing aids.

The purpose of this study is to investigate the possibilities for attaching a new type of direct bone conduction hearing aid. Using a gentle surgical technique, titanium screws were inserted into the temporal bone of fourteen patients suffering from hearing impairment. The implants became integrated with the living bone tissue and have remained so for a follow-up period of, at present, two to four years. It is therefore concluded that titanium implants may be osseointegrated in the temporal bone in a similar manner to that previously described for long bones. The bone-anchored titanium screws were connected to a permanently skin-penetrating abutment, which in turn was used for attachment to a hearing aid. In this way a direct bone conduction without obstructing soft tissue layers is secured. The permanent skin penetration caused no adverse soft tissue effects. The new system has improved pure-tone hearing threshold by about 15 dB. Further research is aimed at the construction of a new hearing aid that is better adapted to the impedance situation existing in the directly bone-anchored cases.

Adolescent↗
PubMed1997

Primary Ewing's sarcoma of the temporal bone with intracranial, extracranial and intraorbital extension. Case report.

Primary cranial Ewing's sarcoma is a very rare malignant tumor. Primary temporal bone Ewing's sarcoma with intraorbital extension is also a very rare condition. In this article we describe a case of primary Ewing's sarcoma of the temporal bone which extended into intracranial, extracranial and intraorbital compartments; manifesting with a swelling in the zygomatic fossa and proptosis of the right eye. The tumor was excised partially, and the patient underwent radiochemotherapy. The patient died 6 months after the therapy, with lung metastasis. The case is discussed with the pertinent literature.

Biomarkers, Tumor↗
PubMed1999

Temporal bone histopathologic findings in a case of interstitial deletion of the long arm of chromosome 2 [del(2) (q31q33)].

The temporal bones of a 24-day-old female neonate with an interstitial deletion of the long arm of chromosome 2 [del(2)(q31q33)] were studied histopathologically, focusing mainly on the inner ear. This is, to our knowledge, the first report of a temporal bone study in a case of this chromosomal aberration. The abnormalities included a shortened cochlea with underdeveloped modiolus in both ears. Total absence of the spiral ganglion cells and the cochlear nerve bundle, accompanied by obliteration of the fundus of the internal auditory meatus by a bony plate, and dislocation of some geniculate ganglion cells to the internal auditory meatus were also observed in the right ear. The absence of the spiral ganglion cells is considered to be the result of some complication in the early fetal life, such as dysgenesis or early degeneration of the neuronal cells. The organ of Corti in the right ear was well-developed and preserved in the middle turn, suggesting that the differentiation of the cochlear sensory epithelium in humans is not dependent upon the innervation, at least on the gross level.

Abnormalities, Multiple↗
PubMed1991

Distribution of structural and trace elements in human temporal bone.

This study was undertaken to evaluate a systematic analysis of mineral and trace elements of individual functionally determined parts of adult temporal bone. Marked differences were observed in basic structural elements (Ca, P, Mg, and Zn) among different bone regions. The more so, molar Ca/P ratio was significantly different in various regions, being highest in the hammer and vestibular regions. Taxonomic analysis revealed specific differences in the mineral ratio between the two petrous bone regions believed to develop from various embryonal bases. According to results, the observed differences in mineral trace element composition of particular regions of human temporal bone might be explained by their developmental specificities and functional adaptation.

Adult↗
PubMed1994

CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation.

Because of its superior visualization of bone detail, compared with that of MR imaging, CT commonly is used in patients who have had otomastoid or other forms of temporal bone surgery. The already complex anatomy of the temporal bone is distorted by the combination of surgical procedures and preexisting abnormalities, making proper identification of the postoperative imaging studies difficult. The purpose of this essay is to familiarize radiologists with the more common neurootologic surgical procedures and the expected postoperative findings in patients who have had this type of surgery. Special emphasis is placed on the indications for the procedure and the distinguishing features associated with each procedure.

Cochlear Implants↗
PubMed1998

[Temporal bone fracture: review of 40 cases (44 traumatic injuries)].

Temporal bone fractures are common injuries in patients suffering cranio-encephalic traumatisms. They call for a precociuos diagnosis, including a careful oto-neurologic examination as well a computerized tomography (CT), in order to asses sequelae and complications arrised from traumata. Here are reported a review of 40 patients with 44 temporal fractures attended in our Hospital, from January 1993 until March 1996. The injured were clinically evaluated in the ENT-Department by computer radiography and the classic audiovestibular battery tests. Particularly emphasized were luxations of the ossicular chain, lesion of the labyrinthine capsula and peripheral facial palsies. Our basic concern is to evaluate the incidence of petrosal involvement in our environment, owing to the scarcity of the national literature, and to analyze the after maths and the management of postraumatic facial paralyses.

Adolescent↗
PubMedDate not supplied

CT of the temporal bone in a patient with osteopathia striata and cranial sclerosis.

The authors present a case of congenital dysplasia affecting the long bones, skull, and other systems in a 7-year-old girl, with special attention to CT of the temporal bone, which showed abnormal ossicle fixation, a narrowed Eustachian canal, thickened sclerotic bone, and a small mastoid antrum and middle ear cavity. CT of the temporal bone can help one distinguish the etiologies of hearing loss associated with this disorder.

Bone Diseases, Developmental↗
PubMed2004

Actinomycosis of the temporal bone: a report of a case.

Actinomycosis is a chronic suppurative infection of the cervicofacial region caused by Actinomyces species, which are anaerobic, gram-positive filamentous bacteria. Although actinomycosis has a propensity for involving the oral cavity, rare cases of actinomycosis involving the temporal bone have been published. We report the case of a 14-year-old girl who presented with clinical, audiometric, and radiologic findings consistent with right chronic suppurative otitis media that persisted despite tympanomastoidectomy. Findings on histologic evaluation of a specimen obtained during revision surgery were consistent with a diagnosis of actinomycosis. Although actinomycosis of the temporal bone is rare, it should be considered in the differential diagnosis of chronic suppurative temporal bone infections that are resistant to standard therapy.

Actinomycosis↗
PubMed2000

[Histopathological study of the temporal bones in patients with primary carcinomas of the ear].

The most common symptoms of patients with carcinomas of the middle ear or mastoid are otorrhea, facial paralysis, and hearing loss, including a sensorineural element and vertigo. The latter two symptoms are indicators of inner ear damage. However, few reports have been made concerning the histopathological changes that occur in the inner ear in the presence of a tumor. The present study was performed to determine the pattern of tumor invasion in the inner ear and the histopathological changes that occur in the inner ear in cases of ear carcinomas. Temporal bone sections from five patients (age: #39-73 years; 3 males and 2 females) who died from a primary carcinoma of the ear were studied histologically. The following features were examined: 1) localization of the tumor in the temporal bone, 2) pattern of tumor invasion in the inner ear, 3) pathological changes in the inner ear, including the cochlea, vestibule and semicircular canals. Tumor cells were still present in the temporal bone sections of all the patients except one, even though the patients had received various treatments for the carcinoma, including radiation therapy, surgery and chemotherapy. Marked inflammatory and necrotic changes were observed in cases where the tumor had invaded the external auditory canal, middle ear cleft, internal auditory canal, and in some cases the inner ear. In cases where the tumor invaded the inner ear via the internal auditory canal rather than directly from the middle ear, the otic capsule is thought to have acted as a barrier against tumor invasion. In addition, marked degenerative changes throughout the entire inner ear structures were noted. These changes may have arisen from an attenuated blood supply to the inner ear as a result of pressure from the tumor in the internal auditory canal, tumor infiltration of the labyrinthine artery.

Adult↗