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Leiomyosarcoma is a malignant tumor of smooth muscle origin. It is rarely encountered in the head and neck area. A patient with leiomyosarcoma of the middle ear and the temporal bone with unusual bone destruction is presented. To our knowledge it is the first report of a middle ear and temporal bone leiomyosarcoma.
The author presents the analysis of 56 CT images of the temporal bone in 5 to 72 year old patients operated on the middle ear; characterizes CT possibilities in the study of the operated ear; shows that the operation outcomes may be different (complete epidermization of the postoperative cavity, the presence of the granulation tissue, cholesteatoma recurrence); presents CT changes in the temporal bone in various perioperative and postoperative complications: otoliquorrhea, paresis of the facial nerve, labyrinthitis, progressive hypoacusis and deafness.
Histological data concerning the structure and the topographical distribution of the eustachian tube submucosal glands is presented in 94 serially-sectioned temporal bones with and without otitis media. The vast majority of the tubal glands are located adjacent to the nasopharynx in the pharyngeal and midportion regions. Mixed glands which contain equal amounts of mucoid and serous elements are found in all age groups, in most specimens, either with or without otitis media. Furthermore, the glandular tissue, along these two medial regions of the tube, does not disclose significant quantitative differences between normal and inflamed specimens. Temporal bones without otitis media harbour few glands in the lateral four regions of the tube, while those with otitis media show a moderate increase of gland formation which is more noticeable in the pretympanum than in the regions around the isthmus (pre-isthmus, isthmus and post-isthmus regions). It is apparent that chronic inflammatory conditions like simple chronic otitis media and secretory otitis media are more often accompanied by gland formation, along the lateral four regions of the tube than acute otitis media.
Rapid prototyping (RP) technique allows automatic fabrication of 3D model parts. This method was applied to make a temporal bone model before cochlear implant surgery. A helical CT scan is used to acquire high resolution data from the middle and the inner ear of the patient. From the scanning data bone structures and soft tissues can be separated because their different grayscale pixel values. By using a guided image processing tool the desired parts of the anatomy can be extracted and 3D data created. The segmented data are processed to the form suitable for creating a high accuracy RP model. The RP model is made in the stereolithography (SLA) process by means of a computer guided HeCd laser beam inducing polymerisation of acrylic solution as it passes layer by layer over the surface of the polymer solution. In this prototype model the anatomy of the temporal bone can be clearly visualised, including, e.g., mastoid cells, tympanic cavity, bony canal of facial nerve, and round and oval windows. The inner ear spaces including vestibule, semicircular canals and cochlear turn are also shaped. The transparent acrylic material allows bonelike mechanical handling. The RP model can be dissected and used in individual surgical planning and simulation prior to cochlear implantation.
Estimated are: 1. The axis of the internal acoustic meatus to the horizontal plane in adults and postnatal changes. 2. Eight coronal sections of the temporal bone have been selected to localize the canal systems and structures in the petrous part of the temporal bone and their variations. 3. Described are the different parts of the facial canal, the carotic canal, the auditive tube, the tensor tympani muscle, the major petrosal nerve, and its distances to the carotic canal, the cochlea, the internal acoustic meatus, the supra- and infracochlear cells, the fenestra vestibuli, the fossa jugularis, the canaliculus cochleae, the vestibulum and the semicircular canals. This report includes the development of the supravestibular and other mastoideal cells in the neighbourhood of the canal systems of the petrous bone and the vestibular aqueduct and sac. Estimated are also the distances between the different canal systems. 4. The investigations are discussed with our earlier researches and the results of other researchers and its diagnostic in clinical importance.
Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissner's membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable.
A case of oculo-auriculo-vertebral dysplasia is presented, with histopathological findings in the temporal bone and eye, and some radiological features. The syndrome consists of anomalies of the first and second branchial arch derivatives associated with ophthalmic and vertebral anomalies. Although clinical features and radiological findings of oculo-auriculo-vertebral dysplasia are documented in the literature, there have been very few reports of the histopathological findings of abnormal temporal bones. These vary from our own findings. The prominent features in our case are: a small middle ear cleft, an absence of ossicles, an aberrant facial nerve, and dysplastic, short lateral and superior semi-circular canals, as well as a narrow internal auditory meatus.
Otorrhea of leaked cerebrospinal fluid and meningitis in a 33-year-old male originated from an encephalic herniation into the middle ear following traumatic temporal bone fracture. CT demonstrated a mixed-type fracture consisting of a longitudinal fracture and a posterior oblique fracture of the left temporal bone. The left tegmen tympani was broken into a bellows-like shape and a bone splinter from it had stuck in the epitympanum at the level of the incus body. Surgery via a middle cranial fossa approach confirmed penetration of the brain tissue between the incus and lateral semicircular canal. The diagnosis and management of this condition are discussed in the context of a literature review.
The purpose of this 4-part series is to demonstrate the high-resolution axial and coronal anatomy of temporal bone from a flat-panel detector-based volume computed tomography (CT) scanner (parts I and II); these imaging planes are then used to outline the effect of different surgical procedures commonly applied to the temporal bone (parts III and IV). The structures that are removed and/or altered in 11 different surgical procedures are color coded and inscribed in axial and coronal sections. Clinically important imaging features and complications after these operations are also discussed. In these high-resolution images, many structures that are below the resolution limit of conventional CT can be seen and localized. It is hoped that this exposition enables one to visualize these structures and surgeries in the mind's eye, even when they fall below the resolution limit using a conventional CT scanner. This article (part II) focuses on the preoperative coronal anatomy.
Basal cell carcinomas involving the ear represent a spectrum of diseases, from a small superficial auricular lesion to an advanced destructive malignancy invading the temporal bone. The biologic activity of the morphea-form basal cell carcinoma variant of tumor and a postauricular location predispose to an aggressive biologic pattern. Management requires a thorough evaluation with determination of the degree of cranial and possible intracranial invasion. These lesions usually can be managed with partial temporal bone resections, although prognosis for patients with advanced lesions may be poor.
Squamous cell carcinoma is the most common malignancy of the external auditory canal, middle ear, and mastoid. Surgical resection is the cornerstone of treatment, with T1 lesions of the external auditory canal treated by lateral temporal bone resection and more advanced lesions treated by subtotal or total temporal bone resection. This article summarizes clinical manifestations, differential diagnosis, management, and differences in treatment philosophy.
OBJECTIVE: To discuss the clinical aspects and management of nontuberculous mycobacteriosis of the temporal bone. STUDY DESIGN: Case report and review of the literature. SETTING: University hospital, tertiary referral center. PATIENT, INTERVENTION, AND RESULTS: The authors describe an uncommon case of nontuberculous mycobacteriosis of the temporal bone in an immunosuppressed 62-year-old woman with facial nerve paralysis caused by disease complication. The case was cured with radical tympanomastoidectomy and prolonged multiple antibiotic therapy. CONCLUSIONS: Nontuberculous mycobacteriosis should be suspected in immunosuppressed patients with intractable middle ear granulations. Cultural and histologic examinations are the mainstay for diagnosis. Long-standing multiantibiotic therapy together with aggressive surgery should be considered as appropriate management.
Otitis media (OM) is an infection localized in the middle ear: mastoid, middle ear cavity, Eustachian tube. The classification of OM includes otitis media with effusion, otitis media without effusion, and chronic otitis media. A rare complication of chronic otitis is cholesterol granuloma of the petrous apex. It may develop in any aerated portion of the temporal bone but most commonly develops when a pathologic process obstruct the air cell tracts to the petrous apex preventing normal aeration.
PURPOSE: To evaluate the prevalence of localized hypoattenuating areas in the cochlear otic capsule at temporal-bone thin-section computed tomography (CT) in pediatric patients and correlate the findings with clinical information. MATERIALS AND METHODS: Temporal-bone thin-section CT images obtained in 73 patients aged 0-9 years (20 Austrian, 53 Finnish; 36 female and 37 male patients) were evaluated for the presence of localized hypoattenuating foci in the region of the fissula ante fenestram of the otic capsule. Clinical information collected for all patients was also evaluated. The data were analyzed with a logistic regression model. RESULTS: Hypoattenuating areas in the region of the fissula ante fenestram were observed in 23 of 73 patients (32%). Hypoattenuating foci were substantially more prevalent in patients younger than 3 years than in those 3 years or older (odds ratio, 0.14; 95% CI: 0.04, 0.52; P =.001). The prevalence did not differ between sexes or according to clinical diagnosis. Only three of the 23 patients with hypoattenuating foci had clinical findings suggestive of otosclerosis, and none had osteogenesis imperfecta. After adjustment for age and sex, the finding was more prevalent among the Finnish patients (odds ratio, 5.4; 95% CI: 1.19, 24.52; P =.02) than among the Austrian patients. CONCLUSION: Hypoattenuating areas in the region of the fissula ante fenestram in the otic capsule at thin-section CT are prevalent among children younger than 3 years in the absence of clinical evidence of otosclerosis or osteogenesis imperfecta and appear in children up to 9 years old.
It is well established that sensorineural hearing loss (SNHL) is an important sequela of acute bacterial meningitis. Previous human temporal bone histopathologic studies have suggested that such hearing loss is due to labyrinthitis. This study involved a detailed and systematic evaluation of the auditory and vestibular end-organs in 41 human temporal bones from patients with acute bacterial meningitis, aimed at describing the spectrum of histopathologic changes within the labyrinth, ascertaining likely routes for spread of infection from the meninges to the inner ear, and comparing the data from humans with those described in a rabbit model of meningogenic labyrinthitis. Our study revealed the following: (a) Suppurative labyrinthitis occurred in 20 (49%) bones. Of these 20 bones, the cochlea was affected in all, whereas the vestibular organs were involved in 10. Eosinophilic staining of inner ear fluids without the presence of inflammatory cells (so-called "serous" labyrinthitis) occurred in 14 of the remaining 21 bones. This staining occurred primarily within the vestibular system. Its significance and pathogenesis remains unknown; (b) Sensory and neural structures of the inner ear appeared intact in the majority of specimens, including bones with suppurative labyrinthitis and those with eosinophilic staining of inner ear fluids. This finding raises the possibility of preventing or reversing SNHL by therapeutic intervention. Spiral ganglion cells were severely degenerated in 12% of bones, indicating a retrocochlear site of hearing loss in addition to the cochlea. This subset of patients may perform poorly after cochlear implantation; (c) It has been traditionally assumed that irreversible and permanent SNHL is caused by suppurative labyrinthitis, whereas reversible SNHL is caused by serous labyrinthitis. Our findings question the validity of these assumptions; (d) The data were consistent with the hypothesis that both the cochlear modiolus and cochlear aqueduct can serve as potential pathways for spread of infection from the meninges to the inner ear; (e) There were many similarities in the histopathology of the inner ear in humans when compared with the rabbit model of meningogenic labyrinthitis. A notable difference was that the cochlear aqueduct appeared to be the sole pathway for spread of infection in the rabbit, whereas in the human, both the modiolus and aqueduct were possible pathways.
The radiation dose and the anatomic detail of computed tomography (CT) and conventional tomography were studied in 18 patients with suspected acoustic neuroma, cholesteatoma, malignant tumor, and temporal bone fracture. It is concluded that CT is the technique of choice in patients suspected of having acoustic neuromas or malignant tumors of the temporal bone, while hypocycloidal tomography should be used to evaluate pateints with otosclerosis, small cholesteatomas, and inflammatory disease of the middle ear. For diagnosing fractures and large cholesteatomas, CT and conventional tomography are complementary.
Chondroblastoma of the skull is a benign but locally aggressive tumor. In the past, simple curettage and radiation therapy have been advocated for treatment of this tumor. We present two patients with chondroblastoma of the temporal bone. The tumor extended through the dura in both patients and into the temporal lobe in one patient. Both patients were treated with wide local excision using a combined extended transmastoid and middle cranial fossa approach. On the basis of these two cases and a review of the literature, we recommend complete surgical excision as the primary treatment for chondroblastoma of the temporal bone.
With the new high resolution CT scanners with target reconstruction, detailed radiological anatomy can be assessed. Hence, very small structures within the petrous portion of the temporal bone are accessible owing to better density resolution. Not only bony structures but also soft tissue elements are directly visible, which represents an advantage over multidirectional conventional tomography. This technique is described and examples of the normal anatomy of the temporal bone are presented.