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Molecular temporal bone pathology: III. Genotyping of the deltaF508 deletion in the DNA of patients with cystic fibrosis.

Genomic DNA from a single celloidin-embedded archival temporal bone section was used to identify a specific genetic mutation. The polymerase chain reaction was used to amplify and detect the deltaF508 deletion, a common molecular genetic defect in cystic fibrosis. This mutation, present in more than 70% of white patients and carriers with cystic fibrosis, results in the deletion of codon 508, which specifies the amino acid phenylalanine of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. When this technique was applied to archival specimens from four patients with cystic fibrosis, all expressed the carrier state of this defective gene. These data demonstrate the feasibility of identifying genetic mutations in archival temporal bone specimens.

Alleles↗

Spontaneous CSF Leaks From the Temporal Bone.

Spontaneous cerebrospinal fluid leaks from the temporal bone seem to be rare; however, increasing numbers of cases are being reported. This paper reports 14 cases. The presenting symptoms included hearing loss, external leaks, mass in the middle ear and external meatus, and facial paresis. All cases were evaluated with computed tomography (CT), eight with CT cisternography, and six with magnetic resonance imaging. In all patients the defect was found in the tegmen; in two, an additional defect could be detected in the posterior fossa. All were surgically treated by a transmastoid extradural technique. There are no recurrences after a mean follow-up period of 1.2 years (5 months to 2.4 years).

Journal Article↗

The Mondini defect in Turner's syndrome. A temporal bone report.

The histopathology of the right temporal bone of a 47 year old deaf woman with Turner's Syndrome (gonadal dysgenesis) is described. The appearances are of the Mondini deformity, the cochlea consisting of a single basal turn with a bulbous apical dilatation. The organ of Corti was absent. The remainder of the bony labyrinth save for the cochlear aqueduct was normal. The patient's death was due to a cerebral astrocytoma. Previous reports concerning the co-existence of gonadal dysgenesis, congenital deafness and non-gonadal neoplasia are discussed.

Astrocytoma↗

Imaging of the temporal bone.

Computed tomography remains the imaging modality of choice in investigating conductive hearing loss. The improvement of MR imaging surface-coil technology is allowing a number of inflammatory and neoplastic diseases in the temporal bone to be detected more effectively. These two modalities when used correctly will detect many of the soft tissue and bony abnormalities of the temporal bone.

Bone Diseases↗

Verrucous carcinoma of the temporal bone.

Verrucous carcinoma, a familiar lesion of the oral cavity and larynx, is distinctly rare in the ear. We report five cases of verrucous carcinoma of the temporal bone, each of which fulfills Ackerman's histologic and biologic criteria. Only three cases of verrucous carcinoma of the ear have been previously reported. Most cases of verrucous cancers of the head and neck demonstrate a lack of nodal involvement, relatively slow growth potential, local invasiveness, and responsiveness to surgical treatment. In our five cases of verrucous carcinoma of the temporal bone, three had a biologic behavior similar to other verrucous tumors, while two cases were unusually aggressive. Three patients were treated surgically and had favorable outcomes, while the remaining two were treated with combination therapy. These cases highlight the difficulty in diagnosis and treatment as well as the lack of understanding of the biologic behavior of this rare otologic entity.

Aged↗

Management of chronic staphylococcal osteomyelitis of the temporal bone: the use of hyperbaric oxygen.

Hyperbaric oxygen (HBO) is an effective adjunct in the management of selected otolaryngologic problems including radiation-induced necrosis of the temporal bone, malignant external otitis, mandibular osteoradionecrosis and refractory osteomyelitis, soft tissue head and necrotizing fasciitis, compromised skin flaps and grafts, acute air or gas embolism, and otologic barotrauma. We describe the management of a patient with insidious Staphylococcus aureus osteomyelitis of the temporal bone by the use of HBO preoperatively and postoperatively in conjunction with surgical debridement. The possible application of angiogenic agents and tetracycline bone-labeling in combination with HBO therapy in the management of refractory neurotologic disease is discussed.

Chronic Disease↗

[The thickness and the pathological findings of the tympanic membranes in otitis media with effusion--a pathological study of the temporal bone].

The purpose of this study is to examine the relation of the grade of the inflammation of the middle ear and the pathological findings of the tympanic membranes using human serial horizontal sections from 16 temporal bones with otitis media with effusion. As controls, we used 96 normal temporal bones. The results were as follows. 1) In cases with a lot of inflammation cells in the middle ear effusion, there were seen much pathological changes in the epidermal layer and the intermediate layer. 2) In the pars flaccida and the posterior point of the malleus handle were noted remarkable changes. 3) The greater part of the cells of the middle ear effusion was neutrophils.

Adolescent↗

Congenital fibrous lesion of the temporal bone.

A neonate had a destructive, fibrous lesion of the temporal bone. There was x-ray evidence of disseminated, lytic disease. A histologic diagnosis of malignant fibrous histiocytoma was made. No treatment was given, yet the child survived with spontaneous resolution of her lesions. We briefly discuss malignant fibrous histiocytoma and propose congenital generalized fibromatosis as an alternative diagnosis to explain the child's recovery.

Bone Neoplasms↗

[Fracture of the temporal bone. Evaluation of 123 cases].

Out of 2,888 blunt head injuries that were treated at the Hermann Hospital Trauma Center of the University of Texas at Houston, only 123 temporal bone fractures were diagnosed in 110 patients. The clinical diagnosis was confirmed with high resolution computerized tomography of the temporal bones. Three main categories of fractures were identified: oblique in 74%, longitudinal in 13% and transverse in 13%. The clinical manifestations included hemotympanum in 83%, cerebrospinal fluid otorrhea in 21% and Battle's sign in 10.6%. One third of the patients had conductive hearing loss, 1/2 had mixed hearing loss and the rest sensorineural loss. On exploration, the most frequent middle ear pathology was incudostapedial joint dislocation. Immediate facial paralysis was observed in 64 patients. Only 11 patients needed facial nerve exploration following signs of denervation, the rest recovered spontaneously. Thirteen patients who had delayed facial paralysis also recovered spontaneously. One third of the patients had persistent unsteadiness 6 weeks following the injury. Other unusual complications encountered include 6 cases of abducent paralysis, 2 cases of trigeminal paralysis and 2 cases of aseptic sigmoid sinus thrombosis.

Adolescent↗

High-resolution flat-panel volume-CT of temporal bone--part 1: axial preoperative anatomy.

The purpose of this four-part series is to show the high-resolution axial and coronal anatomy of the temporal bone from a flat-panel detector-based volume CT (parts 1 and 2); these imaging planes are then used to outline the effect of different surgical procedures commonly applied to the temporal bone (parts 3 and 4). The structures that are removed or altered in 11 different surgical procedures are color-coded and inscribed in axial and coronal sections. Clinically important imaging features and complications following these surgeries will also be 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 one would be able to picture 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 1) focuses on the preoperative axial anatomy.

Humans↗

Computed tomography and magnetic resonance imaging of the normal anatomy of the temporal bone.

The high image quality provided by current high resolution CT bone algorithms in conjunction with the multiplanar and soft tissue imaging capabilities of MRI, provide exquisite anatomic detail of the temporal bone structures. This allows the radiologist to visually dissect this complex, three-dimensional structure, if a firm understanding of normal anatomy exists. In this way, the pathological processes involving the temporal bone can be better understood and correlated with the clinical setting.

Cerebellopontine Angle↗

A networked haptic virtual environment for teaching temporal bone surgery.

This paper describes a computer system for teaching temporal bone surgery using networked haptic work benches. The system enables an instructor and student to collaboratively explore and drill a volumetric bone model including significant anatomical features. Subjective evaluations by otologists have been favourable, and experimental trials are planned.

Australia↗

Giant cell tumor of the temporal bone--a case report.

BACKGROUND: Giant cell tumor is a benign but locally aggressive bone neoplasm which uncommonly involves the skull. The petrous portion of the temporal bone forms a rare location for this tumor. CASE PRESENTATION: The authors report a case of a large giant cell tumor involving the petrous and squamous portions of the temporal bone in a 26 year old male patient. He presented with right side severe hearing loss and facial paresis. Radical excision of the tumor was achieved but facial palsy could not be avoided. CONCLUSION: Radical excision of skull base giant cell tumor may be hazardous but if achieved is the optimal treatment and may be curative.

Journal Article↗

Middle cranial fossa approach to the internal auditory Meatus:A Chinese temporal bone study.

Most techniques applied in the middle cranial fossa approach to the internal auditory meatus were based on anatomic studies in Caucasians. As racial differences in the cranium exist, this paper evaluated the applicability of these techniques in Chinese patients. This paper also evaluated the usefulness of the 30-degree-angled rigid endoscope in identifying the superior semicircular canal (SSC). Thirty Chinese temporal bones were dissected. It was found that, like in Caucasian patients, (1) constant relation exists between the geniculate ganglion and SSC, and (2) the internal auditory meatus of each specimen was situated within a 60-degree angle anterior to the SSC. However, the orientation of the arcuate eminence and its relationship to the SSC in Chinese differed from Caucasians. The endoscope was found to be useful in aiding early identification of the SSC and in differentiating it from surrounding air cells. In conclusion, some recommended landmarks used in hearing preservation via the middle cranial fossa approach may not apply to Chinese patients. The endoscope has the potential to enhance the chances of hearing preservation.

China↗

[CT of the temporal bone in the study of the inner ear structures in detection of the causes of neurosensory hypoacusis].

Computed tomograms of the inner ear structures (n=175) of 150 patients (age 0-75 years) with unaffected temporal bones were studied in detail. It is shown that polyposition CT of the temporal bone is a non-invasive method of visualization of the osseous labyrinth structures: cochlea, vestibule, semicircular canals, aqueducts of the labyrinth and internal acoustic meatus which are reflected on tomograms in 100% cases irrespective of the patient age. Their age-related features are analysed. CT imaging was made in 65 patients with neurosensory hypoacusis of inherited and acquired genesis. The following causes of neurosensory hypoacusis and deafness were revealed: congenital malformation of the labyrinth of Mondini type, common cavity of the labyrinth, cochlear hypoplasia, dysplasia of the vestibule and semicircular canals, a wide aqueduct of the vestibule, stenosis of the internal acoustic meatus, bulboform enlargement of the inner acoustic meatus, neurinoma (schwannoma) of the hearing nerve, Langerhans-cell histiocytosis with affection of the labyrinth capsule, atypical cholesteatoma. The detected changes in the inner ear structures determine further treatment policy.

Adolescent↗

Fibrous dysplasia of the temporal bone. Update with case reports.

Fibrous dysplasia is a fairly common, well demarcated, misdifferentiation of the bone-forming mesenchyme affecting a single, several, or many bones, in which skeletal changes are the salient feature, but in which certain endocrinopathies, abnormal pigmentation of skin and mucous membranes, and occasionally other abnormalities form part of the entire disease process. The clinical and pathological aspects of the disease and its involvement with the temporal bone have been previously discussed. Two recent case histories are added here.

Adult↗

[Temporal bone imaging].

With the advent of high-resolution computed tomography (HRCT), diagnostic imaging has played important roles in the evaluation and management of diseases in the temporal bone. Recent advanced technology such as, multi detector-raw, sub-millimeter slice thickness (0.5 mm), high-speed rotation (0.5 sec/rot), can make more accurate and rapid examination possible. Magnetic resonance imaging (MRI) can provide additional information because of its high contrast of soft tissues. In this article, characteristic findings of several diseases in the temporal bone, such as, anomaly, cholesteatoma, cholesterol granuloma, glomus tumor and other tumors, are presented.

Cholesteatoma, Middle Ear↗

[Vascular, inflammatory and tumorous lesions of the temporal bone and cerebellopontile angle: applications of magnetic resonance tomography].

Advances in high resolution magnetic resonance imaging (MRI) allow the evaluation of the cerebellopontine angle and temporal bone. The purpose of our study was to demonstrate pathological and anatomical aberrations of cerebral arteries in relation to clinical symptoms. The study was carried out on a 1T MR whole body scanner (Impact, Siemens, Erlangen, Germany), using a head coil, a pre- and postcontrast ("Magnevist", Schering, Berlin, Germany) T1-weighted 2D-FLASH sequence and a T2-weighted turbo-spin echo sequence. We examined 22 patients suffering from asymmetric hearing loss, pulse-synchronous tinnitus, hemifacial spasm or facial palsy. The problem of a clear differentiation of meningiomas and acoustic neurinomas by means of MRI is discussed. We identified aberrant AICAs at the cerebellopontine angle in close contact with the V., VII. and VIII. cranial nerve. Inflammatory lesions of the facial and vestibulocochlear nerve were visualised successfully. The potential of the pre- and postcontrast 2D-FLASH sequence for the detection of a wide range of different lesions in the cerebellopontine angle and the temporal bone in MRI of the head was demonstrated.

Arteries↗