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PubMed1979

Metastatic tumors in the temporal bone--a pathophysiologic study.

Nineteen temporal bones were examined from 11 patients who had metastatic temporal bone disease from a distant primary. The salient clinical features were: the high incidence of occult temporal bone involvement (7 of the 10 clinically documented cases), the considerable incidence of melanoma (3 of 10) and the variable correlation between clinical findings and pathologic localization of tumor in the temporal bone. Pathologic examination revealed two distinct modes of tumor spread within the temporal bone: 1) vascularosseous (petrous apex, mastoid, middle ear, external canal); and 2) perineural (nerves in IAC branches, labyrinthine endorgans). Every case was involved by one or both or these routes and no case of CSF-borne metastasis to the perilymphatic space was seen. The external canal was involved extensively in spite of an intact tympanic membrane. Since the presence of symptomatic or occult metastases in the temporal bone affects treatment and prognosis, they must be actively sought by the clinician.

Adenocarcinoma↗
PubMed1996

Metastatic hypopharyngeal carcinoma to the temporal bone.

Two cases of temporal bone metastasis by hypopharyngeal carcinomas are reported. One patient was a 43-year-old Japanese male who developed palsy of left oculomotor, trochlear, trigeminal, abducens and facial nerves. Carcinoma infiltrated the petrous portion of the left temporal bone. Tumor had destroyed a part of the facial canal and invading tumor cells were in contact with the perineurium. The other patient was a 59-year-old male who had no obvious facial nerve or otologic symptoms during the clinical course of his disease. Postmortem findings showed that carcinoma had invaded the right temporal bone and had produced extensive destruction of the facial canal. Degenerative findings were evident in the nerve. In the cases presented here, tumor resulted either from metastatic lymph nodes or had invaded through the suture of the temporal and sphenoid bones around the foramen lacerum to the middle cranial fossa and then infiltrated the temporal bone.

Adult↗
PubMed2000

Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey.

OBJECTIVE: To determine the incidence and etiology of dehiscences of bone overlying the superior semicircular canal in a temporal bone archive. DESIGN: A microscopic study was performed of 1000 temporal bones from 596 adults in a university hospital registry. Specimens were sectioned vertically in the plane of the superior semicircular canal. Measurements of minimum bone thickness over the superior canal were made in a subset of 108 randomly chosen specimens. All bones were examined for thinning or dehiscence relative to these norms. Clinical histories, when available, were reviewed. RESULTS: Complete dehiscence of the superior canal was identified in 5 specimens (0.5%), at the middle fossa floor (n = 1) and where the superior petrosal sinus was in contact with the canal (n = 4). In 14 other specimens (1.4%), the bone at the middle fossa floor (n = 8) or superior petrosal sinus (n = 6) was no thicker than 0.1 mm, significantly less than values measured in the control specimens (P<.001). Abnormalities were typically bilateral. Specimens from infants demonstrated uniformly thin bone over the superior canal in the middle fossa at birth, with gradual thickening until 3 years of age. CONCLUSIONS: Dehiscence of bone overlying the superior canal occurred in approximately 0.5% of temporal bone specimens (0.7% of individuals). In an additional 1.4% of specimens (1.3% of individuals), the bone was markedly thin (< or =0.1 mm), such that it might appear dehiscent even on ultra-high-resolution computed tomography of the temporal bone. Sites affected were in the middle fossa floor or a deep groove for the superior petrosal sinus, often bilaterally. These abnormalities may arise from failure of postnatal bone development. Thin areas of bone over the superior canal may be predisposed to disruption by trauma.

Adult↗
PubMed1996

Metastatic carcinoma of the temporal bone.

Metastatic carcinoma of the temporal bone is rare and often not recognized because it can be either asymptomatic or overshadowed by other metastases late in the disease course. Metastatic evaluation does not usually include temporal bone imaging, and the temporal bone is not routinely sectioned at autopsy, further contributing to unreported metastases. Two case reports of metastasis to the internal auditory canal are presented, as well as a review of 139 such patients reported in the world literature. Analysis includes types of tumor, specific sites of secondary malignancy within the temporal bone, and manifestations. Although uncommon, metastatic carcinoma of the temporal bone must be included in the different diagnosis of any cochleovestibular or facial nerve disorder.

Adenocarcinoma↗
PubMedDate not supplied

Temporal bone chondroblastomas.

OBJECTIVES: To review temporal bone chondroblastomas in regards to their presentation, radiographic findings, histopathology, and treatment.Study design Case report and literature review. METHODS: A case report of a 38-year-old man is reviewed who presented with left-sided mixed hearing loss, otalgia, otorrhea, and a left external auditory canal mass. A computed tomography scan revealed a 6-cm mass involving the petrous and squamous portions of the left temporal bone. CONCLUSIONS: Temporal bone chondroblastomas are extremely rare osseous tumors with only 35 cases previously reported in the literature. Presenting symptomatology and pathology may be confused with more common lesions seen in the temporal bone. Diagnostic radiology, including computed tomography and/or magnetic resonance imaging, as well as immunohistochemical staining with S-100 protein may assist in making the diagnosis. Treatment is complete surgical excision with preservation of vital neurovascular structures.

Adult↗
PubMed2004

Stereo morphology of temporal bone and ear.

BACKGROUND: The temporal bone has the most complicated anatomic feature among the whole human body, which always challenges otolaryngologists. This study was to study three-dimensional (3D) morphology of the temporal bone and the ear by means of a computer image processing technique, for the purpose of providing a 3D image to help in pathological, diagnostic and surgical procedures. METHODS: Forty sets of temporal bone celloidin serial sections with reference points were prepared and the contours of selected structures and reference points were entered into a graphics programme. The technique of computer-aided 3D reconstruction was applied to obtain 3D images and parameters of the temporal bones and the ears. Stereo views of the ossicles (n = 5), the facial nerves (n = 11), the posterior tympanic sinuses (n = 11), the posterior ampullary nerves (n = 4), the endolymphatic ducts and sacs (n = 5), and the bony and membranous labyrinth (n = 1) were reconstructed. RESULTS: Three-dimensional images, including the cochlea, the ossicles, the nerves, the tendons and the endolymphatic fluid system in the temporal bone, were obtained. Stereo picture pairs and 3D parameters of spatial dimensions, angle and volume for these reconstructed structures were calculated. The arrangement of the ossicles, spatial relationship of the bony and membranous labyrinth, the whole course of the facial nerves, the endolymphatic sac and posterior tympanic cavity were clearly observable. Stereo picture pairs made the spatial relationships among the above-mentioned structures much clearer. The operation of the posterior ampullary nerve transection was designed and simulated on the graphic computer based on 3D anatomic investigations. CONCLUSION: The technique of computer-aided 3D reconstruction provides a new tool to observe the morphology of the temporal bone and thus may allow design and study of new surgical approaches.

Ear↗
PubMedDate not supplied

Five-year experience with skin-penetrating bone-anchored implants in the temporal bone.

A method for stable integration of titanium-implants in bone tissue has been developed at the University of Gothenburg, Sweden. Screw shaped implants have been inserted in the temporal bone using a delicate surgical technique. After healing-in of the implants it is, in a later séance, possible to penetrate the skin to establish a reaction-free percutaneous passage. An up to 5-year clinical follow-up has shown the possibilities of this new method in the treatment of patients with e.g. certain hearing disorders or facial defects after tumour surgery.

Follow-Up Studies↗
PubMed2003

[Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone].

Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures.

Ear Canal↗
PubMed1994

Prevalence of carotid canal dehiscence in the human middle ear: a report of 1000 temporal bones.

A total of 1000 human temporal bones were used to study the prevalence of carotid canal dehiscence, microdehiscence, and thin bony coverage. Additionally, this study compares the prevalence according to sex and temporal bone age. A carotid canal dehiscence was detected in 77 (7.7%) bones. It was present bilaterally in 23.2% of the paired temporal bones. The prevalence of carotid canal dehiscence decreases with increasing temporal bone age. It was found in 10 (15.9%) bones in the younger than 2 age group, as opposed to 43 (6.3%) bones from the 40 and older group. The concept of microdehiscence of the carotid canal is introduced. A carotid canal microdehiscence was found in 74 (7.4%) bones. Microdehiscences were noted to occur bilaterally in 12.3% of the paired bones. The prevalence of carotid canal microdehiscence also decreases with increasing temporal bone age. It was detected in 7 (11.1%) bones in the younger than 2 age group, in contrast to 51 (7.5%) bones in the 40 and older group. A total of 134 (15.5%) temporal bones were found to have a thin bony coverage, without the presence of a dehiscence or microdehiscence. The prevalence of thin coverage was noted to increase linearly with age. A thin carotid canal was found in 2 (8.3%) bones from the younger than 2 age group, whereas 113 (17.3%) temporal bones from the 40 and older group exhibited this entity. To the best of our knowledge, this is the first systematic study of histologic sections of a large number of temporal bones that looks at these entities.

Adolescent↗
PubMed1992

Primary lymphoma of the temporal bone.

Involvement of the temporal bone by lymphoreticular neoplasm is rare; all reported cases have been of secondary involvement. This article presents what we believe to be the first two reported cases of primary temporal bone lymphoma. The patients, an elderly man and a boy, both presented with infection of the ear, hearing loss, and facial nerve paresis. In both cases, facial paresis resolved after appropriate chemotherapeutic treatment. Patient presentation and clinical course are discussed in light of published work on temporal bone malignancy. Further investigation, including computed tomography and biopsy, should be considered for patients who present with an apparent middle ear infection unresponsive to medical therapy. The development of facial paralysis in such a patient warrants heightened suspicion of malignancy.

Aged↗
PubMed2004

Facial paralysis caused by metastasis of breast carcinoma to the temporal bone.

Metastatic tumors to the temporal bone are very rare. The most common sites of origin of temporal bone metastases are breast, lung, kidney, gastrointestinal tract, larynx, prostate gland, and thyroid gland. The pathogenesis of spread to the temporal bone is most commonly by the hematogenous route. The common otologic symptoms that manifest with facial nerve paralysis are often thought to be due to a mastoid infection. Here is a report on a case of breast carcinoma presenting with otalgia, otorrhea, and facial paralysis for 2 months. The patient was initially diagnosed as mastoiditis, and later the clinical impression was revised to metastatic breast carcinoma to temporal bone, based on the pathologic findings. Metastatic disease should be considered as a possible etiology in patients with a clinical history of malignant neoplasms presenting with common otologic or vestibular symptoms, especially with facial nerve paralysis.

Aged↗
PubMed2002

Aneurysmal bone cyst of the temporal bone: a case report.

Aneurysmal bone cyst in temporal region is rare. It is a benign condition and may extend intracranially. Total surgical removal is recommended, whenever possible in one stage or in multiple stages. Prognosis is excellent and total removal will effect a cure. An unusual case of aneurysmal bone cyst of temporal region is reported.

Adolescent↗
PubMed1987

Congenital malformations of the inner ear: histologic findings in five temporal bones.

The histopathologic findings in five temporal bones from three patients with congenital malformation of the inner ear are described. The external contour of the cochlea was deformed in two temporal bones, while the internal architecture was abnormal in all five temporal bones. Intracochlear abnormalities included defects in the interscalar septum, deficiencies in the modiolus, and a paucity of neural elements. Spiral ganglion cell populations varied, but were substantially diminished in all five temporal bones. Enlargement of the vestibule and semicircular canals (lateral and posterior) was seen in two temporal bones. A large vestibular aqueduct and saccular hydrops were found in one temporal bone each. An attempt was made to relate the histologic patterns of deformity to the proposed clinical classification of inner ear malformations. Radiographic abnormality of the cochlea would have been detectable in two bones (incomplete partition pattern), while two other bones would have appeared as vestibule-semicircular canal syndromes. One bone would have been radiographically normal.

Chromosomes, Human, Pair 13↗
PubMed1989

Three-dimensional computer reconstruction of a temporal bone.

The complexities of the temporal bone and the critical inter-relationships among its key structures can be simplified with three-dimensional computer-assisted reconstruction. Knowledge of the topography of these structures and their mutual relationships in essential in any surgical approach to the temporal bone. Sixty sagittal histologic sections of a normal left temporal bone were examined. Each section, 30 microns in thickness, was optically enlarged. Segments representing the facial nerve, internal carotid artery, and inner ear structures from individual slides were traced and data were entered into a computer. A personal computer was used for data processing and analysis. Graphic software developed in our laboratory generated images with x-y-z coordinates that could be rotated in any plane. The high resolution of the computer graphics system, combined with the precision of histologic sections, permitted study of the critical three-dimensional anatomic relationships among essential intratemporal bone structures. The capability of reproducing individual and joint images of the intratemporal bone structures and viewing them from all surgical angles gives skull base and otologic surgeons important topographic guidance. Accurate spatial measurements of temporal bone anatomy are now possible with the application of computer graphic technology.

Carotid Artery, Internal↗
PubMed1994

Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: a report of 1000 temporal bones.

A total of 1000 temporal bones were used to study the prevalence of facial canal dehiscence and of persistent stapedial artery in detail. Of the temporal bones studied, 560 (56%) contained at least one facial canal dehiscence. There was a 76.3% prevalence of bilaterality of this canal wall gap. The most common site of dehiscence was the oval window area. The concept of microdehiscence of the facial canal is introduced. One third of the temporal bones observed had a microdehiscence of the facial canal, usually located at the oval window area (74.9%) and found bilaterally 40% of the time. The authors found a 0.48% prevalence (5 out of 1045) of persistent stapedial artery. This is the first histological study of temporal bones to report a prevalence of this vascular anomaly.

Adolescent↗
PubMed2003

Visualization of the temporal bone of the Chinese Visible Human.

Temporal bone anatomy is very difficult to understand. After dataset acquisition of the first Chinese Visible Human, we processed the two-dimensional images to build a digitized visible model of the temporal bone and explore the role of virtual endoscopy in the inner ear. On a SGI workstation three-dimensional computer reconstructions of the ear were generated from the Chinese visible human dataset, viewing the middle and inner ear imitating the traditional otoscopy. The three-dimensional data of the temporal bone were then converted to STL format, and the temporal bone replica were fabricated with rapid prototyping by laminated object manufacturing. The virtual model of the ear was successfully completed, and the virtual endoscopy improved three-dimensional visualization of the middle and inner ear. Physical replica of the temporal bone were built with paper; the accuracy was +/-0.2 mm. The reconstructed model and the replica of the temporal bone can be used to make preoperative plans in the complicated otoneurosurgical operations, allowing various surgical exercises to be carried out on the three-dimensional stereophysical model. The virtual endoscopy stands as a promising new visualization technique for elucidation of the middle and inner ear and reveals a tremendous potential in both clinical and educational settings, providing morphological data for the image diagnosis and otoneurosurgery.

Anatomy, Cross-Sectional↗
PubMed1986

Primary and secondary tumors of the facial nerve. A temporal bone study.

Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.

Cranial Nerve Neoplasms↗