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PubMed2002

Temporal bone dissection simulation--an update.

We report on our continued development of a virtual simulation for temporal bone dissection that provides stereoscopic display, haptic feedback, and aural simulation into a straightforward, comprehensive learning environment. The multimodal interface provides a seamless simulation for non-deterministic drilling and cutting of bone in the surgical context, as well as an intuitive interface for the intelligent tutor for learning regional anatomy. We present novel methodologies for integrating multimodal and multiresolution data sets, including extension to functional and structural segmentation. We will present our initial efforts to validate this environment. Through continued iterations, it is our hope that the system will provide a valuable tool for training future otologic surgeons as well as an environment for the quantitative evaluation of surgical skill.

Aged↗
PubMed2003

Anomalies of the auditory organ in trisomy 18 syndrome: human temporal bone histopathological study.

The purpose of this study was to define the histopathological changes in the temporal bone of a fetus with trisomy 18 syndrome, a stillborn due to perosplanchnia. Several anomalies were found including malformation of the auditory ossicles, residual mesenchyme in the middle ear, aberrant tensor tympani muscle, absence of stapedial tendon, aberrant lateral ampullary nerve and wide endolymphatic sinus. The incus body was deformed and separated from the long process by connective tissue and monocrural stapes was noted in the right ear. Three-dimensional reconstruction images provided a clear view of the auditory ossicle malformation. The abnormal findings in our case indicate that ear anomalies in this syndrome might be derived from the component around the first and second branchial arches.

Chromosomes, Human, Pair 18↗
PubMed2005

Metastatic renal cell carcinoma to the temporal bone: case report.

We report an extremely rare case of metastasic renal cell carcinoma to the temporal bone which presented initially as a jugulotympanic paraganglioma. The clinical and radiological appearances were misleading.Investigations of concomitant high blood pressure revealed a tumour of the right kidney. Biopsy of the mastoid mass was histologically compatible with a metastasis from a clear cell renal carcinoma. The patient underwent a radical nephrectomy and local external radiotherapy to the head. He also received adjuvant treatment with interferon-_ and interleukin 2. The clinical presentation, the radiological and histological features, the patterns of spread, the treatment options and the prognosis of these tumours are discussed. A review of the literature confirms the extremely unusual occurrence of this localisation.

Adult↗
PubMed1980

Primary carcinoma involving the temporal bone: analysis of twenty-five cases.

Twenty-five patients with primary carcinoma involving the temporal bone were reviewed. Pain and discharge were the most common complaints. A history of previous otitis media was found in 64% of the patients. On clinical and radiological assessment, 18 cases were deemed surgically resectable and 7 unresectable. Analysis of treatment revealed 3 groups of patients: an unresectable group of 7 patients treated by primary radical radiation therapy in which there were no long-term survivors; another group received primary radiotherapy with surgery reserved for residual or recurrent disease--4 of this group of 12 survived 4 years or longer; and the remaining group had primary surgery with radical postoperative radiation therapy--4 of this group of 6 patients survived 4 years or longer despite incomplete surgical removal of tumor in all except 1 patient. The results and possible reasons for failure are discussed.

Adult↗
PubMed2000

Yolk sac tumor of the temporal bone: report of a case.

Yolk sac tumor (endodermal sinus tumor) is rarely encountered in the temporal bone. Facial nerve paralysis can be a primary manifestation of this condition. Histologically, the tumor can be difficult to diagnose, although elevated levels of alpha fetoprotein can facilitate its identification. In this report, we describe the case of an 18-month-old girl who developed peripheral VIIth nerve palsy and a polypoid mass in the left external ear canal 3 months following myringotomy. Computed tomography and magnetic resonance imaging revealed that the tumor involved the left external ear canal, middle ear space, and mastoid air cells. Biopsies were consistent with a yolk sac tumor. Special staining demonstrated that only a very few tumor cells were positive for alpha fetoprotein, despite the markedly elevated level of alpha fetoprotein in her serum. The patient was treated with chemotherapy, which included cisplatin, etoposide, and bleomycin. Within a period of weeks, she experienced a complete reversal of her left VIIth nerve palsy, a marked decrease in her serum alpha fetoprotein levels, and a dramatic resolution of the tumor as demonstrated radiographically. Such a successful chemotherapeutic response in this case argues against surgical intervention in other cases, particularly in view of the risk of serious complications with surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

The clinical correlation of temporal bone fractures and spiral computed tomographic scan: a prospective and consecutive study at a level I trauma center.

BACKGROUND: Undetected temporal bone fractures (TBFs) can lead to complications such as hearing loss, facial nerve paralysis, otorrhea, or otorhinorrhea, and can be the cause of life-threatening bacterial meningitis and can easily be missed. METHODS: We prospectively studied patients with head trauma between January 2000 and January 2001. All patients were examined by the attending trauma physician and then underwent cranial helical computed tomographic (CT) scan independent of clinical findings and Glasgow Coma Scale (GCS) score to determine the proportion of TBFs that would have been missed if diagnosis had been based only on clinical evaluation. RESULTS: Three-hundred fifty consecutive patients with head trauma were studied during the 12-month period (GCS score: range, 3-15; median, 13). In 34 (9.7%) of these patients, 38 TBF (30 unilateral and 4 bilateral) were diagnosed by CT scan. However, clinical signs of TBF were present in only 22 of the 34 patients (65%). All missed TBFs were unilateral. Of the patients with missed TBFs, 8 of 20 (40%) had GCS scores of 14 to 15, 1 of 8 (12.5%) had a GCS score of 9 to 13, and 3 of 6 (50%) had GCS scores < 9. Four of 34 (12%) patients developed clinical complications. CONCLUSION: TBFs are common injuries in patients with head trauma. More than one third of these fractures may be missed by clinical diagnosis alone. Although the clinical importance of the missed TBF is debatable, 12% of our patients developed complications. Therefore, to rule out these lesions, routine cranial helical CT scan should be recommended in all patients presenting with head trauma, independent of clinical findings and GCS score.

Fractures, Bone↗
PubMed1988

Fibrous dysplasia of the temporal bone.

A 38-year-old woman with fibrous dysplasia of the entire right half of the mandible and the right temporal bone is presented. She had a unilateral progressive conductive hearing loss and stenosis of the auditory canal complicated by a chronic external otitis, a hidden cholesteatoma, destruction of the ossicles and an impending facial palsy. Surgery was performed to create a new auditory canal, to eradicate the cholesteatoma and to decompress the facial nerve from the surrounding fibrous dysplasia.

Adult↗
PubMed1997

[Chondroblastoma of the temporal bone: a case report].

A 30-year-old male had been suffering from left temporalgia of six months duration and then developed left hearing disturbance. Craniogram and bone window CT revealed a well defined osteolytic lesion in the left temporal bone. CT scan showed an expansile heterogenous mass with calcification. Both T1 and T2 weighted MRI demonstrated a well lobulated mixed intensity mass, but no evidence of dural or intracranial invasion. The tumor exhibited homogenous enhancement on CT and MRI. Angiogram revealed a well marked staining supplied by the left middle meningeal and deep temporal arteries. Subtotal removal of the tumor was carried out with cranioplasty. Histologically, this tumor was composed of round or polygonal chondroblasts, scattered osteoclast-like giant cells with a foci of cartilage in the stroma. Many reports describe giant cell tumor can be differentiated by immunohistochemical demonstration of S100 protein. Although in our case, histological findings simulated those of eosinophilic granuloma, it was diagnosed as chondroblastoma because of the foci of cartilage in the stroma. Because this tumor is usually benign, recurrence of the tumor is rare after surgical resection. Post-operative irradiation has been reported to be effective in decreasing the recurrence of the tumor. But it should be carefully observed because of possible sarcomatous change in such tumors.

Adult↗
PubMed1981

Asymptomatic intracochlear neurinoma. A temporal bone report.

A small intracochlear neurinoma was found in the temporal bone of a 54-year-old man who had no history of hearing loss or dizziness. The tumor was small, confined to the scala tympani, and did not visibly alter the tissues around it. The neurinoma was derived from the distal processes of the cochlear neuron. Intralabyrinthine tumors can cause auditory and vestibular symptoms and are difficult to diagnose.

Ear Neoplasms↗
PubMed2000

[Comparison of microfissures between the oval and round window niche areas in human temporal bone].

There are numerous reports on microfissures in the round window niche area, but not many reports have appeared on microfissures in the oval window niche area. In addition, few studies have compared microfissures between the oval and round window niche areas in the same subjects. Hence, the present study investigated the prevalence of microfissures in both areas in human temporal bones. The study was conducted on the 637 ears of 333 cases. Specimens were prepared according to the conventional methods: after fixation, decalcification and dehydration, each specimen was embedded in Celloidin, and the temporal bones were sectioned horizontally at 25-micron intervals. Every 10th section was stained with hematoxylin & eosin, and each section was analyzed under a light microscope. The prevalence of microfissures was analyzed in relation to the sex, left/right differences and age of the subjects. Microfissures were seen in the oval window niche area in 66.2%, and in the round window niche area in 92.0%. When a microfissure was seen in the oval window niche area, it was also detected in the round window niche area in every case. There were no sex or left/right differences in the prevalence of microfissures, and microfissures occurred bilaterally in most cases. The youngest subject with a microfissure in the oval window niche area was a 14-year-old, and the prevalence increased with age up to approximately 60 years. On the other hand, microfissures in the round window niche area were seen in a 3-year-old, and were seen in most cases over the age of ten. These findings suggest that microfissures are more likely to occur in the round window niche area as compared to the oval window niche area. However, the prevalence of microfissures in the oval window niche area was not low either, and it is important to pay attention to both the oval and round niche areas when microfissures are involved in the formation of perilymph fistulae. Given that the prevalence of microfissures in the oval window niche area increased up to about 60 years of age, not only growth, but also mastication, may be involved in the occurrence of microfissures.

Adult↗
PubMed1993

Epidemic typhus fever and hearing loss: a histological study (Hallpike collection of temporal bone sections).

Hearing loss as a frequent complication of louse-borne epidemic typhus fever has been well documented in the reports of ENT specialists serving in both the Allied and the German armies in the last war. The present paper describes the characteristic histopathological features as noted in sections of the temporal bones from five British soldiers who died in 1944 of typhus fever during the last war in Eastern Asia. The VIIIth nerve showed multiple 'typhus nodules' and there was extensive interstitial neuritis of the VIIIth nerve and demyelination of the nerve fibres. There were also widely scattered aggregations of mononuclear cells in the inner ear. This unique study was based on the Hallpike collection of temporal bone sections.

Adult↗
PubMed1998

Calcium pyrophosphate deposition disease of the temporal bone.

Massive calcium pyrophosphate crystal deposition is a rare disorder that may affect the temporomandibular joint and temporal bone. The diagnosis is difficult, and misdiagnosis as malignancy, particularly chondrosarcoma, is frequent. This can lead to unnecessarily aggressive management. The clinical, radiographic, and pathologic features of this entity are reviewed, and treatment options are discussed.

Aged↗
PubMed1990

Osteoradionecrosis of sphenoid and temporal bones in a patient with maxillary sinus carcinoma: a case report.

A case of radionecrosis of sphenoid and temporal bones is reported. The patient received a combination of surgery, radiotherapy, and chemotherapy for his left maxillary sinus carcinoma. After the combined therapy, necrosis accompanying inflammation developed in the maxillary and temporal regions. Excision of the necrotic tissues was done, and the left ascending ramus of the mandible was resected because of persistent tumor mass at the left infratemporal fossa. Although the excision wound of the maxilla healed by epithelialization, an area of nonvital bone remained exposed in the temporal region, where progressive osteonecrosis with infection led to breakdown of the skin. The necrotic bones of the zygomatic arch and the sphenotemporal sutural region became visible through the skin defect, and computerized tomography scan revealed bone necrosis involving the inferolateral area and the base of the skull. Excision of the necrotic bone and reconstruction with sternocleidomastoid myocutaneous flap were performed.

Carcinoma, Squamous Cell↗
PubMed1984

High-resolution CT in the evaluation of glomus tumors of the temporal bone.

High-resolution computed tomography (HRCT) was performed in 33 cases of glomus tumors of the temporal bone and 10 cases of other tumors in and around the jugular foramen. HRCT helped to differentiate glomus tumors from vascular anomalies and from other benign or malignant lesions, and to determine the extent of deep involvement. It provided essential information for planning the surgical approach. When a lesion is large or appears atypical, complementary angiography is helpful. Otherwise, angiography may not be necessary.

Ear Neoplasms↗
PubMed1998

Removal of titanium implants from the temporal bone: histologic findings.

OBJECTIVE: This study aimed to evaluate the histologic examination of bone tissue surrounding three titanium implants, which were removed since the patients presented with long-standing pain in the implant area. The histologic examination was both qualitatively and quantitatively performed. Furthermore, could an explanation be obtained for the pain in the implant area, which, after removal of the percutaneous implant, disappeared immediately? STUDY DESIGN: Retrospective case review; clinical histomorphometric. SETTING: University Hospital Nijmegen, Göteborg University, Sweden. PATIENTS: Three patients of a consecutive series of 189; 1 man and 2 women who had received a bone-anchored, percutaneous, skin-penetrating, commercially pure titanium implant in the temporal bone, on which a transducer was mounted. The implants were removed because of pain in the implant area from the three patients after 31 months, 18 months, and 8 months, respectively. MAIN OUTCOME MEASURES: The percentage of direct bone-to-metal contact was 81%, 59%, and 42%, respectively. The percentage of bone volume between the threads of the screw was 90, 78, and 75, respectively. RESULTS: The qualitatively histologic findings showed no major differences among the three investigated samples. Quantitatively, the amount of osseointegration depended on the duration of implantation. CONCLUSIONS: Direct bone-to-metal contact and the bone volume between the threads increased as the implantation time increased. No explanation was found for the longstanding pain in the implant area and the relief of pain after removal of the percutaneous implant.

Adult↗
PubMed1987

Association of abnormal appearance of tympanic membrane with minimal temporal bone pneumatization. A cadaver study.

The association of abnormal tympanic membrane appearance with minimal pneumatization of the temporal bone was studied in 28 unilateral formalin-fixed cadaver specimens. The photographic appearance of each tympanic membrane was judged by seven otolaryngologists, and a normalcy score determined. The normalcy score of the tympanic membranes had a weak association (tau = 0.27, p less than 0.05) with pneumatization volume, as determined by computed tomography. The same trend, though not statistically significant, was found with pneumatization area determined by lateral radiographs. For cross-sectional surveys, the otitis media condition is probably best identified by a combination of indicators: bilateral extent of pneumatization as assessed by computed tomography, bilateral appearance of the tympanic membranes, and a history of otitis media.

Adult↗