高分辨率CT对颞骨外伤性面瘫的诊断价值

目的：探讨高分辨率CT（HRCT）对颞骨外伤性面瘫的诊断价值及对手术的指导意义。方法：据临床资料和颞骨HRCT表现,对29例拟行手术治疗的颞骨外伤性面瘫患者提出预测性诊断,并与术中所见进行对比。结果：CT显示骨折线走行情况与术中所见基本符合,不同类型的骨折引起的神经损伤具有各自的特点。面神经损伤的直接征象包括骨折线贯穿骨管、骨管断裂或断离;间接征象包括面神经局部增粗、骨管壁密度降低、膝状神经窝扩大、面神经受压等。各种征象与术中所见的符合率均在90％以上。结论：HRCT可明确显示颞骨骨折线的位置及走行,有助于判断面神经损伤范围、程度以及邻近结构破坏情况,为临床诊断及治疗提供可靠依据。     

Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

Objective

This study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.

高分辨CT扫描在颞骨骨折致面神经损伤中的应用

目的：探讨高分辨ＣＴ扫描在颞骨骨折致面神经损伤中的应用价值。方法：对２８例有面神经损伤的颅脑外伤患者行颞骨薄层ＣＴ扫描,根据颞骨ＣＴ扫描及临床征象行手术。结果：基本恢复６例,部分恢复１８例,无变化４例。结论：高分辨率ＣＴ可明确显示颞骨骨折的位置及走行,有助于手术前判断面神经损伤的部位及相关损伤,以选择适当的手术径路。     

Chondrosarcoma of the temporal bone

Eight patients with a chondrosarcoma of the temporal bone have been treated at the National Hospital for Neurology and Neurosurgery over a 16-year-period. Patients usually presented with symptoms and signs of lower cranial nerve palsies, though in most cases these resolved after surgery. This result, combined with the fact long-term survival can be achieved, makes surgical treatment of these tumours the best option, as the response to primary radiotherapy is uncertain. Surgical access is difficult, but an infratemporal approach is probably the most satisfactory. The use of post-operative adjuvant radiotherapy may provide some benefit. Long-term follow-up is necessary, and for this magnetic resonance imaging (MRI) is preferable to computed tomography (CT) scanning.     

Imaging of the patulous eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique

Objective—To evaluate the 3D anatomy of the ET and its surrounding tissues in cases with or without patulous Eustachian tube (ET) using CT with the multiplanar reconstruction (MPR) technique.

Material and Methods—Twenty patients with a patulous ET and 25 without middle ear problems were investigated. After performing a temporal bone CT examination, MPR images of the ET were reconstructed and measurements were made.

Results—The ET lumen and its surrounding tissues were clearly identified. In the patulous ET group, the ET lumen was open throughout the cartilaginous portion and the volume of the low-density area was smaller in size than in the controls. In unilateral patulous ET patients, the anatomical features were found to be similar on both sides, in spite of the fact that the non-involved side did not show symptoms associated with a patulous ET.

Conclusion—For the first time, we were able to obtain clear reconstructed images of the patulous ET and its surrounding structure and to study its anatomical features. This method is useful for obtaining a better understanding of the ET and ET-related diseases such as patulous ET.     

Abnormal CT temporal bone findings in a case of Kallmann syndrome presenting with conductive hearing loss

Kallmann syndrome is characterised by hypogonadotrophic hypogonadism and hyposmia. Sensorineural hearing loss is a frequently described association with this syndrome. We report a case of Kallmann syndrome presenting with conductive hearing loss and the CT temporal bone findings of absence of all the semicircular canals. We also postulated the causes for the conductive hearing loss and reviewed the relevant literature.     

Lateral temporal bone resection for malignancy of external auditory meatus: our approach

Objective  Surgical management of tumors of the external ear remains controversial with regard to the extent of resection and the efficacy of piecemeal resection compared to standard en bloc resection. The objective was to study the results of lateral temporal bone resection with soft tissue resection used at our centre in managing a series of such cases. Setting  Tertiary referral centre Patients  A retrospective study was carried out on seven cases of temporal bone malignancies treated at our center, with lateral temporal bone resection by the otologic microsurgical technique and superficial parotidectomy, with adjuvant radiotherapy where indicated. The mode of presentation, clinical and pathological staging, extent of surgical resection, reconstructive methods used and adjuvant therapy given were evaluated. The disease free survival on follow-up was noted. Results  Disease free survival achieved was comparable with other published series, with acceptable morbidity patterns. Conclusion  Lateral temporal bone resection using otologic microsurgical technique with soft tissue resection is an effective way of achieving control of temporal bone malignancies. This paper was read by the fifth author at the 59th Annual Conference of the Association of Otolaryngologists of India held at Bhubaneshwar from 4–7 January 2007.     

Histology of sheep temporal bone

Previous studies suggest that there is an excellent correlation between the morphology and dimensions of ear structures in sheep and human beings.AimTo analyze and describe the histology of structures inside the temporal bone in sheep.Material and MethodsA total of 307 slides obtained from vertical and horizontal sections of the temporal bone of eight sheep were analyzed. Structures were classified as similar or not similar to human structures, based on cellularity and histological architecture parameters.Study designExperimental.ResultsThe study revealed similarities between sheep and humans in terms of type of epithelium, bone component, spaces in the auditory meatus, in addition to a marked histological resemblance of cellularity and that of the structures surrounding the ear. The main differences observed were the presence of an anatomic bulla, the absence of aeration in the mastoid and the inferior opening of the hypotympanum into the bulla in sheep.ConclusionBased on these observations, it is possible to conclude that sheep represent an adequate option for training and research in otologic surgery.     

颞骨孤立性骨浆细胞瘤1例

1病例资料患者,男,31岁。因右耳反复流脓6个月,听力渐进性下降,右侧闭眼不能5个月,头痛1个月伴双眼视物模糊于2010-02-26来我院就诊。体检:右耳道大量黄色脓性分泌物,鼓膜不能窥及,右侧周围性血液。纯音测听示:右耳极重度感音神经性聋。双视乳头水肿。实验室检查示:血尿常规、肝肾功能、各项风湿指标大致正常范围。颞骨CT(图1)示:右鼓室及鼓窦软组织影,增强扫描部分     

CT与磁共振成像在儿童人工耳蜗植入术前研究

目的　评价CT与磁共振成像 (magneticresonanceimaging ,MRI)在儿童人工耳蜗植入术前的诊断作用 ,以及对手术选择的影响。方法　 71例 ( 142耳 )双耳重度耳聋、拟行人工耳蜗植入的患儿进行术前CT与MRI检查。结果　CT与MRI均发现 ,12例 ( 2 2耳 )患者有前庭水管扩大 ( 15 5 % ) ;14例 ( 2 5耳 )患儿有Mondini畸形 ( 17 6% ) ;3例 ( 5耳 )患儿有内耳道扩大 ( 3 5 % ) ;2例 ( 4耳 )患者有可疑内耳道底骨质缺损 ( 2 8% )。MRI发现有 5例 ( 5耳 )患者单侧耳蜗纤维化 ( 3 5 % ) ,而CT未见异常。1例 ( 2耳 )患儿的CT显示面神经裸露 ( 1 4% ) ,MRI正常。结论　人工耳蜗植入术前应该进行CT与MRI检查。对于发现前庭水管综合征、Mondini畸形、内耳道扩张及内耳道底骨质缺损有重要意义。这二种影像学检查结果可以相互补充诊断耳蜗纤维化与面神经裸露。对手术适应证的选择以及保证手术正常进行有重要意义     

Haemangioma of the temporal bone

IntroductionHaemangiomas of the temporal bone are rare tumours and haemangiomas involving the middle ear are even rarer. The exceptional nature of these lesions makes their management particularly complicated.Case reportThe authors report the case of a 16-year-old girl, who presented with an osteolytic lesion of the left petrous temporal bone that proved to be a haemangioma with extension to the middle ear, causing conductive hearing loss.DiscussionSurgical biopsy is essential to establish the diagnosis of haemangioma because imaging alone only rarely provides a definitive diagnosis. Surgery is the reference treatment to prevent recurrence. Arteriography is an essential part of the preoperative assessment in order to limit the risk of bleeding.     

CT diagnosis of temporal bone anomalies and cochlear implant surgery in CHARGE association

Abstract

Children with CHARGE have multiple disabilities. Impairments of vision and hearing, balance problems and facial palsy are common. Few reports have dealt with their radiological temporal bone changes and none with cochlear implant surgery. The pre-operative temporal bone computed tomography (CT) and surgical findings of one child with CHARGE and one with a CHARGE-like condition who have received cochlear implants are reported. The findings include absent semicircular canals, narrow orifice for the cochlear nerve, and abnormalities of the oval and round window, the facial canal and the ossicles. CT can be used as a diagnostic tool as these combinations of temporal bone changes are extremely rare in other materials. Cochlear implants may help these often very isolated children to communicate.     

Transpetrosal approach: an anatomical study of temporal bone

Resection of the petrous temporal bone to various degrees provides different levels of access to lesions of the posterior fossa. However, regarding the numerous variations, precise distances of petrosal bone are not still clearly described. This may lead to serious complications during transpetrosal surgeries. Our objective was to evaluate different distances of temporal bone landmarks in order to assess their variations and the possible correlations between them. This anatomical study was performed on 60 temporal bones from 60 human cadavers in the years 2006 and 2007. All the bones contained an adequate portion of the petrous apex and attached fossa dura. Twelve landmarks were defined and 27 different distances were measured for each temporal bone using two-point caliper. Less variation was observed in the superoinferior diameter of horizontal carotid canal with the less coefficient of variation (CV) of 9.29; whereas, the most variation was detected in the inferior (axial) plane of posterior semicircular canal to superior plane of jugular bulb (CV = 57.65). There was a significant correlation between vertical intratemporal diameter of carotid in pyramidal direction, and superior–inferior diameter of horizontal carotid canal (r _Pearson = 0.500, P < 0.001). Other significant correlations were also found between other distances. The variations of different distances and landmarks were evaluated and many significant correlations were demonstrated between them which could potentially aid ENT specialists and neurosurgeons in order to approach anatomical landmarks and cranial fossas more safely during otologic and neurotologic surgeries. It could also help the design of middle ear prosthesis.     

Large vestibular aqueduct syndrome: a human temporal bone study

OBJECTIVES/HYPOTHESIS: Large vestibular aqueduct syndrome (LVAS) is one of the common causes of hearing loss (HL). All prior studies have reported some anomalies associated with LVAS by imaging techniques. This study was undertaken to determine prevalence of LVAS in our temporal bone (TB) collection and its relationship to other systemic or otologic anomalies. STUDY DESIGN: Retrospective, TB histopathologic study. METHODS: Anteroposterior diameters of internal (IA) and external (EA) apertures were measured in 40 normal TBs (40 cases). TBs were considered as large vestibular aqueduct (LVA) if width of apertures was 95% greater than "normals." Systemic and otologic anomalies and histopathology of ears with LVAS were noted. RESULT: Of 1,608 non-"normal" TBs, 63 had LVA. There was negative correlation between IA and EA in 48 TBs with only enlarged IA. Fifteen TBs with enlarged EA always had enlarged IA and were therefore considered as LVAS. The most common pathologic condition was congenital heart anomaly. The most common syndrome or dysplasia was Mondini's. The most common anomalies of external and middle ears were dehiscent facial nerves, low set auricles, and ossicular deformities. Inner ear anomalies included modiolar deficiencies, hair cell loss, interscalar septum defects, and strial atrophy. There was no record of family history of HL, head injury, or craniofacial, branchial, or thyroidal abnormalities. CONCLUSION: Because HL associated with LVAS may be attributed to other ear anomalies, it is important to investigate other inner ear problems and system diagnoses that may indicate a syndrome in patients with radiologically diagnosed LVAS.     

Surgical simulator for temporal bone dissection training

Temporal bone dissection plays an important role in the training of surgeons; however, they are difficult to obtain.AimTo develop a synthetic replica of the temporal bone for dissection training.Study DesignExperimental.Materials and MethodsAn acrylic synthetic resin replica was obtained from a human temporal bone. For the evaluation of the method, we selected five ear surgeons to dissect the model in a laboratory of experimental surgery. A questionnaire was filled, assessing external appearance, the simulation of procedures (placement of ventilation tube, mastoidectomy, decompression of the facial nerve and translabyrinthine access to the internal auditory canal) and their final conclusion.ResultsThe evaluation indicated satisfaction in using the model (80%), being more evident concerning the dissection of the mastoid segment of the facial nerve and translabyrinthine access to the internal auditory canal. The placement of a ventilation tube was reasonable for 60% and satisfactory for 40% of them. Mastoidectomy was satisfactory for 60% and fully satisfactory for 40%.ConclusionDissection in this simulator does not replace otologic training in cadaveric temporal bones. However, given the increasing difficulty in obtaining the latter, the development of new teaching tools should be encouraged to continuously improve surgeons.