Cholesterol crystals in the temporal bone and the paranasal sinuses

In order to study the manifestation and genesis of cholesterol deposits in the temporal bone and the paranasal sinuses, 137 temporal bones and 3 paranasal sinuses with deposits were examined. For histological study, 1036 specimens were obtained from temporal bones, and 16 specimens were obtained from paranasal sinuses. Several stages of a progressive foreign body reaction, including the appearance of histiocytes, granuloma formation and the development of granulation into scar tissue, were observed depending on the size and form of the crystals. Many large deposits were found in the temporal bones of patients with chronic non-suppurative lesions. Blue eardrum and hemotympanum were seen in the last stage of this foreign body reaction in these patients. Small deposits were found in the temporal bones and the paranasal sinuses of patients with chronic suppurative lesions. Most of these deposits were found in the obstructed parts. The pathogenesis of the cholesterol deposits is suspected to be fatty degeneration of the connective tissue.     

Solitary (unicameral) cysts involving the temporal bone

The primary unicameral cyst which involves the temporal bone is very rare. Only about 30 patients have been reported in the literature during the past ten decades. The lesion is most frequently encountered in the first and second decade of life. In contrast to the other locations in the skeleton, it usually remains asymptomatic for a long time until it causes a deformity or dysfunction. The etiology has so far remained obscure. Its occasional association with malformations of the ears and nasopharynx and other developmental anomalies, its incidental bilateral occurrence, and certain histological aspects may suggest a congenital origin or a localized defect in bone formation and remodeling.     

Two cases of incidental epidermoid cysts: sphenoid sinus and temporal bone

Epidermoid cysts or tumors are uncommon. When they do occur they are usually large at presentation, and the initial symptoms usually involve the cranial nerves. Congenital epidermoids are believed to arise as a result of cellular dysfunction during embryogenesis, which leads to an abnormal migration of ectodermal cells. We present 2 cases of epidermoids that were identified incidentally at our institution during radiologic evaluations of head trauma; one was found in the sphenoid sinus and the other in the temporal bone. Both patients were treated surgically. We review the pathogenesis, diagnosis, and imaging characteristics of these epidermoids.     

Osteoradionecrosis of the temporal bone: a surgical technique of treatment

Osteoradionecrosis of the temporal bone is a well-documented complication of radiotherapy to the ear, with potentially lethal complications. Three cases of advanced disease, treated surgically, are presented. In two of these, subtotal petrosectomy with blind-sac closure of the external auditory canal was carried out via an anterior approach. The enclosed space was obliterated with pedicled temporalis muscle. Primary healing took place. One case was similarly obliterated using a prolonged posterior incision. The wound broke down, requiring a microvascular free flap for closure. Radiotherapy jeopardizes the viability of skin flaps. An anterior incision bases the flap behind on the occipital and postauricular arteries. When radiotherapy has been used, this incision has theoretical and practical advantages over a standard posterior incision.     

Spontaneous osteodural defects of the temporal bone: diagnosis and management of 12 cases

Objectives

The objectives of the study were to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of patients with spontaneous dural defect of temporal bone and to explore the possible contribution of idiopathic intracranial hypertension.

Methods

Medical records of consecutive patients with spontaneous defects of the temporal bone were reviewed. Clinical presentation, diagnostic process, exploration of benign intracranial hypertension, surgical management, and outcome of patients are presented.

Results

Six of the 12 patients presenting with spontaneous cerebrospinal fluid otorrhea were women. Ages ranged from 38 to 76 years. Seven patients presented with meningitis. The location and the extent of the occurring defect were detected by computed tomography in all cases. Radiologic signs of empty sella syndrome, indicator of benign intracranial hypertension, were revealed in 3 cases using magnetic resonance imaging. Six tegmen defects were repaired using a middle fossa approach without recurrence. Four patients received the combined approach. All patients had complete resolution of the cerebrospinal fluid leak, although 2 cases developed adverse effects attributable to surgical procedure.

Conclusion

The diagnosis of spontaneous cerebrospinal fluid otorrhea requires clinical suspicion in the setting of meningitis and persistent serous otitis media. High-resolution computed tomography can confirm the diagnosis. The authors' findings advocate the multilayered closure technique through a middle fossa approach.     

Protuberant fibro-osseous lesions of the temporal bone: a unique clinicopathologic diagnosis.

OBJECTIVE: The objective of the study was to describe the clinical presentation and treatment of exophytic fibro-osseous temporal bone lesions, a clinical entity never previously reported, and to consider the differential diagnosis. STUDY DESIGN: The design of the study was a retrospective case review. SETTING: The setting was a tertiary referral center. PATIENTS: Two patients diagnosed with exophytic fibro-osseous temporal bone lesions were included in the study. INTERVENTION: The intervention used was surgical excision. MAIN OUTCOME MEASURE: The main outcome measures were clinical, radiographic, and histopathologic examination. RESULTS: There was no evidence of recurrence at 15 and 17 months after surgery. CONCLUSION: Although fibro-osseous lesions of the temporal bone have been previously reported, there have been no reported cases of an exophytic variant.     

Surgical treatment and outcomes of temporal bone chondroblastoma

Chondroblastoma is an uncommon primary benign bone tumor that usually arises in the epiphyses of the long bones. Temporal bone chondroblastoma is a rare primary bone tumor that affects the floor of the middle cranial fossa and temporomandibular joint (TMJ). The biological nature of temporal bone chondroblastoma is occasionally aggressive because of local invasion and is known to have a high recurrence after curettage. Therefore, complete resection is recommended. However, the literature provides little information regarding long-term surgical outcomes and complications after surgical resection. The authors have retrospectively analyzed four cases of temporal bone chondroblastoma that had been completely excised by a single surgeon with an eventual long-term follow-up. A single surgeon operated on four patients, two males and two females, with a mean age of 34 years, at the Department of Otorhinolaryngology, Severance Hospital. In all cases, the tumor involved the middle cranial fossa dura and the mandibular fossa with variable degree of infiltration. All patients have had no tumor recurrence to date (mean follow-up period of 5 years). Complete surgical resection of the temporal bone chondroblastoma is the gold standard for treatment. Precise preoperative image evaluation of tumor extension and proper management of the dura mater and temporomandibular joint (TMJ) are the major important features in complete surgical removal that minimize complications in temporal bone chondroblastoma treatment.     

Cholesterol granuloma in thyroglossal cysts: a clinicopathological study

Thyroglossal duct cyst (TDC) is a congenital anomaly caused by retention of epithelial remnants from the descent of the thyroid gland during embryological development. Cholesterol granuloma represents a granulomatous reaction to precipitates of cholesterol crystals in tissue, usually related to middle-ear disease. The association of TDC with cholesterol granuloma has hardly been reported. This study describes five patients with TDC and cholesterol granuloma over a 16-year-period. The treatment consisted of excision of the TDC and the mid-portion of the hyoid bone and excision of a core of tissue between the hyoid bone and the foramen cecum (Sistrunk procedure). We speculate that the pathogenesis of cholesterol granuloma in TDC resembles that in the paranasal sinuses, as both sites provide a closed, poorly ventilated hollow structure with slow drainage. Our five patients accounted for 13% of all patients with TDC treated in our center during the same period, indicating that cholesterol granuloma in TDC may not be as rare as previously thought.     

Solitary bone cysts of jaws: surgical treatment and follow-up of six cases

BACKGROUND: The aim of our study was to assess the long term follow-up in six patients who all presented with solitary cysts and underwent minor surgery. At follow-up treatment (range 16 months to 18 years) efficacy was evaluated and screened for any possible future complications. MATERIAL AND METHODS: Since 1985 all patients who presented in the Department of oral and Maxillo-Facial Surgery with a simple bone cyst were retrospectively included in the study. A total of only 6 patients underwent surgery. One patient with a condylar cyst was seen with a delay of 16 months. The others were examined over 5 years. RESULTS: Surgery allowed us to confirm the diagnosis and achieve the treatment of the cyst. One patient who had a cyst in the ramus and was re-operated for a follicular cyst adjacent to the wisdom tooth. No complication or recurrence was observed.     

Erosive mucosal cysts of the temporal bone. A case report with review of the pathogenesis

An erosive mucosal cyst of the mastoid process is reported. The endodermal lining contained both goblet and nonkeratinizing squamous metaplastic mucosa. Possible causes of cyst formation and its relationship to epidermoid and "motor oil" cysts are discussed.