Temporal bone

Abstract: Part 1 Introduction to Surgery of the Ear: Development Anatomy of the Ear: Surgical Anatomy of the Temporal Bone: Diagnosis of Ear Disease: Conventional Radiologic Examination of the Temporal Bone: Neuroradiologic Examination: Principles of Temporal Bone Surgery. Part 2 Surgery of Infections of the Ear: Pathology and Clinical Course of Inflammatory Disease of the Middle Ear: Operations of the Auricle, External Meatus and Tympanic Membrane: The Simple Mastoid Operation: the Open Cavity Mastoid Operations: Intracranial Complications of Otitis Media: Aural Complications of Otitis Media: Mechanics of Hearing: Surgical Correction of Congenital Malfformations of the Sound-Conducting Mechanism: Closure of Tympanic Meembrane Perforations: Tymparoplasty: Diagnosis, Indications for Saurgery and Medical Therapy of Otospongiosis (Otosclerosis): Stapes Operations for Otospongiosis (Otosclerosis). Part 3 Surgery of the Facial Nerve, Endolymphatic Hydrops and Tumours of the Ear: Facial Nerve Surgery: Surgical Treatment of Peripheral Vestibular Disorders: Skull Base Surgery: Acoustic Neuroma and Tumours of the Cerbellopontine Angle: Implantable Hearing Devices: Surgical Anatomy of the Temporal Bone Through Dissection.

Abstract: 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 (#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. Arch Otolaryngol Head Neck Surg. 2000;126:137-147

Abstract: A subtemporal-preauricular infratemporal fossa approach to remove 22 large neoplasms involving the lateral and posterior cranial base is detailed The areas from which a neoplasm could be removed by this approach included the sphenoid and clival bone; the medial half of the petrous temporal bone; the infratemporal fossa; the nasopharynx; the retro- and parapharyngeal area; the ethmoid, sphenoid, and maxillary sinuses; and the intradural clivus-foramen magnum area The pathology of the neoplasms included benign tumors such as meningioma, malignant cartilaginous neoplasms such as chordoma, and other malignant lesions such as nasopharyngeal carcinoma This approach offers many advantages over other anterior and lateral approaches to the lateral and posterior cranial base: these include minimal brain retraction; direct access to the ipsilateral petrous and upper cervical internal carotid artery; reconstruction of extensive cranial base defects, often with the use of a vascularized rectus abdominus flap; preservation of the hearing conduction mechanism when it is not involved by tumor; and the maintenance of excellent facial nerve function postoperatively The use of an anterior extradural approach (transethmoidal) and of an intradural approach (frontotemporal or retromastoid), either concurrently or separately, is necessary in some patients to effect total tumor removal The most serious complication in this series was the death of a patient due to postoperative infection and bilateral carotid artery rupture, which may have been avoided by the use of a rectus abdominis muscle flap for reconstruction Among the 21 surviving patients, 18 had a good outcome, two had a fair outcome, and one with preexisting neurological deficits had a poor outcome One of the surviving patients with a chordoma died of pulmonary metastases 1 year later, without evidence of local recurrence The length of postoperative follow-up evaluation in these patients is insufficient to make any judgment about the effectiveness of this surgical approach in achieving a cure or long-term control of the tumors described

Abstract: In spite of the development of a superior (middle cranial fossa) and posterior (translabyrinthine) approach to the temporal bone, tumours situated in the infralabyrinthine and apical compartments of the pyramid and surrounding base of the skull were still a challenge for neurosurgeons and otologists as well. The infratemporal fossa approach closes the existing gap in the surgical management of the most hidden lesions of the temporal bone. The approach features the permanent anterior transposition of the facial nerve, resection of the mandibular condyle and mobilization of the zygoma and lateral orbital rim. Obliteration of the pneumatic spaces of the temporal bone, with permanent occlusion of the Eustachian tube and blind sac closure of the external auditory canal, avoids the danger of post-operative infection and leads to primary wound healing in the shortest time. Three types of infratemporal fossa approach are presented and dicussed on the basis of 51 operated patients.