Temporal Bone

Temporal bone chondrosarcoma: Presentation of 4 cases and review of the literature

December 19, 2014     Duoduo Tao, MD; Matthew R. Hoffman, MD; Bing Chen, MD, PhD
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We describe 4 cases of chondrosarcoma of the temporal bone, which occurred in a 66-year-old man and in 3 women aged 34, 37, and 47 years. One of these patients was originally diagnosed with an epithelial cyst and another with a middle ear neoplasm. Three patients underwent surgical removal of their tumor, while the other patient declined (a craniotomy for biopsy was performed in this case). An accurate diagnosis in all 4 cases was not made until histopathologic examination was performed. None of the patients received postoperative radiotherapy for various reasons. However, the male patient experienced a tumor recurrence, which necessitated a second surgery, and he did receive radiotherapy after the second operation. All 3 operated patients were doing well at the most recent follow-up, and the other patient was soon lost to follow-up. Because of its rarity and potential for severe complications, temporal bone chondrosarcoma remains a difficult disease to diagnose and manage.

Facial nerve palsy associated with a cystic lesion of the temporal bone

March 18, 2014     Na Hyun Kim, MD; Seung-Ho Shin, MD
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Abstract

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone leions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

Acquired cholesteatoma presenting as a pars squamosa temporal bone mass

February 12, 2014     Christopher Vanison, MD; Eric M. Jaryszak, MD, PhD; Amanda L. Yaun, MD; and Diego A. Preciado, MD, PhD
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Abstract

Acquired cholesteatomas typically arise in the middle ear and mastoid cavities; they rarely present elsewhere. We describe a case of acquired cholesteatoma that presented as a large mass of the pars squamosa of the temporal bone in a 16-year-old girl. The mass was surgically removed without complication. To the best of our knowledge, this is only the second reported case of an acquired cholesteatoma in the lateral temporal bone.

How to approach a bilobed petrous apex granuloma: A case report

January 21, 2014     Aaron G. Benson, MD
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Abstract

Cholesterol granulomas are the most common lesions involving the petrous apex. However, they are still an uncommon finding overall, and they often remain undiagnosed until they have become extremely large and symptomatic. Many surgical approaches to the petrous apex exist. Factors that often influence the surgical approach include the surgeon's experience, the patient's anatomy, and the patient's hearing status. The purpose of this case report--which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left-sided pulsatile tinnitus--is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.

Bilateral posterior semicircular canal dehiscence in the setting of Hallermann-Streiff syndrome

September 7, 2012     John C. Goddard, MD; Eric R. Oliver, MD; Ted A. Meyer, MD, PhD
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Abstract

Hallermann-Streiff syndrome, also known as oculomandibulofacial syndrome, is a rare congenital disorder affecting growth and cranial, dental, ocular, pilocutaneous, and mental development. In addition to routine audiologic testing in patients with this syndrome, high-resolution computed tomography of the temporal bones should be performed in those with documented or suspected sensorineural hearing loss. Cochlear implantation may be considered, as in other children with syndromic hearing loss and certain inner ear abnormalities, if the appropriate audiologic, psychosocial, and medical criteria are met. The current case report radiographically and clinically characterizes inner ear dysplasia in an 8-year-old patient with Hallermann-Streiff syndrome. High-resolution computed tomography of the temporal bones revealed a hypoplastic bony island between the vestibule and horizontal semicircular canals, as well as incomplete bony coverage of the posterior semicircular canal crura bilaterally. To our knowledge, this is the first report of a pediatric patient demonstrating bilateral posterior semicircular canal dehiscence.

Middle fossa repair of bilateral large congenital tegmental defects with meningoencephaloceles

June 4, 2012     Anil Joshi, MS(ENT), MRCS; Wendy Smith, FRCS(ORL–HNS); David A. Moffat, FRCS
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Abstract

Spontaneous temporal meningoencephaloceles are unusual. When they do occur, they present with a variety of signs and symptoms, which can make diagnosis and management challenging. We report the interesting case of a 49-year-old woman with bilateral congenital temporal meningoencephaloceles. She presented with a 12-month history of bilateral fluctuating hearing loss, and she more recently developed right-sided acute otitis media with meningitis. The presentation of bilateral extensive tegmental defects and meningoencephaloceles with a fluctuating hearing loss and meningitis associated with acute otitis media affecting one ear and then subsequently the other ear is extremely rare and difficult to diagnose. It requires a very careful clinical and radiologic assessment. Methods of surgical repair differ depending on the size of the defects.

Primary acquired cholesteatoma

April 30, 2012     Joseph A. Ursick, MD; Jose N. Fayad, MD
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Cholesteatomas are believed to form as the result of poor eustachian tube function with resultant tympanic membrane retraction and a lack of normal epithelial migration.

Extraorbital pseudotumor of the petrous apex: Biopsy via a transnasal endoscopic approach

March 31, 2012     Jeffrey J. Nelson, MD and Parul Goyal, MD
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Abstract

Extraorbital idiopathic pseudotumors of the skull base are very uncommon. We report the case of a 50-year-old woman who presented with left ophthalmoplegia and vision loss. Imaging studies revealed an enhancing lesion involving the left petrous apex and cavernous sinus. A transnasal endoscopic approach was used to obtain a biopsy of the left petrous apex. Pathology identified the lesion as an idiopathic pseudotumor. The patient was treated with high-dose steroids and steroid-sparing immunomodulators, and she experienced a significant improvement. To the best of our knowledge, this is the first reported case of a transnasal endoscopic approach to a biopsy of a pseudotumor involving the petrous apex. We discuss the features of this case, and we review the literature on this condition.

Osteomyelitis of the temporal bone in identical twin infants

June 13, 2011     Sampath C. Prasad, MS, DNB, Kishore Chandra Prasad, DLO, MS, FACS, Rukma Bhandary, DLO, MS, Kumar Abhijith, MS, and Pallavi Sampath, DNB
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Abstract

Osteomyelitis of the skull base almost always occurs in elderly patients with diabetes; however, it may occur in patients with compromised immune function regardless of their age. We present the cases of a pair of immunocompetent, 2-year-old identical twins who experienced osteomyelitis of the temporal bone almost exactly 1 year apart. An incident such as this, in this age group, has never been reported in the literature.

Primary lymphoma of the temporal bone presenting as XIIth cranial nerve weakness

March 1, 2011     Zi Yang Jiang, MD and Miriam I. Saadia-Redleaf, MD
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Abstract

Primary lymphoma of the temporal bone is an extremely rare finding in clinical practice. Although it is treated as a type of non-Hodgkin lymphoma, the absence of systemic signs and symptoms makes detection dependent on the tumor's local mass effect. In this article, we report a case of temporal bone lymphoma that caused XIIth nerve palsy. We also discuss the clinical manifestations of temporal bone lymphoma and the importance of imaging the head and neck when any idiopathic cranial nerve palsy develops.

Characteristics of osteoma of the temporal bone in young adolescents

February 1, 2011     Borlingegowda Viswanatha, MS, DLO
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Abstract

The author conducted a retrospective review of the clinical presentation, management, and complications of temporal bone osteoma in young adolescents. The study population was made up of 9 patients-5 girls and 4 boys, aged 12 to 15 years at presentation (mean: 13.7)-who had been seen for radiologically and histopathologically proven temporal bone osteoma at the author's institution over a 9-year period. Of this group, 5 patients had extracanalicular osteoma (3 in the mastoid portion of the temporal bone, 1 in the squamous portion, and 1 in the mastoid antrum) and 4 patients had osteoma of the external auditory canal. Six of the 9 patients underwent surgical treatment; of the remainder, 1 refused surgery and 2 were managed conservatively with ongoing observation. All patients were followed for a minimum of 1 year, and no recurrences and no complications were observed during that time.

Inflammatory pseudotumor (plasma cell granuloma) of the temporal bone

June 30, 2010     Dare V. Ajibade, BA, Iwao K. Tanaka, MD, Kapila V. Paghdal, PharmD, MD, Neena Mirani, MD, Huey-Jen Lee, MD, and Robert W. Jyung, MD
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Abstract

We report the case of a 41-year-old man who presented with progressive right-sided ear pressure, otalgia, hearing loss, tinnitus, and intermittent otorrhea. Computed tomography and magnetic resonance imaging detected a soft-tissue mass in the right mastoid with intracranial invasion and erosion through the tegmen tympani and mastoid cortex. Histopathologic examination was consistent with an inflammatory pseudotumor (plasma cell granuloma). These lesions rarely occur in the temporal bone. When they do, they are locally destructive and can erode bone and soft tissues. Aggressive surgery is recommended as a first-line treatment, with adjunctive steroid or radiotherapy reserved for residual or refractory disease. Our patient subsequently experienced multiple recurrences, and his treatment required all of these modalities. At the most recent follow-up, he was disease-free and doing well.

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