Temporal Bone

The role of angiography in managing patients with temporal bone fractures: A retrospective study of 64 cases

April 30, 2009     K. Asif Ahmed, MD, David Allison, MD, Wesley S. Whatley, MD, and Rakesh K. Chandra, MD
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Abstract

We conducted a retrospective study of the utility of angiography in the evaluation of patients with temporal bone fractures. Our study population was made up of 64 patients-58 males and 6 females, aged 14 to 75 years (mean: 35.3)-with a temporal bone fracture who had presented to a level I trauma center over a 1-year period. Records were reviewed and data were obtained on the mechanism of injury; the type of fracture; associated injuries, particularly neurocranial injuries detected on computed tomography (CT) of the head; and any angiographic findings that might have been obtained. The primary outcomes measures were the type of treatment administered (conservative vs. surgical) and mortality. Patients were assigned to 1 of 4 groups according to CT results and angiographic findings, if any: normal CT and no angiogram (group 1; n = 12), abnormal CT and no angiogram (group 2; n = 28), abnormal CT and an abnormal angiogram (group 3; n = 9), and abnormal CT and a normal angiogram (group 4; n = 15). Conservative treatment was administered to all 12 patients in group 1 and to 9 patients (60%) in group 4; surgical treatment was provided to two-thirds of the patients in both group 2 and group 3. Mortality was low in group 1 (n = 0), group 3 (n = 1; 11%), and group 4 (n = 1; 7%), but high in group 2 (n = 10; 36%). In fact, the key finding of this study was that mortality in the group with an abnormal CT and no angiogram (group 2) was significantly higher than mortality in the group with an abnormal CT and an abnormal angiogram (group 3) (p = 0.02), even though the injuries in the 2 groups were similarly severe and their management was similarly aggressive. We conclude that current guidelines for angiography may need to be expanded to include all patients who have CT evidence of neurocranial injury in order to detect those vascular injuries that need aggressive management and thus lower overall mortality.

Multiple paragangliomata of the lungs and temporal bone

October 31, 2008     Husain A. Sattar, MD, Dorise L. Yang, MD, Aliya N. Husain, MD, Miriam I. Redleaf, MD, and Vijay S. Dayal, MD
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Abstract

We report the case of a 71-year-old woman with multiple benign lung paragangliomata and a benign glomus jugulare paraganglioma in one temporal bone that mimicked a malignancy. The patient's lung lesions did not regress with chemotherapy. Subsequent histologic markers suggested several very slowly dividing tumors. We review the patient's medical course and pathology from both sites. A finding of multiple lung paragangliomata should raise the suspicion of a multicentric rather than malignant tumor. Before any chemotherapeutic regimen is initiated, a thorough physical examination of the head and neck should be performed, and biopsy material should be tested for markers of cell division.

Extracanalicular osteoma of the temporal bone

June 30, 2008     Borlingegowda Viswanatha, MS, DLO
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Abstract

Extracanalicular osteomas of the temporal bone are rare, slow-growing, benign neoplasms. Although they may occur anywhere in the temporal bone, they are most common in the mastoid area. Often, symptoms are negligible and treatment is unnecessary. However, surgical removal is indicated when growth of the osteoma causes distressing symptoms or cosmetic issues. The patient described in this report had no symptoms but underwent surgical excision of a mastoid osteoma for cosmetic reasons. At 4-month follow-up, she remains asymptomatic and recurrence-free.

An estimate of the number of mastoidectomy procedures performed annually in the United States

April 30, 2008     Lesley C. French, MD, Mary S. Dietrich, PhD, and Robert F. Labadie, MD, PhD
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Abstract

We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10,000 population in Maryland and 2.55 to 2.74/10,000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10,000 population. Based on these data, we estimate that between 30,000 and 60,000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.

Fibrous dysplasia of the temporal bone complicated by cholesteatoma and thrombophlebitis of the transverse and sigmoid sinuses: A case report

February 1, 2008     Rodrigo Martinez, MD and Jay B. Farrior, MD
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Abstract

Fibrous dysplasia is a benign condition that can affect the skull and facial bones and cause a broad spectrum of otolaryngologic conditions. We present the case of a boy with polyostotic fibrous dysplasia with involvement of the temporal bone that was first diagnosed when he was 9 years old. His condition eventually became complicated by cholesteatoma and thrombophlebitis of the left transverse and sigmoid sinuses, and he died of his disease at the age of 19 years. We discuss these and other complications of fibrous dysplasia of the temporal bone and their management.

Concomitant inflammatory pseudotumor of the temporal bone and lung: A case report

September 30, 2007     Joo Hyung Lee, MD; Min Kyo Jung, MD; Chang Eun Song, MD; Sang Won Yeo, MD; Hye Kyung Lee, MD; Po Song Yang, MD; Soo Whan Kim, MD
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Abstract

Inflammatory pseudotumors are histologically benign but locally destructive lesions that are usually found in the lung, although some cases of temporal bone involvement have been reported. To the best of our knowledge, no case of simultaneous involvement of the temporal bone and the lung has been previously reported in the literature. We describe such a case in a 39-year-old man. The temporal bone lesion was removed in its entirety, and the lung lesion was treated with steroid therapy. At the 2-month follow-up, the size of the lung mass on chest x-ray was significantly reduced, and at 1 year, the patient was asymptomatic.

A study of middle cranial fossa anatomy and anatomic variations

July 31, 2007     Hamid R. Djalilian, MD; Kunal H. Thakkar, MD; Sanaz Hamidi, MD; Aaron G. Benson, MD; Mahmood F. Mafee, MD
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Abstract
We conducted a study to establish standardized measurements of the common anatomic landmarks used during surgery via the middle cranial fossa approach. Results were based on high-resolution computed tomography (CT) images of 98 temporal bones in 54 consecutively presenting patients. Measurements were obtained with the assistance of the standard PACS (picture archiving and communication system) software. We found that the superior semicircular canal (SSC) dome was not the highest point on the temporal bone (i.e., the arcuate eminence) in 78 of the temporal bone images (79.6%). Pneumatization above the SSC and above the internal auditory canal (IAC) was found in 27 (27.6%) and 39 (39.8%) temporal bone images, respectively. The anterior wall of the external auditory canal was always anterior to the anterior wall of the IAC. The mean angles between the SSC and the posterior and anterior walls of the IAC were 42.3° and 60.8°, respectively. We also measured other distances, and we compared our findings with those published by others. We hope that the results of our study will help surgeons safely and rapidly locate anatomic landmarks when performing surgery via the middle cranial fossa approach.

Otogenic tension pneumocephalus caused by therapeutic lumbar CSF drainage for post-traumatic hydrocephalus: A case report

June 30, 2007     Edwin K. Chan, MD; Lawrence Z. Meiteles, MD
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Abstract
Tension pneumocephalus occurs when a continuous flow of air accumulates in the intracranial cavity and produces a mass effect on the brain. We describe a case in which tension pneumocephalus was caused by the performance of continuous lumbar CSF drainage in a middle-aged man who had experienced a temporal bone fracture. Continuous lumbar CSF drainage is commonly performed in patients with temporal bone or basilar skull fractures to treat concomitant post-traumatic CSF rhinorrhea, CSF otorrhea, and/or hydrocephalus. However, to the best of our knowledge, there has been no previously reported case of tension pneumocephalus occurring as a complication of this procedure in a patient with a temporal bone fracture.

Eosinophilic granuloma: Bilateral temporal bone involvement

May 31, 2007     Chester P. Barton III, MD; Drew Horlbeck, MD
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Abstract
Eosinophilic granuloma is an uncommon condition that is characterized by unifocal or multifocal osteolytic lesions that often affect the skull. Unilateral lesions of the temporal bone are not uncommon, but bilateral temporal bone lesions are rare. In fact, to the best of our knowledge, fewer than 20 such cases have been reported during the past 40 years. We report a new case of bilateral temporal bone eosinophilic granuloma, and we review the disease process and its treatment.

Embryonal rhabdomyosarcoma of the temporal bone

March 31, 2007     Borlingegowda Viswanatha, MS, DLO
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CT appearance of incudomalleolar dislocation

February 1, 2007     HenriĆ«tte E. Westerlaan, MD; Joost Gravendeel, MD
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Primary B cell lymphoma of the external auditory canal

August 31, 2006     Sheldon P. Hersh, MD; Winston G. Harrison, MD; David J. Hersh, MD
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Abstract
Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis. The patient was treated with external-beam radiation and remained disease-free throughout 9 years of follow-up. We also point out that the presence of non-Hodgkin's lymphoma in an unusual site may be an indication that the patient has an acquired immunodeficiency syndrome.
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