Left Temporal Bone Research Articles

Symptom: Unilateral Facial Paralysis

Symptom: Unilateral Facial Paralysis

Langerhans Cell Histiocytosis of the Temporal Bone in Children: Two Cases Report

Langerhans cell histiocytosis is a rare hematologic disease due to multiplication and accumulation of Langerhans cells, which are immature dendritic cells. The clinical presentation is highly variable and can range from isolated, self-healing skin or bone lesions to life-threatening multisystem disease. We report 2 cases confirmed by Histological and immunohistochemical evaluation of temporal bone biopsies. The first case is a 2-year-old child with chronic bilateral otorrhea and polyuria-polydipsia syndrome. Physical examination showed bilateral retroauricular redness and induration with filling all of the right and left external ear canal. Computed tomography showed osseous lysis of the temporal bone bilaterally. Magnetic resonance imaging of the brain showed the presence of pituitary infiltration. The second case is 2-year-old girl with chronic left otorrhea. Clinical examination objectified the presence of redness and induration in the left mastoid with the presence of an inflammatory polyp filling the entire left external auditory canal. Computed tomography revealed a left temporal bone lysis. Both patients were treated with chemotherapy.

Mastoid neoplasm: a clinical case

Background. Middle ear neoplasm is a rare pathology accounting for about 0.7% total head and neck tumours. The article describes the clinical presentation, diagnostic methods and surgical treatment for neoplasms of mastoid process, a quite rare tumour localisation.Clinical Case Description. Patient G., 66 yo, was admitted to a otorhinolaryngological unit with a preliminary diagnosis of left mastoid neoplasm and complaints of non-transient headache on the left and slight hearing loss in both ears. The symptoms have been persisting since childhood. Laboratory tests without abnormalities. Voluminous invasive neoplasm of left temporal bone mastoid in CT. Left mastoidectomy with mastoid neoplasm resection was performed routinely, with a histological examination of surgical material. Benign angiofibroma in morbid histology. Definitive diagnosis: neoplasm of left mastoid. Relief from headache and overall improvement were reported by the patient in two months after surgery.Conclusion. Benign mastoid angiofibroma is a rare tumour in terms of localisation and morphology reluctant to diagnosis in an asymptomatic form. We suggest computed tomography as the main diagnostic and surgery — as main treatment method in this pathology. The disease has a life-favourable prognosis.

Successful surgical repair of a temporal and parietal bone fracture with associated traumatic brain injury in a fourteen-day-old foal

A fourteen-day-old warmblood colt presented with severe neurological signs of unknown origin. The foal was recumbent and comatose, and showed spastic motion of the head. Computed tomography (CT) examination revealed multiple impression fractures to the left parietal and temporal bones, as well as traumatic brain injury. Three fragments of the temporal bone were dislocated into the cranial vault. The foal was surgically treated within 24 hours of presentation: the fragments were elevated and the largest fragment was fixated with an L-shaped titanium MatrixMidface 0.8 mm reconstruction plate. The brain injury resolved with medical treatment and supportive care. Apart from a localized wound abscess that was drained, postoperative healing was uneventful and the foal regained the ability to ambulate 18 days after surgery. Follow-up CT imaging documented good fracture healing and a favorable development of the soft tissue injuries. Seven months after surgery, the foal was fully recovered and showed no neurological signs.

A rare metastatic follicular thyroid carcinoma masquerading as primary sinonasal carcinoma presentation with unusual orbit, skull base and brain metastases

Tumour involving the sinonasal tract account for only 1% of all malignancies. The large majority of tumours affecting sinonasal tract are mainly primary neoplasm or from direct extension of adjacent region; metastatic tumour affecting sinonasal tract are extremely rare. Most of the metastases are originate from carcinoma inferior to the clavicle, including renal, breast, lung, and prostate. The incidence of metastases to sphenoid sinus are even rare. We describe a rare case of metastases of FTC to sinonasal tract, mimicking primary sinonasal carcinoma presentation, with unusual orbit, skull base and brain metastases.A 66-year-old lady with history of subtotal thyroidectomy for FTC presented with epistaxis associated with proptosis of left eye. Nasal endoscopy revealed vascularised mass occupying the entire left nasal cavity. Endoscopic transnasal biopsy was performed which showed metastatic FTC with positive immunochemical staining for thyroglobulin, and thyroid transcription factor-1. Computed tomography angiography demostrated a large vascular tumour involving the left maxillary sinus, bilateral ethmoid and sphenoid sinuses. The mass causing erosion of nasal septum and pterygoid plates and left temporal bone, with extension to left orbit, infratemporal fossa and intracranial. Patient received thyroid stimulating hormone suppression therapy followed by radio-iodine ablation.As surprisingly rare, the purpose of our study is to raise the awareness regarding the possibility of FTC metastatizing to sinonasal tract, orbit, skull base and intracranial. The completion thyroidectomy intervention is crucial for better future prognosis. Thyroid carcinoma should be considered in differential diagnosis of epistaxis and potential primary neoplasm in patient with orbital metastases.

Cholesteatoma Masquerading as Cerumen

Cerumen is composed of glandular secretions and desquamated epithelial cells. It protects and lubricates the external auditory canal. Impacted cerumen causes canal occlusion and pressure over the tympanic membrane, causing ear discomfort, conductive hearing loss, itching, etc. Up to 6% of the general population are affected with impacted cerumen, which includes 10% of children, more than 30% of the elderly and people with cognitive impairment. Persistent symptoms despite resolution of impaction and patient repeatedly should raise suspicion of alternative diagnosis and prompt for further evaluation. A 20-year-old female patient came with complaints of decreased hearing and ear discharge. On otoscopic examination of left ear, impacted cerumen was seen in the attic region. On removal of wax with the aid of oto-endoscopy, attic region was found to be filled with cholesteatoma debris. On pure tone audiometry, patient had mild conductive hearing loss of 30 db and computed tomography of left temporal bone revealed ill-defined soft tissue density in the middle ear (epitympanum) with erosion of head of malleus and short process of incus. Blunting of scutum was also seen. Attic reconstruction and type III tympanoplasty was performed. On histopathological examination, the section showed keratin flakes with bacterial colonies which were consistent with cholesteatoma. In conclusion, any case of impacted cerumen should not be ignored by otorhinolaryngologist. Further evaluation with thorough examination under otomicroscope/otoendoscope has to be done which can lead to different diagnosis and treatment plan.

Frontal bone virtual reconstruction and geometric morphometric analysis of the mid-Pleistocene hominin KNM-OG 45500 (Olorgesailie, Kenya).

KNM-OG 45500 is a hominin fossil composed of parts of a frontal bone, left temporal bone, and cranial vault pieces. Since its discovery along the Olorgesailie Formation (Kenya) in 2003, it has been associated with the Homo erectus hypodigm. The specimen, derived from a geological context dated to ca. 900 Ka BP, has been described as a very small individual of probable female sex. However, despite its status as an important hominin specimen, it has not been used in a quantitative comparative framework because of its fragmentary condition. Here, we undertake a virtual reconstruction of the better-preserved fragment, the frontal bone. We additionally apply geometric morphometric analyses, using a geographically diverse fossil and modern human sample, in order to investigate the morphological affinities of KNM-OG 45500. Our results show that the frontal shape of KNM-OG 45500 exhibits similarities with Early Pleistocene fossils from Eurasia and Africa that are assigned to H. erectus sensu lato (s.l.). Its size, on the other hand, is notably smaller than most other Homo erectus fossils and modern humans and similar to the specimens from Dmanisi (Georgia) and to Homo naledi. Taken together, our analyses of the frontal bone suggest a taxonomic attribution of KNM-OG 45500 to H. erectus s.l. and extend even further the range of size variability associated with this taxon around 900 Ka BP.

NFB-05. AN UNUSUAL PRESENTATION OF RECURRENT LANGERHANS CELL HISTIOCYTOSIS OF THE CRANIOFACIAL BONES IN A PATIENT WITH NEUROFIBROMATOSIS TYPE I

Neurofibromatosis type 1 (NF1), predisposes patients to benign and malignant tumors due to lack of suppression of the mitogen activated protein kinase (MAPK) signaling pathway. Langerhans cell histiocytosis (LCH) manifests in numerous ways, from localized lesions to multisystem organ involvement secondary to a constitutively active MAPK signaling cascade often driven by BRAF mutations. While both LCH and NF1 are characterized by overactive MAPK signaling, there are few reports of the two diseases occurring simultaneously. We report a novel case of a patient with underlying NF1 and recurrent LCH without a BRAFV600E mutation. She initially presented at 2 years of age with an aggressive appearing mass of the left temporal bone found on surveillance imaging. Pathology was consistent with Langerhans histiocytosis and she was treated with the LCH-III protocol for patients with high-risk LCH due to the location of her lesion. Five years after completion of therapy, MRI demonstrated development of a calvarial mass consistent with relapsed LCH in a new risk site. Lesional curettage was performed and pathology confirmed recurrence of LCH with juvenile xanthogranulomatous features. BRAF testing of blood and the lesion were negative for any BRAF alterations. Further genomic evaluation of the tumor is in progress at this time to evaluate for other known mutations associated with LCH. The patient is currently receiving monthly cytarabine treatment which she has tolerated to date. Our patient represents a unique presentation of recurrent LCH in a patient with NF1 and further molecular evaluation may help identify other drivers of LCH activation.

Osteolytic lesions on the os petrosum of a Bronze Age individual from La Llana cave (Northern Spain) compatible with a possible case of otitis media. A multifaceted methodological approach

ObjectiveTo encourage the use of different methodological approaches for the identification of paleopathological lesions and to evaluate osteolytic lesions found on a temporal bone from La Llana cave (Spain). MaterialsCranial remains recovered from from La Llana cave (Spain) dated to the Bronze Age, 3300 ± 25 BP (1631−1509 cal BC). MethodsThe cranium underwent macroscopic, microscopic and computed tomography scan examinations. ResultsThe Tegmen tympani of the left temporal bone is present but is missing on the right. Both cochleae are intact. Both the right and left temporal bones display osteolytic lesions, with the left Tegmen tympani displaying deep and profuse pits on the endocranial surface, exposing the ear channel. ConclusionsThe lesions are compatible with otitis media (atticitis). By using different methods of analysis, the presence and effects of infection were identified. SignificanceThis systematically described case contributes to our understanding of disease in the past and describes otitis-related lesions in archeological contexts for comparative purposes. LimitationsThe fragmentary and damaged cranial remains rendered evaluation difficult and diagnosis tentative. Suggestions for Further ResearchThe use of different approaches to diagnose otitis media in archeological skeletal collections is recommended to improve the knowledge of health status and lifestyle of past populations.

A rare presentation of left postaural mastoid osteoma

<p class="keywords">Osteomas are benign slow growing tumors of mesenchymal origin. Most commonly found along the long bones like proximal shaft of femur around 19% followed by tibia around 10% and head and neck osteomas around 0.1 to 1%. We report a rare case of postaural osteoma in a 44 year old female with cosmetic deformity and discuss its differential diagnoses and treatment protocol. A 44-year-old female presented to ear, nose and throat (ENT) outpatient department (OPD) with complaints of swelling in the left postaural region since 25 years gradually increasing in size. On examination, there was a single swelling in the left post aural region measuring about 4×5×3 (cms) hard in consistency and non-tender. Non contrast computerized tomography (CT) of temporal bone showed well defined extracranial dense sclerotic bony lesion arising from mastoid part of left temporal bone likely osteoma. Patient planned for excision and histopathological examination was consistent with osteoma.<strong> </strong>In conclusion, though osteoma in mastoid bone is a very rare possibility still it should be kept in consideration in the list of differential diagnoses of the tumors of temporal bone. We highlight the need for a careful clinical evaluation supported by radiologic and histopathological investigations which will help in the diagnosis, resulting in better prognosis.</p>

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.

Symptom: Conductive Hearing Loss after Cholesteatoma Surgery

Symptom: Conductive Hearing Loss after Cholesteatoma Surgery

A rare case of epidermal inclusion cyst: an unusual complication of ear surgery

BackgroundEpidermal inclusion cysts are common tumours of the hand in industrial workers caused by entrapment of epidermal elements within the dermis. They are unusual in the head and neck region more so in the temporal region.Case presentationWe present a 27-year-old man with a 3-month history of a slow-growing swelling in the left temporal region. He had a history of chronic otitis media and underwent an end-aural tympanomastoid surgery 5 years earlier. Physical examination revealed a 5 × 3 × 2.5 cm cystic globular minimally tender mass in the temporal fossa along with squamous active otitis media with bony erosion of the outer attic wall. High-resolution computed tomography of the left temporal bone revealed otomastoiditis with erosion of the scutum; ossicles were not identified. We hereby describe the diagnostic challenge and the plan of management of this lesion.ConclusionsEpidermal inclusion cyst must be considered in the differential diagnosis of temporal fossa lesions especially in patients with a prior history of ipsilateral tympanomastoid surgery.

POST-GLENOID FORAMEN: A RARE EMISSARY FORAMEN IN HUMAN SKULL

Objective: The aim of the present study was to determine the presence of post-glenoid foramen in human skulls.
 Methods: The study was carried out in 100 adult dry human skulls with 200 temporal bones on each side (right and left) which were collected from the Department of Anatomy at RVS Dental College and Hospital, Coimbatore. The selected skulls were placed on a flat table and the considerable foramen was visually identified by two investigators. The foramen was examined by a probing method to find out its patency.
 Results: Of 100 skulls (200 temporal bones), only one skull showed a unilateral post-glenoid foramen on the mandibular fossa of the left side temporal bone (2% of 200).
 Conclusion: The emissary veins are considered as an important encephalic venous drainage that connects the intracranial and extracranial venous pathway through emissary foramen. If there is little variation, and rare occurrence of the emissary foramen may cause serious pathological condition. Thereby, the present study highlights one of the rare emissary foramen, the post-glenoid foramen. This anatomical study of post-glenoid foramen may help the surgeons while operating temporomandibular joint and inner ear malformation to avoid the risk of accidental bleeding during surgery.

Temporal bone histopathology: Superior semicircular canal dehiscence.

ObjectivesTo present a histopathological case of a 91‐year‐old woman who was diagnosed with superior semicircular canal dehiscence postmortem.MethodsThe patient was a registered donor with the National Temporal Bone Donor Program at the NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry. Computed tomography imaging was performed on each temporal bone. The temporal bones were decalcified with ethylenediaminetetracetate and embedded in celloidin, and tissue sections were stained with hematoxylin and eosin. Horizontal sections were taken through the left temporal bone, and vertical sections were taken through the right temporal bone.ResultsHistopathological sections taken through the right temporal bone demonstrated no bone between the membranous wall of the superior semicircular canal and the middle fossa dura. There was no histopathological evidence of superior semicircular canal dehiscence in the left temporal bone; however, a small dehiscence would not be identified on horizontal sections. Microcavitations were observed in the common crus of the left temporal bone.ConclusionThis reports describes the case of a woman who was diagnosed with superior semicircular canal dehiscence postmortem. The presence of microcavitations in the temporal bone is consistent with osteoclastic activity, which may play a role in the development of superior canal dehiscence.

X-InDels efficacy evaluation in a critical samples paternity case: A Spanish Civil War case from the memorial of the camposines (Tarragona, Spain)

The Memorial of the Camposines (la Fatarella, Tarragona, Spain) consists in a place that honours all combatants of the Spanish Civil War (1936–1939), without distinction of sides. The site was included in the research carried out by the multidisciplinary team coordinated by the program of the General Directorate of Democratic Memory, Generalitat of Catalonia, Spain, for the identification of the victims of the Spanish Civil War. The case investigated on the present study consisted on a presumable paternity. To accomplish the study of the presumptive father critical samples, one of the combatants found on the Memorial, two bone samples were selected - a petrous portion of left temporal bone, and a condyle of foramen magnum, both fractured and at a very bad stage of conservation. After a specific DNA extraction for critical bone sample, the next step was an autosomal and Y-chromosome analysis, trying to find a possible coincidence with any possible familiar, from the familial database. A potential match was found, indicating a possible living daughter. However, between both autosomal profiles one Mendelian incompatibility was detected, and also several allelic dropout phenomena in the presumptive father’s profile. Therefore, samples were analysed for a 32 X-chromosome Insertion-Deletion (InDel) polymorphisms battery, assessing their ability to solve, or at least complementing autosomal information, in a complex paternity case.It was possible to confirm the efficacy of these 32 X-InDels polymorphisms, by solving undoubtedly the case. Due to the five incompatibilities detected between both X-InDels profiles, it was now possible to discard immediately a possible paternity case.

Use of an acrylic jig to aid orbital reconstruction after resection of a sphenoid intraosseous meningioma: a technical note.

A 48-year-old woman presented to neurosurgery with proptosis of the left globe and worsening pain and swelling in the left temporal region. Her visual acuity was unaffected. A computed tomogram (CT) of her head showed a large expansile lesion that involved the left frontal, parietal, temporal, and sphenoid bones (Fig. 1 and Supplemental Fig. S1). It impinged on the orbit, causing proptosis and crowding of the orbital contents. A diagnosis of intraosseous meningioma was suspected.

Symptom: Postauricular Mass

Symptom: Postauricular Mass

Unusual neurosurgical emergency in Paget\u2019s disease of the skull: a case report and review of the literature

IntroductionPaget’s disease of bone is usually asymptomatic in most cases. The neurosurgeon should be familiar with the common presentation and complications. The rare presentation of this case of Paget’s disease of the skull raised our attention to report it.Case descriptionA Paget’s disease patient presented in the emergency department with a disturbed conscious level (GCS 8) without any history of trauma or seizures. CT showed severe hypertrophied left frontal, temporal, and parietal bones with midline shift. The patient underwent an emergency left decompressive craniectomy. Postoperative CT scan was done and showed frontoparietal epidural hematoma on the opposite side which was evacuated immediately. The patient started to improve and became fully conscious in few days with marked improvement of the motor power of her right side.Discussion and evaluationSevere skull involvement and impending brain herniation may occur in Paget’s disease of the skull which needs urgent decompressive surgery. Contralateral epidural hematoma after decompressive surgery may rarely occur and should be suspected in case of intraoperative brain swelling and postoperative failure of improvement. Neurosurgeons and radiologists should recognize the rare phenomenon of periosteal bone formation in the pagetic bone and its extension into surrounding tissues.ConclusionsIn our case, we faced an unusual life-threatening condition in a patient of Paget’s disease with severe skull involvement leading to rapid deterioration of consciousness and impending brain herniation. The neurosurgeon should be aware of this rare emergency condition.

A 3-Dimensional Model of the Human Round Window Membrane.

The round window membrane (RWM) is small in size, making it difficult to clarify its shape and structure. The authors examined a 40x magnified 3-dimensional model of the human RWM to clarify its morphologic aspects and characteristics. An RWM specimen was obtained from an archival, formalin-fixed, decalcified, left temporal bone of an 84-year-old female cadaver. The data obtained by laser scanning microscopy were input into a 3-dimensional printer. After a model of the RWM was created, the following features were examined: striae on the surfaces, curvatures, thickness, and areas. Cross sections of the original specimen were made for histological observations. The contour of this RWM model was approximately elliptic, with a saddle shape. When illuminated from the scala tympani side, the surface facing the fossula exhibited dark anterior and clear posterior portions. A borderline appeared where the 2 portions were bound along the short axis of the ellipse. This borderline was identified as the line of inflection. Collagen fibers were shown to run parallel to the borderline in the posterior portion but were fanned out in the anterior portion. The magnified 3-dimensional model clarified gross anatomy and characteristics of the RWM. It is good teaching material for small tissues, such as the RWM.