Mastoid Research Articles

Morpho-metric study of the facial nerve in the Andaman and Nicobar islands population: A Cadaveric study

Background: Facial nerve (FN) is the seventh cranial nerve. It is the only cranial nerve which has a long course in a bony canal. From the brain stem, to its terminal branches, it changes its direction 5 times, to innervate, muscles of the second pharyngeal arch. Hence, it is morphometric study and has great clinical importance. Aims and Objectives: This study was conducted to ascertain the variations of the length of facial Never at different parts of the crania so that this study could be helpful for neurosurgeon, radiologist, and clinician, to deal with various diseases of FN. Materials and Methods: Thirty-five (35) male cadaveric temporal bones, were taken out, by removing soft parts attached to it. The FN was exposed. The length of the FN was measured, by digital vernier calliper, in different regions, of the temporal bone. Results: 7.90 (SD±1.24) in petrous part, 3.7 (SD±0.40) in labyrinthine part, 12.13 (SD±0.36) in tympanic, 12.24 (SD±1.86) mastoid part, 15.76 (SD±0.54) length of nerve to stapedius, and 19.06 (SD±0.66) length of branches of chorda-tympani. Conclusion: The present cadaveric study has clinical importance, for the ENT surgeon, neurosurgeon, neurophysician, and the radiologist.

New classification and surgical strategy for work type I congenital first branchial cleft anomalies in children.

To investigate the anatomical relationships between the structures adjacent to the cartilaginous portion of the ear canal in children with Work type I congenital branchial cleft anomalies (CFBCAs) and to develop new classifications and surgical strategies. Retrospective analysis was performed on 50 children with Work type I CFBCAs admitted between December 2018 and December 2022. Among the 50 children, total parotidectomy was performed on 49 sides. In 44 cases (88%), the main body of the lesion was closely associated with the cartilage of the inferior ear canal wall. Among these cases, the lesions in 40 cases occurred within the space enclosed by the dorsal inferior wall cartilage, mastoid process, and parotid gland, while in the remaining four cases, the lesions were located between the anterior inferior wall cartilage and parotid gland. Based on the preoperative imaging observations, clinical manifestations, and intraoperative findings, the cases were classified into 6 subtypes (a to f) including 21 cases (42%) of Type Ia (inferior wall of EAC), 7 cases (14%) of Type Ib (bottom wall of EAC), 12 cases (24%) of Type Ic (posterior-inferior wall of EAC), 4 cases (8%) of Type Id (anterior-inferior wall of EAC), 4 cases (8%) of Type Ie (anterior ear wall of EAC), and 2 cases (4%) of Type If (isolated from parotid). Surgical intervention is the only treatment for first branchial cleft anomalies and a comprehensive understanding of the classifications will help with the precise localisation and excision of the lesions.

Adaptation peculiarities of the liver structure in some representatives of the order Lagoriform

The work is devoted to the study of the adaptive features of the histological structure of the liver of some representatives of the hare order. The material for the study was organocomplexes from clinically healthy productive rabbits, decorative rabbits and white hare. Research work was carried out at the Department of Anatomy and Physiology of the Federal State Budgetary Educational Institution of Higher Education of the State Agrarian University of the Northern Trans-Urals. Conducted morphometric studies and selected material for morphological and histological studies. The liver of the studied species of the order Lagomorphs has a convex parietal and slightly concave visceral surface. The right and left lobes of the liver are divided into lateral and medial parts. In a productive rabbit and a decorative rabbit, the lateral right lobe is shorter than the lateral left lobe, and in the white hare, both of these are short. The square share of all is an elongated quadrangular shape. Caudate and mastoid processes are small. The gallbladder lies between the right lateral and right medial lobes and does not extend beyond the ventral edge of the liver. Histological studies were carried out according to generally accepted methods. In all species of the order of lagomorphs, formed triads were observed located on the border between the lobules. Hepatocytes form hepatic laminae. Trabeculae and loose fibrous connective tissue are not expressed. Analyzing the obtained histological data, we can say that the adaptive features will include: in rabbits bred under industrial conditions - an increased area of hepatocytes (376.29±22.95 µm2) and nuclei (52.44±4.51 µm2), a decrease in NCR 0.16±0.007; in ornamental rabbits - a decrease in the area of hepatocytes (38.32±1.77 µm2) and nuclei (7.06±0.59 µm2), but the average value of the Nuclear-Cytoplasmic Ratio is 0.42±0.01; in the hare - the average values of the area of hepatocytes (260.79±15.88 µm2) and nuclei (41.58±1.32 µm2), NCR 0.4±0.01. These features indicate significant differences in the nutrition and maintenance of these animals, as well as various adaptation processes.

Effect of occlusion effect by bone-conducted sound on monosyllable articulation.

Bone conduction (BC) technology allows us to hear sounds without having anything blocking our ears and enables hearing even when wearing earplugs. However, optimizing this technology presents challenges, particularly in relation to the occlusion effect (OE), a phenomenon that takes place when the ear canal is occluded, causing low-frequency sounds to seem louder than their original intensity. While some facial regions exhibit greater OE than conventional areas, the impact of OE on speech perception in different facial regions has not been thoroughly investigated. This study explores the relationship between OE and speech perception in various facial regions to inform the functionality of BC technology. We conducted a quantitative analysis of monosyllable articulation in the mastoid process, condylar process, nasal bone, and infraorbital region using both female and male voices to assess OE's impact on speech perception. Our findings reveal that OE improves articulation, facilitating voice communication; however, the extent of articulation enhancement varies depending on the stimulus location and phoneme. By examining OE's role in speech perception, this research report contributes to the development and use of more effective BC technology applications.

Characteristics of Frequency Resolution and Speech Perception Using Bone Conduction on Different Human Facial Parts.

In conventional bone-conduction (BC) devices, a vibrator is typically attached to the mastoid process of the temporal bone or the condyle process of the mandible. However, BC-sound presentations to facial parts such as the nose and cheek have also been investigated recently. As the face is the among the most complex structures of the human body, transmission of sounds using BC on different facial parts are likely to show different perception and propagation characteristics than those presented to conventional parts. However, the characteristics of BC sound presented to different part of the face have not yet been studied in detail. To test the frequency discrimination ability, we measured difference limens for frequency (DLFs). We also conducted monosyllable articulation tests in Japanese to assess the speech-perception characteristics when BC sounds are presented to various facial (nasal, infraorbital region, zygomatic, jaw angle, and chin) and conventional (mastoid and condyle process) parts of a normal-hearing subject. The results suggest that, at least in the parts investigated in the current study, the frequency resolution and intelligibility of the facial parts were about the same as those of the conventional parts. These results indicate that practical frequency information and speech perception are possible with BC devices attached to different facial parts.

Analysis of mastoid portion of facial nerve course in temporal bone using computed tomography.

<b>Introduction:</b> The facial nerve (FN) follows a complex route in the temporal bone. Successful temporal bone surgery requires knowledge of its course which can be achieved using imaging methods such as computed tomography. This investigation aims to analyze the FN course in its mastoid portion and second genu and the frequency of its atypical course.</br></br> <b>Material and methods:</b> This is a retrospective study that enrolled 104 CT scans of temporal bones of patients followed up in the outpatient clinic of the Otorhinolaryngology Department of Dentistry Faculty of the Medical University of Warsaw between 2020 and 2022. FN courses were classified as straight, bulging, or letter "S"-like. Other parameters estimated: </br> • position of the second genu according to the prominence of the lateral semicircular canal (classified as lateral, medial, or middle) and its distance from a line adjacent to the lateral semicircular canal was measured;</br> • the distance between the short process of the incus and the outermost point of the second genu;</br> • the course of the mastoid portion of FN and the location of SG in comparison to the tympanic portion of n. VII. The course was later classified as lateral, medial, or middle.</br></br> <b>Results:</b> Among the 104 assessed temporal bones, the course of the mastoid portion of FN was classified as bulging in 47 cases (45.2%). Straight and letter "S"-like courses were present in 41 (39.4%) and 16 (15.4%) cases, respectively. Deviation of the second genu according to the prominence of the lateral semicircular canal was medial in 86 cases (82.7%), and middle in 4 cases (3.8%). In the rest, second genu was paramedian to the prominence of the later circular canal. The mean distance between the short process of the incus and the outermost point of SG was 4.9 mm (0.73 mm). The mastoid portion was located laterally, medially, and in the middle of the tympanic portion plane in, respectively, 4.8%, 83.7%, and 11.5%. The second genu was located laterally, medially, and in the middle of the tympanic portion plane in 1.9%, 73.1%, and 25%, respectively. In conclusion, seven temporal bones (6.7%) of five patients presented with a lateral displacement of FN in relation to the established anatomical landmarks.</br></br> <b>Conclusions:</b> Although the atypical course of FN, including the lateral displacement of the mastoid portion, is rare, screening for it is crucial before surgical exploration.

Complex Treatment of Complicated Chronic Purulent Epitympanitis

The authors pay special attention to the fact that in chronic purulent epitympanitis, bone tissue is involved in the inflammatory process, and a chronic purulent-destructive change occurs in the cells of the mastoid process. Osteomyelitis of the bones leads to local and intracranial complications. Therefore, during sanitizing operations of the middle ear in epitympanitis, it is necessary to radically remove all foci of destructively altered structures of the middle ear system with exposure of the dura mater of the middle and posterior cranial fossae. Postoperative management of patients should be directed to intensive care.

Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve.

The dorsal scapular nerve (DSN) entrapment neuropathy has recently been recognized as a common cause of circumscapular pain and cases of winged scapula. Course of the nerve is important because the middle scalene muscle is frequently accessed for surgical treatments. Studies in the literature have not focused on the morphometric relationship of the DSN with the scalene muscles and its relationship with the long thoracic nerve (LTN). The neck regions of 13 adult cadavers were dissected bilaterally. The relationship of DSN with scalene muscles and LTN was evaluated. Cervical spinal nerves involved in the formation of the DSN were identified. Three types of DSN were observed based on the cervical spinal nerves from which it originates, five types of DSN from its relationship with the scalene muscles, and two types of DSN from its relationship with the LTN. The distance from where the nerve pierces the scalene muscle to the mastoid process was found to be greater in DSNs originating from C4 and C5 (93.85 ± 4.11 mm, p = 0.033). In DSNs not connected with LTN, the distance from where the nerve pierces the scalene muscle to the superior trunk/C5 (12.74 ± 7.73 mm, p = 0.008) and the length of the nerve within the scalene muscle (14.94 ± 5.5 mm, p = 0.029) were found to be statistically significantly greater. The topographic and morphometric anatomy of the proximal part of the DSN is important, especially for scalene muscles-focused surgical treatments and interscalene nerve blocks. We believe our results may guide clinical approaches and surgery.

Applying a geometric morphometric surface semilandmark-based approach for assessing sexual dimorphism in cranial bones

Traditionally, sex estimation in human skulls has been carried out applying non-metric and inter-landmark distance approaches. Such estimation has substantially improved with the introduction of geometric morphometric semilandmark-based registration, representing a useful tool for capturing the complex morphology of 3D surfaces, particularly in human skulls. Taking in account these improvements, the main purpose of this study is to show the benefits of these techniques for assessing by means of a quantitative, hypothesis testing approach the differential phenotypic expression of sexual dimorphism in human cranial traits, using the frontal bone, the mastoid process of the temporal bone, and the zygomatic bone as proxies. According to our main results: i) accuracy and precision of sex estimation is higher when the shape variable is included in the analysis than when it is not, ii) numerical classification tends to be more accurate in males than in females for both shape and size components of sexual dimorphism, and iii) a single trait or two traits in combination would be more successful in sex classification than the three traits taken as a whole. The introduction in the present study of a surface semilandmark-based approach for quantitatively assessing sexual dimorphism in human skull considerably improves the capture of sexual dimorphic signatures, corroborating the importance of the information carried by the surface of the frontal bone, mastoid process, and zygomatic bone. Our results suggest that shape and size components should be considered as relevant factors in making a differential, bone- dependent sex assessment in human crania.

Study on Microsurgical Anatomy of External Branch of Superior Laryngeal Nerve Related to Carotid Endarterectomy.

To explore the methods of protecting the external branch of the superior laryngeal nerve during carotid endarterectomy through microsurgical anatomic study of the external branch of the superior laryngeal nerve in cadaveric specimens. A total of 30 cadaveric specimens (60 sides) were dissected to measure the thickness of the external branch of the superior laryngeal nerve. A triangular area was exposed, bounded by the lower border of the digastric muscle superiorly, the medial edge of the sternocleidomastoid muscle laterally, and the upper border of the superior thyroid artery inferiorly. The probability of the occurrence of the external branch of the superior laryngeal nerve in this area was observed and recorded. The distance among the midpoint of the external branch of the superior laryngeal nerve in this area with the tip of the mastoid process and the angle of the mandible as well as the bifurcation of the common carotid artery was measured and recorded. Among 30 specimens of cadaveric heads (60 sides) examined 53 external branches of the superior laryngeal nerve were observed while 7 were absent. Of the 53 branches observed, 5 were located outside the anatomic triangle region mentioned above, while the remaining 48 branches were located within the anatomic triangle region with a probability of ~80%. The thickness of the midpoint of the external branches of the superior laryngeal nerve within the anatomic triangle region was 0.93mm (0.72-1.15mm [±0.83 SD]), located 0.34cm [-1.62-2.43cm (±0.96 SD)] posterior to the angle of the mandible, 1.28cm (-1.33 to 3.42cm (±0.93 SD)] inferiorly; 2.84cm (0.51-5.14cm±1.09 SD) anterior to the tip of the mastoid process, 4.51cm (2.82-6.39cm±0.76 SD) inferiorly; 1.64cm [0.57-3.78cm (±0.89 SD)] superior to the bifurcation of the carotid artery. During carotid endarterectomy procedure, using the cervical anatomic triangle region, as well as the angle of the mandible, the tip of the mastoid process, and the bifurcation of the carotid artery as anatomic landmarks, is of significant clinical importance for protecting the external branches of the superior laryngeal nerve.

Epithelioid Hemangioendothelioma of the Mastoid Bone with Extension of Middle Cranial Fossa: A Case Report.

Epithelioid hemangioendothelioma (EHE) is a rare sarcoma of vascular origin. It is frequently seen in the liver, lungs and bones. Cases with mastoid bone and intracranial extension are rarer.A 40 year old male, presented with a history of progressive headaches and a mass in the postauricular region for a duration of three months. Computer tomography of the temporal bone showed an approximately 40 × 30mm soft tissue with osteolytic bony changes located in the mastoid bone.Epithelioid hemangioendothelioma is a rare sarcoma of vascular origin. Surgery is the first line of therapy. Prognosis is generally good, and may be better for primary intracranial disease than that for EHE originating elsewhere.

Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis.

Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.

Automated model for identification on mastoid of temporal bone image

Mastoiditis occurs due to inflammation that can affect the structure of the mastoid bone. The mastoid bone consists of the mastoid air cell system (MACS) which protects the ear structures and regulates air pressure in the ear and has different sizes and characteristics, making it very difficult to identify precisely. This study aims to identify and find the right MACS size by developing an automatic identification model and obtaining the optimal threshold value in the segmentation process using the extended adaptive threshold (eAT) method. The research dataset uses computed tomography (CT)-scan images of 308 slices of 12 patients indicated for mastoiditis. The results of this study provide identification that has the right MACS accuracy and size. Overall, the optimal segmentation process obtained the smallest threshold value of 57 and the largest threshold value of 63, the smallest MACS size is 4.025 cm2 and the largest is 8.816 cm2 with an accuracy rate of 93.4%. The smaller MACS size indicates inflammation in the mastoid area and these patients require more intensive treatment.

Ballistic injury to the neck in a soldier injured in the war in Ukraine

Introduction and relevance: Penetrating neck trauma results in a 10% mortality rate for patients and management can be challenging, often requiring a multidisciplinary approach.Methods: This is a case report of a 33-year-old male patient who received a neck gunshot through the oral cavity during close combat on the south front of the Ukrainian-Russian war in January 2023.Clinical discussion: A CT scan revealed a foreign body in the neck on the right side, between the mastoid process and the right jaw angle. A CT scan with contrast revealed a foreign body in the neck – a bullet – and helped with observing relations to surrounding tissues and following the bullet’s trajectory. The multidisciplinary team performed surgery for foreign body removal. As a first step, carotid arteries and the internal jugular vein were dissected and looped to control potential bleeding. The bullet was 7.62 caliber. The patient recovered well with minimal postoperative complications, including hypoglossal and facial nerve neuropathy, which resolved in two weeks.Conclusion: The proximity gunshot resulted in unexpectedly moderate tissue injury, but regardless of the relatively low destruction of palate tissue, the location of the foreign body near carotid arteries made the surgery approach challenging.

Morphometric Study of Supra-meatal Triangle and Mastoid process in the Adult dry Skulls

Introduction: This study was done with an objective to do a craniometric study of supra meatal triangle and mastoid process to explore the variations as a determinant to sex. Methodology: A total of 47 skull bones formed our study sample which comprised of 31 males and 16 females Six landmarks were identifi ed on each side of the skulland measurements were taken using Digital Vernier caliper with precision of 0.01. Observations and Results: The area of supra-meatal triangle in male was 134.68± 21.69 mm3 on the right side and 134.17± 16.98 mm3 on the left side. In females the area of supra-meatal triangle was 114.82± 21.99 mm3 on right side and 122.46± 24.05 mm3 on the left side. In male skulls, the length, breadth and width of the mastoid process on the right side was 23.56 ± 2.88, 19.81 ± 2.49 and 11.46 ± 2.51 mm and the left side measurements were 23.33 ± 2.17, 18.93 ± 1.91 and 10.84 ± 2.39mm respectively. In females the length, breath and width of mastoid were 23.03 ± 2.94, 18.87 ± 2.42 and 10.03 ± 2.32 mm on right side and 22.06 ± 1.99, 17.85± 2.22 and 9.43 ± 1.89 mm in left side respectively. conclusion: In this present study the supra meatal triangle and all measurements of mastoid process were greater in males with the mastoid breadth and width showed statistically signifi cant values. The fi ndings can be applied to unknown skull samples or bone fragmentsand can provide insight to future studies of forensic anthropologists and ENT surgeons.

Simplified Easy-Accessible Smartphone-Based Photogrammetry for 3-Dimensional Anatomy Presentation Exemplified With a Photorealistic Cadaver-Based Model of the Intracranial and Extracranial Course of the Facial Nerve.

Smartphone-based photogrammetry (SMPhP) was recently presented as a practical and simple algorithm to create photorealistic 3-dimensional (3D) models that benefit from volumetric presentation of real anatomic dissections. Subsequently, there is a need to adapt the techniques for realistic depiction of layered anatomic structures, such as the course of cranial nerves and deep intracranial structures; the feasibility must be tested empirically. This study sought to adapt and test the technique for visualization of the combined intracranial and extracranial course of the facial nerve's complex anatomy and analyze feasibility and limitations. We dissected 1 latex-injected cadaver head to depict the facial nerve from the meatal to the extracranial portion. A smartphone camera alone was used to photograph the specimen, and dynamic lighting was applied to improve presentation of deep anatomic structures. Three-dimensional models were created with a cloud-based photogrammetry application. Four 3D models were generated. Two models showed the extracranial portions of the facial nerve before and after removal of the parotid gland; 1 model showed the facial nerve in the fallopian canal after mastoidectomy, and 1 model showed the intratemporal segments. Relevant anatomic structures were annotated through a web-viewer platform. The photographic quality of the 3D models provided sufficient resolution for imaging of the extracranial and mastoid portions of the facial nerve, whereas imaging of the meatal segment only lacked sufficient precision and resolution. A simple and accessible SMPhP algorithm allows 3D visualization of complex intracranial and extracranial neuroanatomy with sufficient detail to realistically depict superficial and deeper anatomic structures.

BROWN TUMOR OF PRIMARY HYPERPARATHYROIDISM ASSOCIATED WITH ECTOPIC PARATHYROID TISSUE

This study presents an unusual case of primary hyperparathyroidism with a brown tumor caused by ectopic parathyroid tissue within the mediastinum. A 48-year-old male was admitted, complaining of a painful and hemorrhagic swelling in the anterior mandible, of unknown duration. The patient's medical history was uneventful. Spiral computed tomography revealed well-defined multilocular radiolucencies located within the anterior and body of the mandible, bilateral mastoid processes, and temporal bone, causing significant cortical expansion and thinning. An incisional biopsy of the anterior mandible showed a central giant cell lesion, and laboratory exams detected high values of parathormone, alkaline phosphate, and calcium. Further sestamibi-SPECT parathyroid scintigraphy was carried out and hyperfunctioning ectopic parathyroid tissue within the mediastinum region was detected. The patient was referred to an endocrinologist and is being prepared for thoracic surgery for analysis of the ectopic parathyroid tissue. This study presents an unusual case of primary hyperparathyroidism with a brown tumor caused by ectopic parathyroid tissue within the mediastinum. A 48-year-old male was admitted, complaining of a painful and hemorrhagic swelling in the anterior mandible, of unknown duration. The patient's medical history was uneventful. Spiral computed tomography revealed well-defined multilocular radiolucencies located within the anterior and body of the mandible, bilateral mastoid processes, and temporal bone, causing significant cortical expansion and thinning. An incisional biopsy of the anterior mandible showed a central giant cell lesion, and laboratory exams detected high values of parathormone, alkaline phosphate, and calcium. Further sestamibi-SPECT parathyroid scintigraphy was carried out and hyperfunctioning ectopic parathyroid tissue within the mediastinum region was detected. The patient was referred to an endocrinologist and is being prepared for thoracic surgery for analysis of the ectopic parathyroid tissue.

Динамика основных показателей инвалидности детей и подростков Азербайджанской Республики в условиях обязательной диспансеризации

The dynamics of the main indicators of childhood disability is important for determining guidelines in the medical, social, and economic directions of the development of society and the state. In the course of the analysis, it was revealed that during the period of the introduction of mandatory medical examination of the child population in the Republic of Azerbaijan, the increase in the number of children with disabilities in 2019 compared to 2014 was 16.1%. However, the number of children with disabilities with a primary diagnosis decreased by 17.7%. The greatest decrease in the level of primary disability was observed in the following types of diseases: diseases of the circulatory system – by 86.5%; tuberculosis – by 67.4%; respiratory diseases – by 66.8%; injuries, poisoning and some other effects of external causes – by 64.7%, etc. At the same time, an increase in primary disability among children was noted for such diseases as: mental and behavioral disorders – by 70.9%; diseases of the ear and mastoid process – by 52.6%; congenital anomalies (malformations), deformities and chromosomal disorders – by 38.6%, as well as a number of others.

Communication between the temporomandibular joint articular space and the extradural space in patients with temporal bone pneumatization: implications for temporomandibular joint surgery

The pneumatization of the articular portion of the temporal bone is an anatomical variant that can modify the barrier between the articular space and the middle cranial fossa. Thus, this study aimed to identify the presence and degree of pneumatization, as well as the existence of pneumatic cell dehiscence towards the extradural or articular space determining whether it could lead to direct communication between the articular and extradural spaces. Hence, One-hundred skull computed tomography images were selected. The presence and extension of pneumatization were classified according to scores 0, 1, 2, and 3. Dehiscence towards extradural and articular spaces was recorded. In total, 200 TMJ from 100 patients were assessed and 40.5% of pneumatization cases were observed. The most prevalent score was 0 (restricted to the mastoid process), while the least prevalent score was 3 (extending beyond the crest of articular eminence). Dehiscence of the pneumatic cells towards the extradural space is more common than towards the articular space. One complete communication between the extradural and articular spaces was observed. Considering the results, it was concluded that to avoid neurological and ontological complications, awareness of the potential anatomical communications between articular and extradural spaces, particularly in patients with extensive pneumatisation, is necessary.

Anatomical and Clinical Evaluation of Tympanic Tegmen and Mastoid Bone with Multidetector Computed Tomography

Anatomical and Clinical Evaluation of Tympanic Tegmen and Mastoid Bone with Multidetector Computed Tomography