Petrous Bone Research Articles

A Computer Vision Algorithm to Classify Pneumatization of the Mastoid Process on Temporal Bone Computed Tomography Scans.

Pneumatization of the mastoid process is variable and of significance to the operative surgeon. Surgical approaches to the temporal bone require an understanding of pneumatization and its implications for surgical access. This study aims to determine the feasibility of using deep learning convolutional neural network algorithms to classify pneumatization of the mastoid process. De-identified petrous temporal bone images were acquired from a tertiary hospital radiology picture archiving and communication system. A binary classification mode in the pretrained convolutional neural network was used to investigate the utility of convolutional neural networks in temporal bone imaging. False positive and negative images were reanalyzed by the investigators and qualitatively assessed to consider reasons for inaccuracy. The overall accuracy of the model was 0.954. At a probability threshold of 65%, the sensitivity of the model was 0.860 (95% CI 0.783-0.934) and the specificity was 0.989 (95% CI 0.960-0.999). The positive predictive value was 0.973 (95% CI 0.904-0.993) and the negative predictive value was 0.935 (95% CI 0.901-0.965). The false positive rate was 0.006. The F1 number was 0.926 demonstrating a high accuracy for the model. The temporal bone is a complex anatomical region of interest to otolaryngologists. Surgical planning requires high-resolution computed tomography scans, the interpretation of which can be augmented with machine learning. This initial study demonstrates the feasibility of utilizing machine learning algorithms to discriminate anatomical variation with a high degree of accuracy. It is hoped this will lead to further investigation regarding more complex anatomical structures in the temporal bone.

Зависимость клинических проявлений паралитического лагофтальма от уровня и давности поражения лицевого нерва

The path of the facial nerve is associated with multiple nerves, bones and soft tissues, including n. trigeminus, n. intermedius, petrosal bone and parotid gland. Due to this fact, facial palsy results not only in lagophthalmos but also in dysfunction of tear production and even vision lost in some cases. The aim of the study is to compare clinical signs of lagophthalmos in patients with various levels and duration of facial palsy. We analyzed 120 cases of lagophthalmos in patients aged 5–90 y.o. with duration of facial palsy from 2 month to 90 years. The patients were divided into 4 groups according to the level of nerve damage: 1 – in the cerebral part of the nerve, 2 – in petrosal bone, 3 – in the area of parotid gland, and 4 – indefinite. The light forms of keratopathy were dominant in all of the groups (72.5 %). There was a very weak correlation between the duration of facial palsy and margin to the low limb distance (r = 0.190; p < 0.05). The width of the eye fissure was significantly different between 1st and 3rd groups (p = 0.019), 1st and 4th groups (p = 0.042), 2nd и 3rd (p = 0.038), 2nd and 4th (p = 0.043). Although the results of Schirmer 1 tests was significantly different only between 1st and 3rd groups (p < 0.001). Severity of clinical signs in paralytic lagophthalmos depends in most on the level of facial nerve damage and can be due to concurrent damage of n. trigeminus. The duration of the facial palsy and involvement of n. intermedius do not play any significant role. Keywords: n. facialis, n. trigeminus, n. intermedius, neurotrophic keratopathy, exposure keratopathy, exposure keratitis

A comparison of five DNA extraction methods from degraded human skeletal remains

Extracting DNA from degraded human remains poses a challenge for any forensic genetics laboratory, as it requires efficient high-throughput methods. While little research has compared different techniques, silica in suspension has been identified in the literature as the best method for recovering small fragments, which are often present in these types of samples. In this study, we tested five DNA extraction protocols on 25 different degraded skeletal remains. Including the humerus, ulna, tibia, femur, and petrous bone. The five protocols were organic extraction by phenol/chloroform/isoamyl alcohol, silica in suspension, High Pure Nucleic Acid Large Volume silica columns (Roche), InnoXtract™ Bone (InnoGenomics), and PrepFiler™ BTA with AutoMate™ Express robot (ThermoFisher). We analysed five DNA quantification parameters (small human target quantity, large human target quantity, human male target quantity, degradation index, and internal PCR control threshold), and five DNA profile parameters (number of alleles with peak height higher than analytic and stochastic threshold, average relative fluorescence units (RFU), heterozygous balance, and number of reportable loci) were analysed. Our results suggest that organic extraction by phenol/chloroform/isoamyl alcohol was the best performing method in terms of both quantification and DNA profile results. However, Roche silica columns were found to be the most efficient method.

Improving kinship probability in analysis of ancient skeletons using identity SNPs and MPS technology.

In forensic kinship analysis and human identification cases, analysis of STRs is the gold standard. When badly preserved ancient DNA is used for kinship analysis, short identity SNPs are more promising for successful amplification. In this work, kinship analysis was performed on two skeletons from the Early Middle Ages. The surface contaminants of petrous bones were removed by chemical cleaning and UV irradiation; DNA was isolated through full demineralization and purified in an EZ1 Advanced XL machine. The PowerQuant kit was used to analyze DNA yield and degradation, and on average, 17 ng DNA/g of petrous bone was obtained. Both skeletons were typed in duplicate for STR markers using the Investigator EssplexPlus SE QS kit, and comparison of partial consensus genotypes showed shared allelic variants at most loci amplified, indicating close kinship. After statistical calculation, the full-sibling kinship probability was too low for kinship confirmation, and additional analyses were performed with PCR-MPS using the Precision ID Identity Panel. The HID Ion Chef Instrument was used to prepare the libraries and for templating and the Ion GeneStudio S5 System for sequencing. Analysis of identity SNPs produced full genetic profiles from both skeletons. For combined likelihood ratio (LR) calculation, the product rule was used, combining LR for STRs and LR for SNPs, and a combined LR of 3.3 × 107 (corresponding to a full-sibling probability of 99.999997%) was calculated. Through the SNP PCR-MPS that followed the STR analysis, full-sibling kinship between the ancient skeletons excavated from an early medieval grave was confirmed.

LABYRINTHINE FISTULA : A SEVERE COMPLICATION OF CHOLESTEATOMA

The labyrinthine fistula is a severe complication of chronic otitis media withcholesteatoma. It is the consequence of a progressive erosion of the endochondral bonecovering and closing the labyrinth by the cholesteatoma matrix. As thelabyrinth is connected to the cochlea, a labyrinthine fistula can lead to sensorineural hearingloss in addition to vertigo. Computed tomography imaging of the petrous bones issystematic, specifying the seat and extension of the cholesteatoma, and evaluating the extentof bone lysis.We report the case of a young female patient who presents a chronic otitis media withcholesteatoma complicated by a labyrinthinefistula and a left temporal brain abscess.

Sellar-Parasellar and Petrous Bone Metastasis from Differentiated Thyroid Carcinoma: Imaging Characteristics and Follow-Up Profile Post Radioiodine Therapy.

Sella turcica and petrous bone metastasis from differentiated thyroid carcinoma are rare clinical entities, with only a few limited cases reported to date. Two cases, one of sella turcica metastasis and the other of petrous bone metastasis from carcinoma of the thyroid gland, are presented. The cases diagnosed to have arisen from poorly differentiated thyroid carcinoma and follicular carcinoma of thyroid, respectively, subsequently underwent total thyroidectomy, radioiodine (RAI) scans and RAI therapies with iodine-131, external radiotherapy, and levothyroxine suppression with follow-up. Their clinical symptoms gradually subsided, with reduction in serum thyroglobulin, and finally resulted in disease stabilization. With the multimodality therapeutic approach, both patients are alive to date, with 48- and 60-month survival post diagnosis, respectively.

EVALUATION OF RADIATION DOSE IN MULTI-SLICE COMPUTED TOMOGRAPHY PROTOCOLS OF HEAD AND NECK REGIONS.

In head and neck computed tomography (CT) imaging, the optimisation of radiation dose is crucial due to the presence of radio-sensitive organs. This study aimed to evaluate the radiation dose in multi-slice CT for head and neck examinations. Volume CT dose index, dose length product and effective dose (E) were assessed for 10 head and neck CT scans performed on 292 adult patients (mean age 49.2±15.9y). The study resulted in median E values of 0.82, 1.62, 2.43, 0.93, 1.70, 0.83, 3.55, 6.25, 2.19 and 5.26mSv, respectively, for sinuses (non-contrast (NC)), sinuses (NC) and contrast-enhanced (CE), petrous bone (PTB)/internal auditory meatus (IAM) (NC+CE), PTB/IAM (NC), orbit (NC+CE), orbit (NC), brain with the orbit (NC), brain CT angiography (CTA) subtraction, neck (NC) and brain/neck (NC). Furthermore, the overall radiation doses of this institution were found to be below the values suggested by similar studies. However, optimisation of the dose is required for brain CTA.

Management of tympanic retraction pockets: case of Mali

Background: This study aims to study the epidemiological and therapeutic aspects of tympanic retraction pockets in the ENT-CCF department of the CHU GT. Method: This was a descriptive prospective study. Results: A total of 9400 patients consulted during the study period. A retraction pocket was diagnosed in 70 patients, i.e., 0.74% of all consultations. The most represented age group was that of [25-39 years]. The average age was 45.71 years. The extremes of ages were 10 years and 81 years. The female gender was the most represented, i.e., 60% with a sex ratio꞊0.67. CT of the petrous bone was performed in two patients. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stage I charachon. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon). Cartilaginous tympanoplasty was performed in one patient, antroatticotomy associated with reinforcement tympanoplasty was performed in one patient (1.43%). Conclusions: The pockets of tympanic retraction constitute a particular nosological entity which deserves rigorous monitoring. The ENT surgeon will be faced with two major challenges: the erosion of the ossicular chain and their potential risk of progression towards cholesteatoma. The diversity of therapeutic options represents an issue that makes this entity a hot topic.

E016 Erosive psoriatic arthritis causing deafness

Abstract Background/Aims Hearing loss from systemic psoriatic disease is rare, and cases reported in the literature have been reported with sensorineural deficits. Conductive hearing loss due to psoriatic arthritis has not been specifically reported in the literature, and this is believed to be the first reported case of erosive psoriatic arthritis causing conductive hearing loss. Presented is an illustrated case of a patient complaining of worsening bilateral hearing loss who underwent investigations under otolaryngology and audiology, and subsequent CT imaging which identified erosion of the temporal bone, posterior to the left temporomandibular joint, resulting in subluxation into the external auditory canal leading to complete occlusion of the canal. Methods 58yo female with psoriatic arthritis, psoriasis, and Raynaud’s phenomenon presenting with an 18-month history of hearing loss, worst on the left, but with some improvement on mouth opening. Treatment of her psoriatic arthritis has been with Ixekizumab since July 2021 with good overall disease control. Previous DMARD therapy includes methotrexate, sulfasalazine, and hydroxychloroquine, and previous biologic therapy of adalimumab and secukinumab. She had undergone bilateral reshaping of the mandibular condyle & fossa 20 years ago for presumed degenerative arthropathy that was non-responsive to conservative management; further details of the surgery will be presented. Results Patient was referred to audiology and otolaryngology who noted significant narrowing of both ear canals on examination. Audiological investigations revealed a right sided sensorineural hearing loss, and mixed pattern of hearing loss on the left. The patient proceeded to have skull vault imaging to assess for a structural cause of her left sided hearing loss. The finding of the CT petrous bones revealed soft tissue swelling associated with erosion of the anterior wall of the temporal and mandibular bones, causing subluxation and mass effect into the external auditory canal with no other cause for left-sided hearing loss demonstrated. Interestingly her hearing improved slightly with jaw opening and dynamic MRI may be indicated if surgical intervention is an option. Conclusion Our patient has a mixed hearing loss. The specific cause of the sensorineural component in our patient is not known but sensorineural loss has been reported in patients with psoriatic disease. The pathogenesis of psoriasis associated sensorineural hearing loss remains unclear however emerging evidence may implicate the downregulation of gap junction beta-2 protein encoding connexin 26 an integral cell signalling gap protein. We believe this is the first reported case where conductive hearing loss has resulted from a direct result of psoriatic arthritis from erosive temporomandibular joint disease leading to mass effect on the audio vestibular anatomy. It is a stark reminder of the consequences of erosive disease and the importance of surveillance of temporomandibular joint function in psoriatic arthritis patients given this rare but potential complication. Disclosure A.K. Coulton: None. W.R. Gubbins: None. S. Young-Min: None.

Human bony labyrinth as a sex indicator in subadults

Due to the durability and good preservation of the petrous bone in archaeological and forensic contexts, the value of the inner ear as a sex indicator has been evaluated in various studies. Previous findings suggest that the morphology of the bony labyrinth is not stable in the postnatal period. In this study, we aim to assess the sexual dimorphism of the bony labyrinth via analysis of computed tomography (CT) data obtained from 170 subadults (birth to 20 y.o.) and test whether the postnatal changes of the bony labyrinth affect the level of dimorphism in the inner ear. A set of 10 linear measurements of 3D labyrinth models as well as 10 size and shape indices were analyzed. Sexually dimorphic variables were used to produce sex estimation formulae with discriminant function analysis. The produced formulae allowed for the correct classification of up to 75.3 % of individuals aged from birth to 15 years old. Sexual dimorphism was not significant for individuals between 16 and 20 years of age. This study suggests that the morphology of the subadult bony labyrinth exhibits significant sexual dimorphism in individuals under 16 years of age, which can aid the forensic identification process. Although postnatal growth of the temporal bone seems to affect the level of sexual dimorphism present in the inner ear, the formulae created in this study could be used as an additional tool for sex estimation of subadult (<16 y.o.) remains.

Density separation of petrous bone powders for optimized ancient DNA yields.

Density separation is a process routinely used to segregate minerals, organic matter, and even microplastics, from soils and sediments. Here we apply density separation to archaeological bone powders before DNA extraction to increase endogenous DNA recovery relative to a standard control extraction of the same powders. Using nontoxic heavy liquid solutions, we separated powders from the petrous bones of 10 individuals of similar archaeological preservation into eight density intervals (2.15 to 2.45 g/cm3, in 0.05 increments). We found that the 2.30 to 2.35 g/cm3 and 2.35 to 2.40 g/cm3 intervals yielded up to 5.28-fold more endogenous unique DNA than the corresponding standard extraction (and up to 8.53-fold before duplicate read removal), while maintaining signals of ancient DNA authenticity and not reducing library complexity. Although small 0.05 g/cm3 intervals may maximally optimize yields, a single separation to remove materials with a density above 2.40 g/cm3 yielded up to 2.57-fold more endogenous DNA on average, which enables the simultaneous separation of samples that vary in preservation or in the type of material analyzed. While requiring no new ancient DNA laboratory equipment and fewer than 30 min of extra laboratory work, the implementation of density separation before DNA extraction can substantially boost endogenous DNA yields without decreasing library complexity. Although subsequent studies are required, we present theoretical and practical foundations that may prove useful when applied to other ancient DNA substrates such as teeth, other bones, and sediments.

805 External Validation of the McGovern Score for Predicting Pediatric Blunt Cerebrovascular Injury

INTRODUCTION: Blunt cerebrovascular injury (BCVI) is defined as blunt trauma to the head and neck leading to damage to the vertebral and/or carotid arteries. The risk factors for pediatric BCVI have not been clearly described and which pediatric patients are considered “high-risk” and in need of angiographic/vessel imaging is largely based on clinical and institutional treatment patterns. Our group previously proposed a screening tool, the McGovern score, to identify pediatric trauma patients at high risk for BCVI. METHODS: This multicenter, retrospective, hospital-based, cohort study involved data collected for all pediatric (&lt;16 years) trauma patients who presented to the emergency department between 2003 and 2017 at 6 level 1 pediatric trauma centers. This trauma registry was then queried for patients who received a CTA as a screening method for BCVI. Patient age, arrival date, length of follow-up, and MOI were recorded. Glasgow Coma Scale (GCS) on arrival and the presence or absence of a focal neurological deficit. The obtained radiological variables included the presence or absence of a carotid canal fracture, petrous temporal bone fracture, and cerebral infarction as determined on CT scanning. Patients who were found to have BCVI were queried for mode of treatment, type of intracranial injury, artery damaged, and BCVI injury grade. The McGovern score was calculated for all patients who underwent CTA across all data groups. RESULTS: 1012 patients underwent CTA. 72 of these patients were found to have BCVI, 51 of which were in the external cohort. Across all data groups, the McGovern score has a &gt;80% sensitivity and &gt;98% NPV. CONCLUSIONS: The McGovern score is an effective and generalizable screening tool for pediatric BCVI.

Pre-Operative Evaluation of Petrous Temporal Bone Pathologies by CT and MRI in Cochlear Implant Candidates

Aim: To evaluate pathologies of the petrous temporal bone in cochlear implant candidates on CT and MRI preoperatively. Methods: A cross-sectional study was conducted at Combined Military Hospital Lahore from Jan 2014 to April 2016. 163 candidates were evaluated on CT and 149 were evaluated on MRI. All patients belonged to pediatric age group. Pathologies were grouped using classification of Sennaroglu &amp; Saatci and every pathology was sought in all the cases ensuring that the pathologiesare not missed. Results: High-resolution CT scan temporal bone revealed 69.9% normal studies. Chronic otitis media with mastoiditis was major abnormality observed in 16.6% of cases. Unilateral mastoiditis was seen in 6.1% of patients. Bilateral CSOM without mastoiditis was seen bilaterally in 1.8% of cases. While unilateral CSOM was observed 0.6 % of patients. Among inner ear malformations, Mondini malformation was seen in 4 cases (2.5%). A high jugular bulb was seen in 2 cases (1.2%).93.3% of cases were labeled as normal study on MRI. Four cases showed Mondini malformation. Infective process of middle ear showed a cumulative frequency of 2.7%. Inner ear aplasia was found in one patient. Sclerosing labyrinthitis was also found in one case. Conclusion: Both CT and MRI have substantial role in pre-operative evaluation of petrous temporal bone in cochlear implant candidates. Preoperative evaluation of petrous temporal bone by CT scan and MRI successfully identifies pathologies which can be absolute or relative contraindications of the cochlear implant as well as conditions in which surgical procedure needs to be modified. Keywords: Cochlear implants, HRCT temporal bone, MRI cochlea, Mastoiditis, Mondini malformation

Evolution of semiaquatic habits in hippos and their extinct relatives: insights from the ear region

Abstract Since molecular data identified hippopotamids as the closest living relatives of cetaceans, a common aquatic/semiaquatic ancestor hypothesis for these modern taxa has naturally been proposed. However, recent molecular studies concluded that most molecular adaptations in extant cetaceans occurred after their split from hippopotamids. If the question of aquatic affinities of the first cetaceans has been investigated at large, it has not been the case for the forebears of hippopotamids. Sensory organs are drastically affected by underwater perception. In this work, we question the aquatic affinities of fossil hippopotamoids through an investigation of the morphology and morphometrics of the petrosal bone and cochlea of 12 extinct hippopotamoid taxa. Petrosal and bony labyrinth morphological characters constitute a source of structured phylogenetic signal, both supporting major hippopotamoid clades and bringing original relationships. The morphometric study of functional measurements of the cochlear canal shows that anthracotheres bridge the morphological gap between terrestrial artiodactyls and modern hippopotamids. The integrated functional signal of the ear region further supports convergent acquisitions of semiaquatic behaviour in hippopotamids and cetaceans and indicates that terrestrial hearing was an ancestral trait among Hippopotamoidea. We highlight multiple convergent acquisitions of semiaquatic traits in the ear region of hippopotamoids and new robust phylogenetic characters.

How Physical and Molecular Anthropology Interplay in the Creation of Biological Profiles of Unidentified Migrants

The skeletal sex and ancestry of unidentified human crania can be inferred both from physical and from molecular features. This paper depicts and discusses the experiences of physical and molecular anthropologists on a set of commingled crania from the largest Mediterranean shipwreck disaster on 18 April 2015, in order to facilitate identification of human crania. Twenty-one disarticulated crania that were recovered from the above-mentioned shipwreck were analyzed to estimate skeletal sex and ancestry, following a physical and a molecular pipeline. The physical analyses applied morphological and metric methods that provided posterior probabilities for the crania to be classified into a sex or ancestral group. The molecular analyses were performed on petrous bones via a shotgun sequencing approach that allowed us to determine the sex of each individual and to retrieve the complete mitochondrial genome, Y chromosome single nucleotide polymorphisms, up to 597573 SNPs across the human genome from each individual. The morphometric sex analyses showed that most crania belonged to male individuals, although some estimations remained uncertain or undetermined. Inconsistent results were obtained for ancestry estimation as well, since morphological methods classified the crania mostly as European/White, in contrast to the most numerous African forms determined by craniometric analyses. This quite agreed with molecular analyses that identified only African males. Overall, undetermined and contrasting results were obtained between disciplines, preventing the creation of reliable and sound biological profiles that could provide guidance on the sex and ancestral group of the victims. Therefore, the times may not be mature for a merger of physical and molecular anthropology. However, future investigations of this research avenue would pave the way to the possible development of novel tools, methods, and wider reference databases that could address the limitations of both disciplines.

The ear region of the Philippine flying lemur Cynocephalus volans (Placentalia, Dermoptera).

The placental order Dermoptera, which includes two extant species, the Philippine and Sunda flying lemurs, Cynocephalus volans and Galeopterus variegatus, respectively, is generally held to be the sister group of Primates. Yet, little has been reported on their cranial anatomy. Here, the anatomy of the ear region is described and illustrated for a juvenile and adult C. volans based on CT scans. The inclusion of a juvenile is essential as nearly all cranial sutures are fused in the adult. Soft tissues are reconstructed based on sectioned histological pre- and postnatal specimens previously reported by the author. Numerous unusual features are identified, including: a small parasphenoid beneath the basisphenoid, a tensor tympani fossa on the epitympanic wing of the squamosal, a cavum supracochleare for the geniculate ganglion of the facial nerve that is not enclosed in the petrosal bone, a secondary facial foramen between the petrosal and squamosal, a secondary posttemporal foramen leading to the primary one, a subarcuate fossa that is floored in part by a large contribution from the squamosal, a body of the incus larger than the head of the malleus, and a crus longum of the incus that lacks an osseous connection to the lenticular process. Documentation of the anatomy of the Philippine flying lemur ear region is an essential first step in morphological phylogenetic analyses where features of the basicranium are widely sampled.

Increased Petrous Bone Uptake on 18 F-PSMA-1007 PET/CT Due to Otospongiosis.

We report the case of a 74-year-old man who had undergone radical prostatectomy for prostatic cancer 6 months earlier. Elevated prostate-specific antigen during follow-up prompted 18 F-prostate-specific membrane antigen (PSMA) ligand PET/CT ( 18 F-PSMA-1007 PET/CT) to search for new manifestations of prostate cancer, revealing an increased focal uptake (SUV max , 5.9) in the left cochlear/pericochlear temporal bone and equivocal PSMA-RADS-3a external iliac nodes. Comparison with cone-beam CT and MRI showed that the focal temporal bone uptake corresponded to the typical morphological features of active otospongiosis (otosclerosis) in the context of a previously known long-standing otospongiosis.

Radiologic Imaging of Pediatric Hearing Loss

Hearing loss in childhood has serious consequences for the entire development of the child. It is very important to make an accurate early diagnosis. The assessment usually includes physical, genetic, and radiological examination. In imaging diagnostics, CT, Cone Beam CT and or MRI of the petrous bone are the usual imaging modalities for the assessment of diseases of mastoid air cells, middle ear, external ear, the cochlea, the vestibulocochlear nerve, and the brain.

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Morphological variations in malleus among the male and female.

To determine gender-based morphological variations in malleus. The cross-sectional descriptive study was conducted at the Ear-Nose-Throat and Radiology departments of a public-sector hospital in Karachi, from January 20 to July 23, 2021, and comprised subjects of either gender aged 10-51 years who had intact ear ossicles. They were divided into equal male and female groups. After history and a thorough examination of the ear, high-resolution computed tomography scan of petrous temporal bone was done. The images were studied for malleus, to measure the parameters of its head width, length and shape of manubrium, and total length of malleus for possible morphological variations along gender lines. Data was analysed using SPSS 23. Of the 50 subjects, 25(50%) were males with mean width of the head 3.04±0.34mm, mean length of manubrium 4.47±0.48mm, and mean total length of malleus 7.76±0.60mm. The corresponding values in 25(50%) females were 3.00±0.28mm, 4.31±0.45mm and 7.41±0.51mm. The total length of malleus between both genders was significantly different (p= 0.031). The shape of manubrium was straight in 10(40%) males and 8(32%) females, and curved in 15(60%) males and 17(68%) females. Width of head, length of manubrium and total length of malleus were different in gender terms, but the total length of malleus was significantly different.