Computed tomography in the diagnosis of exudative otitis media

Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).     

Potentialities of temporal bone computed tomography in the study of the facial nerve and in the diagnosis of peripheral pareses of thr 7th pair of cranial nerves

Computed tomography (CT) was used to examine 200 patients (400 temporal bones) aged 3 to 74 years who had no signs of facial nerve lesion and 28 patients who had clinical manifestations of peripheral paresis of the facial nerve of varying genesis. Multipositional CT of the temporal bone is the most informative mode of visualization of the fallopian canal which is embodied on tomographic scans in 100% of cases irrespective of the age of a patient. CT data indicate that the formation of the facial nerve canal brings to completion by the age of 6 years. The following causes of n. facialis paresis were identified: facial neuroma; sarcoma of the temporal bone sarcoma; dehiscence of the canal wall in otitis media acuta; destruction of the tympanic wall of the canal in otitis nedia chronica, fractures of the temporal bone, anomalies of the fallopian canal in temporal bone malformations; stenosis of the canal in fibrous dysplasia. The detected alterations of the n. facialis canal permits further policy of management of a patient to be defined.     

Preoperative computed tomography of temporal bones and its use in selecting patients with sensorineural deafness for cochlear implantation

Cochlear implantation (CI) involves the insertion of electrode systems in the inner ear in order to restore hearing in patients with sensorineural deafness. Positive CI results are closely related with careful selection of candidates. Preoperative computed tomography (CT) and its results are decisive in this selection. Temporal bone CT was made in 40 patients aged 1 to 57 years who had sensorineural deafness. The following changes were detected: malformations of the inner ear, the inner auditory canal, meningititis-induced cochlear obliteration, post-traumatic temporal bone changes, local auditory ossicle malformation, inflammatory middle ear changes, the high position of the jugular vein bulb, and its diverticula. Temporal bone CT plays an important role in selecting candidates for CI and circumvents potential difficulties and complications at CI.     

An attempt at comparing CT images of petrous bone with analogical sections of anatomical specimens

The purpose of the paper was to present comparative laminar anatomy of human temporal bone on the basis of cross-sections of autopsy specimens and CT scans made in identical thin layers. The investigations were made on 20 temporal bones taken during anatomopathological dissections of cadavers of men and women (aged 40 to 60 a) without visible pathological changes in the skull. The CT examinations were made by means of a Siemens Somatom DR 2 apparatus, using high resolution programme, on 10 patients who had pathological changes in the ear. The obtained scans were compared with temporal bone cross-sections, schemas of regular anatomical relation of 8 layers corresponding to routine CT examinations were worked out.     

Potentialities of temporal bone CT in the diagnosis of chronic purulent otitis media and its complications

Temporal bone CT was used to examine a group of 87 patients with chronic purulent otitis media (103 temporal bones). The patients' age ranged from 2 to 74 years. A scheme was developed and proposed to evaluate the temporal bone by CT. The CT signs of chronic purulent otitis media uncomplicated by cholesteatoma and those of cholesteatomic purulent otitis were identified. The CT symptomatology of chronic purulent otitis includes: sclerotic changes in the bone tissue of the mastoid process, impaired pneumatization of the cavities of the middle ear, including the tympanic cavity, destructive changes in auditory ossicles, carious changes in the walls of the cavities of the middle ear. The CT semiotics of cholesteatoma depends on its site and spread into the temporal bone and includes as follows: deformation of the epitympanum due to soft tissue mass-induced destruction of the lateral wall; the dilated entrance into the antrum; the presence of a cavity with the sclerosed walls in the antromastoid area; carious changes in the auditory ossicles; the displacement of a chain of ossicles medially or laterally in relation to the initial site of cholesteatoma. CT reflects carious changes in the walls of the cavities of the middle ear, including the roof and labyrinthine wall of the tympanum, which allows labyrinthine fistula and intracranial cholesteatomic complications. The study of the temporal bone by the proposed scheme may reveal anomalies and the specific features of its structure: the presentation of the sigmoid sinus, the high elevation of the bulb of the jugular vein, diverticulum of the latter, the low standing of the bottom of the ACH.     

Potentialities of temporal bone computed tomography in the identification of causes of hypoacusis of postinflammatory genesis

Temporal bone computed tomography (CT) was used to examine 64 patients with impaired hearing due to inflammatory diseases of the middle year. In 21 patients, the pathological process was bilateral. A total of 85 series of temporal bone CT scans were analyzed. The patients' age ranged from 2 to 66 years. CT verified adhesive otitis media in 62 cases, otosclerosis in 7, local malformation of the auditory ossicles and/or the labyrinthine fenestrae in 11. No CT changes were revealed in 5 cases. The CT symptoms of adhesive otitis media were identified. These included soft tissue bands and/or soft tissue-density portions that fix the auditory ossicles or block the niches of the labyrinthine fenestrae (31 temporal bones); sclerosis or ossification of the ligaments and tendons of the middle ear (7 temporal bones); calcification foci in the tympanic cavity (9 cases); osteosclerotic changes in the epitympanus (2 cases); cicatricial changes in the tympanic membrane (24 cases); destructive changes in the auditory ossicles (19 temporal bones). There has been evidence that CT may be used for the differential diagnosis of adhesive otitis media from otosclerosis and congenital malformations of the structures of the middle ear.     

Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy

The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.     

Idiopathic carpal tunnel syndrome caused by carpal stenosis.

Computed tomography was used to measure the cross-sectional area of the carpal canals in normal controls of both sexes and in women with idiopathic carpal tunnel syndrome. The women controls had significantly smaller carpal canals than the men controls both proximally and distally. In the patients both the proximal and distal cross-sectional areas were significantly reduced compared with the women controls. The measurements showed that carpal canal stenosis is associated with idiopathic carpal tunnel syndrome, narrowing of the canal is bilateral in patients who have unilateral symptoms, and narrowing is greater in the proximal carpal canal. There was no correlation between age and the size of the canal. The difference in the size of the carpal canal between normal men and women might explain the tendency of women to develop carpal tunnel syndrome. The lack of correlation between age and the size of the canal suggests that stenosis of the carpal canal is inherited rather than acquired. Symptoms arise only later in life, when degenerated changes in the content or the walls of the carpal canal compete with the median nerve for space and its function becomes impaired by compression.     

Computed tomography of the temporal bones in children with developmental anomalies of the external and middle ear]

Computed polypositional high-resolution tomography (CT) was provided to 45 children with dysplasia of the external acoustic meatus (EAM). The computed tomograms were analyzed in accordance with the scheme which included the evaluation of the following structures: atresia or stenosis area, pneumatized mastoid process, tympanic cavity, ant rum, osteal opening of the Eustachian tube, chain of auditory ossicles, windows of the labyrinth, internal ear, facial nerve canal, and large vessels. Preoperative CT of the temporal bones allows for the evaluation of the above-listed structures, which is of paramount importance for the planning of the patient management policy. Also, CT enables the assessment of the risk of surgical intervention associated with a potential injury to the facial nerve, large vessels, and temporomandibular articulation. CT is to be an indispensable diagnostic modality for examination of children presenting with EAM dysplasia.     

Lateral angle: a method for sexing using the petrous bone

We report on the results of applying the so-called lateral angle method for sex determination on skeletal remains. The lateral angle denotes the angle of the internal auditory canal in relation to the medial surface of the petrous part of the temporal bone. The method involves making a small cast of the proximal part of the internal acoustic canal and determining the angle at which the canal opens up to the surface of the petrous bone. The method has the great advantage of utilizing one of the sturdiest bone elements of the human skeleton, and may thus be especially suited for analyses of very fragmented skeletal remains or cremated bones, where the petrous bone may still be readily recognizable. The method was tested using a forensic sample of 113 petrous bones with known sex. Intra- and interobserver testing was also performed. We found a statistically significant difference in angle size between males and females (mean angle size of males, 39.3 degrees ; mean angle size of females, 48.2 degrees ; P < 0.001). There was no bilateral difference in angle size. In blind trials, 83.2% of petrous bones were assigned to the correct sex. We also tested the lateral angle method against an archaeological skeletal sample. True sex was not known for this sample; instead, sexing had been carried out by assessing pelvic and cranial morphology in independent trials. We found a higher concordance between the lateral angle and "pelvic" sex than for lateral angle and "cranial" sex. Finally, we note that subadult sexing may also be possible with this method.     

Optimal Ancient DNA Yields from the Inner Ear Part of the Human Petrous Bone

The invention and development of next or second generation sequencing methods has resulted in a dramatic transformation of ancient DNA research and allowed shotgun sequencing of entire genomes from fossil specimens. However, although there are exceptions, most fossil specimens contain only low (~ 1% or less) percentages of endogenous DNA. The only skeletal element for which a systematically higher endogenous DNA content compared to other skeletal elements has been shown is the petrous part of the temporal bone. In this study we investigate whether (a) different parts of the petrous bone of archaeological human specimens give different percentages of endogenous DNA yields, (b) there are significant differences in average DNA read lengths, damage patterns and total DNA concentration, and (c) it is possible to obtain endogenous ancient DNA from petrous bones from hot environments. We carried out intra-petrous comparisons for ten petrous bones from specimens from Holocene archaeological contexts across Eurasia dated between 10,000-1,800 calibrated years before present (cal. BP). We obtained shotgun DNA sequences from three distinct areas within the petrous: a spongy part of trabecular bone (part A), the dense part of cortical bone encircling the osseous inner ear, or otic capsule (part B), and the dense part within the otic capsule (part C). Our results confirm that dense bone parts of the petrous bone can provide high endogenous aDNA yields and indicate that endogenous DNA fractions for part C can exceed those obtained for part B by up to 65-fold and those from part A by up to 177-fold, while total endogenous DNA concentrations are up to 126-fold and 109-fold higher for these comparisons. Our results also show that while endogenous yields from part C were lower than 1% for samples from hot (both arid and humid) parts, the DNA damage patterns indicate that at least some of the reads originate from ancient DNA molecules, potentially enabling ancient DNA analyses of samples from hot regions that are otherwise not amenable to ancient DNA analyses.     

Computerized x-ray tomography of fossil hominid skulls

The newest generation of Computerized Tomography (CT) scanning appears to provide x-ray pictures of the internal structures of a rather heavily mineralized Homo erectus skull, i.e., Pithecanthropus IV, notably of its temporal bones, that reveal more details than traditional x-ray procedures. An analysis of the right temporal bone shows that it is extremely pneumatized, that the oval shape of the external meatus does not result from fractures as previously suggested, and that the middle ear and the internal auditory meatus have probably been damaged during restoration. Labyrinthine structures can be seen, and the facial nerve canal appears to be of a relative small size.     

Is the lateral angle of the internal acoustic canal sexually dimorphic in non-adults? An investigation by routine cranial magnetic resonance imaging

The lateral angle of the internal acoustic canal is one of the measurements of petrous bone that has been previously studied for sex estimation, mostly in adults. We aimed at evaluating the effects of age, side, and sex on the lateral angle of the internal acoustic canal in pediatric patients.Pediatric routine cranial MRI studies were retrospectively investigated for this study. The lateral angle was measured on T2-weighted axial images when the anterior and posterior lips of the meatus and the cochlea were clearly visible on the same image. The data were evaluated for age, side and sex-related changes. Although 552 temporal bones from 273 patients were inspected, due to exclusion criteria lateral angle could be satisfactorily measured only in 101 temporal bones from 58 patients. The measurements did not differ significantly between sexes. An age-related, statistically significant decrease was observed for the entire pediatric sample studied, as well as for the males, but not for females. The measurements did not differ from side to side.The significant age-related decrease in lateral angle in male pediatric patients that was not detected in female counterparts may be the reflection of a sex-related difference in temporal bone development during childhood. Routine cranial MRI data may help investigators study age and sex-related changes in lateral angle in children.     

Obstetric implications of neanderthal robusticity and bone density

Neanderthal pelvic morphology is not well understood, despite the recent find and analysis of the Kebara 2 pelvis. Many of the proposed hypotheses focus on the possible need for a larger birth canal. A previously unexplored aspect involves possible direct obstetric implications of bone robusticity and density. These characteristics ocan affect obstetrics in modern humans, especially the molding of the neonate's head during parturition: engineering studies have shown that denser neonate cranial bones undergo less deformation, and thicker (more robust) cranial bones would also be expected to deform less during the birth process. These bone characteristics may also result in a less flexible birth canal. Thus, more robust or denser bones could result in the need for a larger birth canal or a smaller neonate head, due to decreased flexibility. Examples from modern populations are discussed and the conclusions applied to Neanderthals, who are known to have had high bone robusticity and may have had high bone density, given their heavy musculature. (A positive association between muscle mass and bone density has been observed repeatedly in modern humans.) We conclude that bone robusticity and density may have obstetrical implications for Neanderthals, with particular importance for neonate head molding during birth.     

Diagnosis and surgical treatment of defects in the wall of the orbit of children and adults using demineralized bone allografts

Accuracy of diagnosis defines the quality of treatment in patients with traumatic damage to eyelet walls. In this area, complex functional and anatomical breaches are typical and require full characterization of pathological changes in bone and soft tissue structures. A new plastic material with a high degree level of demineralization called “Perfoost” can be used to treat defects in the bones of the face of children and adults. In the present study, 79 patients with fractured eyelet walls were treated between 1999 and 2006 by grafting the defect wall with demineralized bone allografts. Grafts were applied from 2 days to 18 months after trauma. Magnetic resonance computer CT was used to check the realignment of allografts every 6 months after the reconstructive operation. The post-operative period of the observation was from 6 months to 7 years after the operation. Good or satisfactory results were obtained for 97.47 % of patients.     

Fitting manifold surfaces to three-dimensional point clouds

We present a technique for fitting a smooth, locally parameterized surface model (called the manifold surface model) to unevenly scattered data describing an anatomical structure. These data are acquired from medical imaging modalities such as CT scans or MRI. The manifold surface is useful for problems which require analyzable or parametric surfaces fitted to data acquired from surfaces of arbitrary topology (e.g., entire bones). This surface modeling work is part of a larger project to model and analyze skeletal joints, in particular the complex of small bones within the wrist and hand. To demonstrate the suitability of this model we fit to several different bones in the hand, and to the same bone from multiple people.     

Morphometric dimensions of metacarpal bones in the population structure analysis (island of Krk, Croatia)

The population structure analysis by means of the osteometric dimensions of metacarpal bones in the population groups of the northern Adriatic island of Krk, Croatia was performed. The sample consisted of randomly sampled adult islanders (94 males and 79 females) aged from 18 to 85 years from six villages of the island of Krk. "Biological distances" were estimated by the Mahalanobis D2 analysis for bone length (L), total diaphysis width (T) and medullary canal width (M) dimensions of the second left metacarpal bone. Analysis of the osteometric dimensions of metacarpal bones as a measure of biological distance between population groups of the island of Krk indicated bio-cultural and socio-cultural events, rather than geographical distances, to be the primary determinants of anthropogenetic structure of today's population groups of the island.     

Atresia of the external acoustic meatus in prehistoric populations

A case of atresia of the external acoustic meatus is presented from a prehistoric Late Woodland site in Iowa. The affected individual was a female aged 30 to 40 years. The left temporal bone displayed a thin bony plate occluding the external acoustic canal. No evidence of middle ear or inner ear malformation was observed on the axial tomographs, although the external canal was shortened. The individual is diagnosed as having a mild case of congenital atresia. The report extends the geographical and temporal distributions of this archaeologically rare condition.     

The skeletal anatomy of mandibulofacial dysostosis (Treacher Collins syndrome)

Three-dimensional osseous surface re-formation imaging from CT scans was used to examine the facial skeletons of 14 living patients with mandibulofacial dysostosis. Partial to complete aplasia of the zygomatic process of the temporal bone, mild hypoplasia to aplasia of the frontal process of the zygoma, antimongoloid slant of the transverse orbital axis, and hypoplasia of the medial pterygoid plates and muscles are common to all patients examined. Deformities of the zygoma, zygomatic process of the frontal bone, mandible, and lateral pterygoid plates and muscles vary from minimal to severe, including aplasia. The body of the zygoma is the least affected part of the bone. Right-left asymmetry characterizes these deformities in all patients. The most consistent skeletal aplasia (cleft) in mandibulofacial dysostosis involves the zygomatic process of the temporal bone rather than the zygoma itself.     

Position and position variations of the canal system of the temporal bone in frontal section

Estimated are: 1. The axis of the internal acoustic meatus to the horizontal plane in adults and postnatal changes. 2. Eight coronal sections of the temporal bone have been selected to localize the canal systems and structures in the petrous part of the temporal bone and their variations. 3. Described are the different parts of the facial canal, the carotic canal, the auditive tube, the tensor tympani muscle, the major petrosal nerve, and its distances to the carotic canal, the cochlea, the internal acoustic meatus, the supra- and infracochlear cells, the fenestra vestibuli, the fossa jugularis, the canaliculus cochleae, the vestibulum and the semicircular canals. This report includes the development of the supravestibular and other mastoideal cells in the neighbourhood of the canal systems of the petrous bone and the vestibular aqueduct and sac. Estimated are also the distances between the different canal systems. 4. The investigations are discussed with our earlier researches and the results of other researchers and its diagnostic in clinical importance.