Reconstruction of Mastoid Cortex Defects with Hydroxyapatite Cement for Negative Sequelae of Mastoidectomy.

OBJECTIVES: Mastoid cortex defects resulting from mastoidectomy surgery can rarely lead to negative sequelae, including unsightly post-auricular depression and discomfort. This study sought to evaluate the use of hydroxyapatite cement (HAC) to reconstruct mastoidectomy cortex defects. METHODS: Retrospective chart review was undertaken for all patients that underwent reconstruction of the mastoid cortex using HAC at a single tertiary medical center between 2013 and 2019. Collected data included demographics, indications for mastoidectomy, complications, and associated symptom status. RESULTS: Twenty-nine patients that underwent mastoid cortex repair using HAC were included, and ten of these underwent mastoid revision in a secondary procedure to reconstruct the mastoid cortex with a specific goal to eliminate negative signs and symptoms. There were no associated postoperative complications and no instances of post-auricular depression following repair. All cases of secondary reconstruction resolved the primary signs and symptoms that prompted mastoid revision. CONCLUSIONS: HAC mastoid cortex reconstruction may be a safe and effective method to resolve negative sequelae resulting from previous mastoidectomy defects. Also, upfront HAC mastoid cortex reconstruction appears viable in select instances as an option to prevent potential future complications.

A rare case report: Cervical subcutaneous and mediastinal emphysema due to mastoid fracture.

Subcutaneous emphysema occurs when air enters the soft tissue, which usually appears in the soft tissues of the chest wall or neck. It may also arise from pneumothorax or skin lacerations after trauma or other reasons. Mediastinal emphysema may be either associated with subcutaneous emphysema or seen alone. The air in the mastoid cells may spread from the retropharyngeal region or various neck compartments into the mediastinum. Usually, no severe neurological or clinical findings are observed except crepitation on palpation. We present a case report of a mastoid fracture as a rare cause of cervical subcutaneous and mediastinal emphysema.

Nasal blowing induces subcutaneous emphysema post penetrating mastoid tip trauma.

We describe the case of a child with an isolated penetrating trauma to the mastoid tip. Nasal blowing consequently induced air bubbles coming through the mastoid cutaneous fistula and causing extensive subcutaneous neck emphysema. A computed tomography (CT) demonstrated a right mastoid tip bone fracture with extensive cervical subcutaneous emphysema. The patient was treated conservatively with antibiotics and did not require operative intervention. His subsequent course was uncomplicated. This case emphasizes the importance of taking seriously even what seems to be a minor skin laceration.

Estudo da técnica de Hoshi na inclinação do processo mastoide como uma característica sexual / Hoshi techniques study in the slope of the mastoid process as a sexual characteristic

Sabe-se que o processo mastoide (PM) tem sido utilizado como uma característica diferencial entre crânios de espécies diferentes e mesmo entre os sexos. Muitos são os métodos utilizados para se diferenciar os processos mastoides masculinos dos femininos. Tal diferenciação é muito importante na antropologia física e na forense. Neste trabalho foi utilizada a metodologia empregada por Hoshi (1962) na qual classifica os PM segundo a sua curvatura. O objetivo deste trabalho foi verificar a aplicabilidade desta metodologia. Foram utilizados 305 crânios humanos identificados segundo o sexo, grupo étnico e idade, pertencentes ao Museu de Crânios da Disciplina de Anatomia Descriptiva e Topográfica da Escola Paulista de Medicina - UNIFESP. Os resultados obtidos foram submetidos à análise estatística (análise descritiva e teste quiquadrado) e constatou-se que as inclinações do tipo M (70,87%) são estatisticamente típicas do sexo masculino, enquanto as inclinações do tipo N (47,47%) e F (36,36%) são encontradas nos crânios femininos, sendo suas incidências estatisticamente significativas, demonstrando que as inclinações dos tipos N e F caracterizam, na amostra em questão, os crânios femininos. Os resultados alcançados demonstraram que o método desenvolvido por Hoshi é aplicável e de fácil execução(AU)

It is known that the mastoid process (PM) has been used as a differential feature among skulls of different species and even between the sexes. Many are the methods used to differentiate the male mastoids from the female ones. Such a difference is very important in physical anthropology and forensics. In this work we use the methodology used by Hoshi (1962) in which it classifies PM according to its curvature. The objective of this work was to verify the applicability of this methodology. 305 skulls were used, identified by sex, ethnic group and age, belonging to the Museum of Skulls of the Discipline of Anatomy at the Paulista School of Medicine - UNIFESP. The results obtained were submitted to statistical analysis (descriptive analysis and chi-square test) and it was verified that the M-type inclinations (70.87%) are statistically typical of the male sex, while the N-type inclinations (47.47%) and F (36.36% ) are found in female skulls, and their incidence is statistically significant, demonstrating that the N and F inclinations characterize female skulls in the sample. The results showed that the method developed by Hoshi is applicable and easy to implement(AU)

Facial nerve palsy following mild mastoid trauma on trampoline.

We present a case report of a 14-year-old boy who was jumping on a trampoline when he struck his right mastoid on a support pole. The following day, he developed a right-sided facial droop and inability to close his right eye. He presented to the emergency department, where CT of his temporal bone was negative and he was started on prednisone. Over the next month, he had spontaneous recovery of his facial nerve (FN) function. In cases of traumatic FN palsy, urgent referral to otolaryngology is needed, even without a fracture of the temporal bone, as edema within the facial nerve could require decompressive surgery. Steroids, while used in this patient, are of questionable benefit in the limited data available. Patient's with traumatic FN palsies should be instructed to use eye lubricant frequently and tape his eye closed at night, as corneal drying could lead to permanent damage. Proper evaluation, management, and referral are needed in cases of traumatic FN palsy to prevent long-term morbidity.

Mastoid Osteoma - Is "Trauma" A Possible Etiologic Factor.

A 19 year old female presented with painful postaural swelling of three years duration with preceding history of trauma. Clinically and radilogically the diagnosis of mastoid osteoma was made. As patient was symptomatic the osteoma was removed and cortical mastoidectomy was done. We emphasise that symptomatic mastoid osteomas must be treated early even if they are small in size to prevent the development of giant osteomas. The case is reported for its rarity with relevant review of literature. To the best of our knowledge this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor.

Spontaneous Epidural Pneumocephalus.

Spontaneous epidural pneumocephalus is a rare condition. The authors reported a 35-year-old male patient with tinnutus, dull headache, and swelling on his head. Patient had a history of head trauma and skull fracture from when he was 5 years old. Cranial computed tomography revealed increase in pneumatization of right mastoid air cells and large epidural air in temporoparietal region. Inner table of right temporal bone got thinner, causing communication of mastoid air cells with epidural space. Epidural air had septations and exerted mass effect on the right parietal lobe with minimal midline shift. Thinning of also right parietal bone caused extension of epidural air into the right parietal subcutaneous tissue and hence subcutaneous swelling. There was no obvious fracture line. Spontaneous epidural pneumocephalus is extremely rare condition that may cause severe complications. There are several etiologic factors. Head trauma can be the eliciting factor in the authors' patient. It is important to be familiar with its presentation and imaging findings to make early diagnosis and treatment.

Calculation of the mastoid cell volume of infants from computed tomography imaging.

OBJECTIVE: The objective of this study was to calculate the mastoid cell volume of infants using computed tomography imaging. METHODS: We calculated the mastoid cell volumes of 87 infants younger than 1 year classified into 4 age groups. RESULTS: There were significant (P = 0.0001) differences in the ear mastoid cell volumes (cm(3)) among the 0- to 3-, 4- to 6-, 7- to 9-, and 10- to 12-month age groups. Generally, the mastoid cell volume increased with age. CONCLUSIONS: Mastoid cell volume correlates with the age of infants up to 1 year. We plan to expand this study and determine cutoff values for the mastoid cell volumes of infants.

Labyrinthine concussion following gunshot injury: A case report.

OBJECTIVE: Labyrinthine concussion due to a postauricular gunshot wound has not been well reported. DESIGN: Retrospective chart review. STUDY SAMPLE: We describe an otherwise healthy 22-year-old male who received a gunshot wound to the left mastoid and subsequently reported hearing loss and rotational vertigo. RESULTS: Audiometric testing demonstrated significant inverted scoop shaped sensorineural hearing loss. Vestibular diagnostic testing indicated a significant uncompensated left peripheral vestibulopathy. Imaging demonstrated no structural changes to the middle ear or labyrinth, suggesting that the auditory and vestibular losses noted on diagnostic examination were likely due to labyrinthine concussion. CONCLUSIONS: Labyrinthine concussion may lead to reduced vestibular reflex pathway following gunshot wounds to the temporal bone. Clinical presentation is likely to vary significantly among cases.

Role of mastoid pneumatization in temporal bone fractures.

BACKGROUND AND PURPOSE: The mastoid portion of the temporal bone has multiple functional roles in the organism, including regulation of pressure in the middle ear and protection of the inner ear. We investigated whether mastoid pneumatization plays a role in the protection of vital structures in the temporal bone during direct lateral trauma. MATERIAL AND METHODS: The study was performed on 20 human temporal bones isolated from cadavers. In the study group formed by 10 temporal bone samples, mastoid cells were removed and the resulting neocavities were filled. The mastoids were maintained intact in the control group. All samples were impacted at the same speed and kinetic energy. The resultant temporal bone fractures were evaluated by CT. RESULTS: Temporal squama fractures were 2.88 times more frequent, and mastoid fractures were 2.76 times more frequent in the study group. Facial nerve canal fractures were 6 times more frequent in the study group and involved all the segments of the facial nerve. Carotid canal fractures and jugular foramen fractures were 2.33 and 2.5 times, respectively, more frequent in the study group. CONCLUSIONS: The mastoid portion of the temporal bone plays a role in the absorption and dispersion of kinetic energy during direct lateral trauma to the temporal bone, reducing the incidence of fracture in the setting of direct trauma.

Delayed diagnosis of intracranial injury due to a dog bite--a case report and review of the literature.

OBJECTIVES: Dog bite injury of the head and neck is not rare in children although intracranial injury is reported anecdotally. Among the case reports there is a significant number of patients in whom the diagnosis of penetrating cranial injury was delayed. The aim of the study was to describe a patient with a trans mastoid head injury due to a dog bite that was not diagnosed at presentation and review similar cases in the literature. METHODS: A 13-year-old girl was admitted to the emergency room with severe head, neck and breast lacerations. She was transferred to the operating room for debridement and only then was a trans mastoid fracture diagnosed. We searched for case reports in the literature describing children suffering from dog bites in whom the diagnosis of intracranial injury was delayed. RESULTS: We found descriptions of five children, 4 after dog bite and one after tiger bite. Four of them were under two years of age and all had scalp lacerations that were treated at presentation. The time period to diagnosing the brain injury was one day to three weeks. The symptoms that led to the diagnosis were fever in 3 patients, meningitis in two, brain abscess in one child and four of them developed neurological signs. All of the children had surgical intervention after diagnosis. CONCLUSIONS: Intracranial injury after dog bite should be suspected in any child with scalp lacerations. Adequate investigations should be performed at presentation with careful attention to this specific type of trauma.

Técnica con arcos botantes para la abertura de la sutura occipitomastoidea / Using the structural buttresses of the skull to open the occipitomastoid suture

El agujero rasgado posterior es una zona clave en el tratamiento craneal osteopático, pues nos permite actuar sobre el importante paquete vasculonervioso que lo atraviesa. Las técnicas estructurales de articulación se utilizan para liberar las suturas y devolver la movilidad a las fibras óseas e intersuturales en disfunción. El objetivo de la Técnica con arcos botantes para la sutura occipitomastoidea es mejorar la elasticidad ósea para desimbricar la sutura descomprimiéndola, y liberar el agujero rasgado posterior y su contenido. Son indispensables una buena evaluación diagnóstica, el conocimiento de los beneficios y riesgos, y una correcta ejecución, para recuperar la movilidad del la sutura y los huesos occipital y temporal, consiguiendo de este modo, mejorar la sintomatología (AU)

The jugular foramen is key to atypical cranial osteopathy treatment as it allows us to act on the vasculonervous bundle that passes through it. Structural articulatory techniques were used to open the sutures and restore mobility to the dysfunctioning intersutural and bone fibers. The objective of using the structural buttresses technique to open the occipitomastoid suture is to improve bone elasticity to open the decompresed suture and to release the jugular foramen and the elements its contains. A good diagnostic assessment, awareness of the benefits and risks and correct employment of the technique are essential to restore mobility to the suture and the occipital and temporal bones, thereby improving the symtomatology (AU)

Dehiscencia de la tercera porción del nervio facial / Dehiscence of the third portion of the facial nerve

No disponible

Petrous bone fractures violating otic capsule.

OBJECTIVE: This study presents our experience with a series of patients suffering from petrous bone fractures violating the otic capsule who underwent subtotal petrosectomy combined with eustachian tube, middle ear, and mastoid obliteration, with the goal of preventing cerebrospinal fluid (CSF) leak and meningitis. METHODS: This study enrolled 26 patients between 1997 and 2011. The clinical symptoms, otoscopy, and preoperative and postoperative audiometry and facial function, as well as CSF leak or meningitis, were evaluated in each patient. The entire group underwent a subtotal petrosectomy using the technique described in detail by Fisch. In addition, each patient was interviewed using a questionnaire to evaluate the impact on quality of life. RESULTS: Intraoperatively, we found significant CSF leaks in 14 patients (42.5%). No patient reported other episodes of CSF leak or meningitis after the surgery. The patients' responses of facial nerve function were slightly worse than the House-Brackmann evaluation (50% versus 42.3%; p < 0.05). The vast majority (88.5%) of the patients experienced no social impact. CONCLUSION: Our findings suggest the importance of not underestimating the risk for CSF leak in the petrous bone fractures violating the otic capsule. Preoperative counseling regarding the various troublesome complications must adequately motivate candidates to undergo surgery by pointing out the positive impact of the proposed treatment.

Comparison of the clinical relevance of traditional and new classification systems of temporal bone fractures.

Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed. Since these categories have shown little association with clinical symptoms, new classifications have been introduced, including those related to the involvement of the petrous bone and otic capsule. We have formulated a new classification based on the involvement of four parts of the temporal bone (squama, tympanic, mastoid, and petrous) and assessed which of these classification systems is the most rational using a retrospective chart review in hospital settings (KyungHee Medical Center, Seoul, Korea and Samsung Changwon Hospital, Changwon, Korea). The association between each classification and clinical symptoms was examined by analyzing temporal bone computed tomography scans of 129 patients diagnosed as temporal bone fractures over the past 7 years. Using the traditional classification, there was a significant correlation between transverse fractures and the incidence of sensorineural hearing loss. Patients with petrous bone fractures had significantly higher incidence rates of sensorineural hearing loss, vertigo, and eardrum perforation than patients without petrous bone involvement. Involvement of the otic capsule was significantly associated with sensorineural hearing loss and the severity of hearing loss. The associations of the traditional classification and the classification according to the involvement of the otic capsule, four parts of temporal bone with clinical symptoms were not high. Petrous bone fractures were significantly associated with sensorineural hearing loss, vertigo, and eardrum perforation, suggesting that this classification may be optimally associated with clinical symptoms including hearing and the results of otological examination.

Management of complication from temporal bone fractures.

The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squama-mastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.