Asymptomatic bilateral elongated and mineralized stylohyoid complex: Report of one case / Proceso estilohioideo elongado y calcificado asintomático: Presentación de un caso

The stylohyoid process is a cylindrical bony structure surrounded by important anatomical structures including vessels and nerves. Calcification and elongation of the stylohyoid ligament complex over 30 mm may be associated with neck and facial pain, known as Eagle's syndrome. However, a bilateral ossified and elongated stylohyoid complex may be devoid of symptoms. We report a 79-year-old symptom-free female who presented on a routine conventional dental radiographic exam an 80.96 mm psendoarticulated stylohyoid complex in the left side and an 75.85 mm on the other. On CAT sean, both processes were calcified.

El proceso estilohioideo es una estructura ósea rodeada por nervios y vasos sanguíneos. La calcificación elongación del ligamento estilohioideo en más de 30 mm puede asociarse a dolor facial y del cuello, conocido como síndrome de Eagle. Sin embargo, esta alteración anatómica puede ser asintomática. Presentamos una mujer asintomática de 79 años a quien se le descubrieron procesos estilohioideo pseudo articulado de 80,96 mm a un lado y 75,85 mm al otro lado, en una radiografía dental convencional. En la tomografía axial computada, ambos procesos estaban calcificados.

The Significance of a Hypoplastic Bony Canal for the Cochlear Nerve in Patients with Sensorineural Hearing Loss: CT and MRI Findings

PURPOSE: The purpose of this study is to evaluate the significance of the hypoplastic canal for the cochlear nerve in patients with sensorineural hearing loss (SNHL) and the relationship between the hypoplastic bony canal and aplasia or hypoplasia of the cochlear nerve. MATERIALS AND METHODS: A retrospective review of high resolution temporal CT(HRCT) and MRI findings was conducted. The narrow bony canal of the cochlear nerve and the relative size of the internal auditory canal were correlated with the cochlear nerve deficiency on MRI. The comparative size of the component nerves (facial, cochlear, superior vestibular, inferior vestibular nerve), and the relative size of the internal auditory canal and the bony canal of the cochlear nerve were measured. The clinical history and the results of the clinical examination were reviewed for each patient. RESULTS: High resolution MRI showed aplasia of the common vestibulocochlear nerve in one patient and a deficiency of the cochlear nerve in 9 patients. These abnormalities occurred in association with a prominent narrowing of the canal for the cochlear nerve and a stenosis of the internal auditory canal, which was observed on temporal bone CT in 9 patients with congenital SNHL. Three patients had normal IAC, despite the presence of a hypoplastic cochlear nerve on the side on which they had SNHL. In one patient, the narrowing of the canal for the cochlear nerve and internal auditory canal were not found to be associated with acquired SNHL. CONCLUSION: The hypoplastic bony canal for the cochlear nerve might be more highly indicative of congenital cochlear nerve deficiency than that of the narrow internal auditory canal, and the position of the crista falciformis should also be carefully.

The Usefulness of MR Imaging of the Temporal Bone in the Evaluation of Patients with Facial and Audiovestibular Dysfunction

OBJECTIVE: To evaluate the clinical utility of MR imaging of the temporal bone in patients with facial and audiovestibular dysfunction with particular emphasis on the importance of contrast enhancement. MATERIALS AND METHODS: We retrospectively reviewed the MR images of 179 patients [72 men, 107 women; average age, 44 (range, 1-77) years] who presented with peripheral facial palsy (n=15), audiometrically proven sensorineural hearing loss (n=104), vertigo (n=109), or tinnitus (n=92). Positive MR imaging findings possibly responsible for the patients' clinical manifestations were categorized according to the anatomic sites and presumed etiologies of the lesions. We also assessed the utility of contrast-enhanced MR imaging by analyzing its contribution to the demonstration of lesions which would otherwise not have been apparent. All MR images were interpreted by two neuroradiologists, who reached their conclusions by consensus. RESULTS: MR images demonstrated positive findings, thought to account for the presenting symptoms, in 78 (44%) of 179 patients, including 15 (100%) of 15 with peripheral facial palsy, 43 (41%) of 104 with sensorineural hearing loss, 40 (37%) of 109 with vertigo, and 39 (42%) of 92 with tinnitus. Thirty (38%) of those 78 patients had lesions that could be confidently recognized only at contrastenhanced MR imaging. CONCLUSION: Even though its use led to positive findings in less than half of these patients, MR imaging of the temporal bone is a useful diagnostic procedure in the evaluation of those with facial and audiovestibular dysfunction. Because it was only at contrast-enhanced MR imaging that a significant number of patients showed positive imaging findings which explained their clinical manifestations, the use of contrast material is highly recommended.

Congenital External Auditory Canal Atresia and Stenosis: Temporal Bone CT Findings

PURPOSE: To determine the computed tomographic (CT) findings of atresia and stenosis of the external auditory canal (EAC), and to describe associated abnormalities in surrounding structures. MATERIALS AND METHODS: We retrospectively reviewed the axial and coronal CT images of the temporal bone in 15 patients (M:F=8:7; mean age, 15.8 years) with 16 cases of EAC atresia (unilateral n=11, bilateral n=1) and EAC stenosis (unilateral n=3). Associated abnormalities of the EAC, tympanic cavity, ossicles, mastoid air cells, eustachian tube, facial nerve course, mandibular condyle and condylar fossa, sigmoid sinus and jugular bulb, and the base of the middle cranial fossa were evaluated. RESULTS: Thirteen cases of bony EAC atresia (one bilateral), with an atretic bony plate, were noted, and one case of unilateral membranous atresia, in which a soft tissue the EAC. A unilateral lesion occurred more frequently on the right temporal bone (n=8, 73%). Associated abnormalities included a small tympanic cavity (n=8, 62%), decreased mastoid pneumatization (n=8, 62%), displacement of the mandibular condyle and the posterior wall of the condylar fossa (n=7, 54%), dilatation of the Eustachian tube (n=7, 54%), and inferior displacement of the temporal fossa base (n=8, 62%). Abnormalities of ossicles were noted in the malleolus (n=12, 92%), incus (n=10, 77%) and stapes (n=6, 46%). The course of the facial nerve was abnormal in four cases, and abnormality of the auditory canal was noted in one. Among three cases of EAC stenosis, ossicular aplasia was observed in one, and in another the location of the mandibular condyle and condylar fossa was abnormal. In the remaining case there was no associated abnormality. CONCLUSION: Atresia of the EAC is frequently accompanied by abnormalities of the middle ear cavity, ossicles, and adjacent structures other than the inner ear. For patients with atresia and stenosis of this canal, CT of the temporal bone is essentially helpful in evaluating these associated abnormalities.