Anatomical and Clinical Evaluation of Tympanic Tegmen and Mastoid Bone with Multidetector Computed Tomography / Evaluación Anatómica y Clínica del Tegmen Timpánico y Hueso Mastoideo con Tomografía Computarizada Multidetector

SUMMARY: Tegmen level and mastoid bone thickness are important parameters of surgical risk in middle ear and mastoid region surgeries. This retrospective cohort study was conducted to provide a risk classification for the mastoid and middle ear regions. The study population comprised of 300 patients who underwent multidetector computed tomography (MDCT) for various indications. Patients with no pathology that disrupted the structure of the temporal region were included in the study. A risk classification was generated by analyzing the data obtained from mastoid and tympanic tegmen depths and the mastoid bone thickness by MDCT. The mastoid and tympanic tegmen were lower on the right side than on the left. In women, the right-sided mastoid bone thickness and mastoid tegmen were lower, and low-level tympanic and mastoid tegmen on the left and thin right mastoid bones were more common. According to the risk classifications for mastoid and middle ear region surgeries, women demonstrated a higher risk than men. In addition, as the thickness of the mastoid bone increased, the levels of the mastoid and tympanic tegmen increased. The present study provides a proper risk classification that may be helpful for preoperative risk assessment prior to middle ear and mastoid region surgery.

El nivel del tegmen y el grosor del hueso mastoideo son parámetros importantes del riesgo quirúrgico en las cirugías del oído medio y la región mastoidea. Este estudio de cohorte retrospectivo se llevó a cabo para proporcionar una clasificación del riesgo en las regiones mastoidea y del oído medio. La población de estudio estuvo compuesta por 300 pacientes que se sometieron a una tomografía computarizada multidetector (MDCT) por diversas indicaciones. Se incluyeron en el estudio pacientes sin patología que alterase la estructura de la región temporal. Se generó una clasificación de riesgo analizando los datos obtenidos de las profundidades del tegmen mastoideo y timpánico y el grosor del hueso mastoideo por TCMD. El tegmen mastoideo y timpánico estaban más bajos en el lado derecho que en el izquierdo. En las mujeres, el grosor del hueso mastoideo del lado derecho y el tegmen mastoideo eran más bajos, y eran más frecuente la presencia de tegmen timpánico y mastoideo de bajo nivel en los huesos mastoideos izquierdo y delgados en el lado derecho. Según las clasificaciones de riesgo de las cirugías de la región mastoidea y del oído medio, las mujeres presentaban un mayor riesgo que los hombres. Además, a medida que aumentaba el grosor del hueso mastoides, aumentaban los niveles del tegmen mastoideo y timpánico. El presente estudio proporciona una clasificación de adecuada de riesgo que puede ser útil para la evaluación preoperatoria del riesgo antes de la cirugía del oído medio y la región mastoidea.

Prevalence, morphology, morphometry and associated clinical implications of mastoid emissary veins: narrative review / Prevalência, morfologia, morfometria e implicações clínicas das veias emissárias mastóideas: uma revisão narrativa

Abstract The mastoid emissary vein connects the posterior auricular vein to the sigmoid sinus and varies in size, number, location, and course, resulting in clinical complications. This study was conducted in response to the vast clinical implications associated with this vein. The aim of this review is to highlight and describe the prevalence, varied morphology, and morphometry of the mastoid emissary vein, how these varied parameters cause clinical complications, and how these can be rectified and avoided. A literature survey was conducted using various databases and different terms related to mastoid emissary vein were used to search the literature. Pitfalls related to surgery in the vicinity of this vein and their remedies were elucidated. The literature search revealed that the prevalence, morphology, and morphometry of mastoid emissary veins vary immensely and are responsible for morbidity and mortality. Pre-operative identification of mastoid veins is thus essential and so multidetector computed tomography of the temporal bone should be scheduled before planning surgery.

Resumo A veia emissária mastóidea que conecta a veia auricular posterior ao seio sigmoide pode variar em tamanho, número, localização e curso, resultando em complicações clínicas. O objetivo desta revisão é destacar e descrever a prevalência, variação morfológica e morfometria da veia emissária mastóidea, além de como esses parâmetros causam complicações clínicas e como corrigi-las e reduzi-las. Foram conduzidas buscas em diversas bases de dados utilizando diferentes termos relacionados à veia emissária mastóidea. As armadilhas relacionadas a procedimentos cirúrgicos realizados nas proximidades dessa veia e as respectivas soluções foram descritas. A pesquisa na literatura revelou que a prevalência, a morfologia e a morfometria da veia emissária mastóidea variam imensamente, sendo responsáveis ​​por alta morbidade e mortalidade. Portanto, a identificação da veia mastóidea deve ser realizada no pré-operatório através de tomografia computadorizada multidetectores do osso temporal, antes do planejamento cirúrgico.

Determination of age and sex using bimastoid diameter: a cone beam computed tomography Study / Deteminación de la edad y el sexo mediante el diámetro bimastoide: un estudio en tomografía computarizada de haz cónico (CBCT)

Abstract This study aimed to investigate the possibility of age and sex determination using bimastoid diameter with cone-beam computed tomography (CBCT). This retrospective study investigated 100 female and 100 male patients aged 18-83 years (mean age: 45.55±16.28 years). To measure bimastoid diameter, the appropriate image was chosen from sagittal, coronal, and axial images of CBCT in which the measurement points could be best detected. The distance between the points of the mastoid process was measured using three-dimensional coronal reconstruction. The mean bimastoid breadth was 106.12±6.22mm. The bimastoid diameter in male cases was higher than that in female cases (110.69±4.53mm vs. 101.65±4.00mm). There was no significant difference in bimastoid breadth with advancing age. For sex determination, morphometric measurements of bimastoid diameter ensured a high rate of dimorphism in the Turkish subpopulation. CBCT morphometric analysis may be reliable and convenient for evaluating sex and may be recommended to compare population data.

Resumen Este estudio tuvo como objetivo investigar la posibilidad de determinar la edad y el sexo utilizando el diámetro bimastoideo con tomografía computarizada de haz cónico (CBCT). Este estudio retrospectivo investigó a 100 mujeres y 100 hombres de entre 18 y 83 años (edad media: 45,55±16,28 años). Para medir el diámetro bimastoideo, se eligió la imagen adecuada de las imágenes sagital, coronal y axial de CBCT en las que los puntos de medición se podían detectar mejor. La distancia entre los puntos del proceso mastoideo se midió mediante reconstrucción coronal tridimensional. La amplitud media del bimastoide fue de 106,12± 6,22mm. El diámetro del bimastoide en los casos masculinos fue mayor que en los casos femeninos (110,69±4,53 mm frente a 101,65±4,00mm). No hubo diferencias significativas en la amplitud del bimastoide con la edad. Para la determinación del sexo, las mediciones morfométricas del diámetro bimastoide aseguraron una alta tasa de dimorfismo en la subpoblación turca. El análisis morfométrico CBCT puede ser confiable y conveniente para evaluar el sexo y puede recomendarse para comparar datos poblacionales.

Absceso mastoideo como presentación de colesteatoma congénito en preescolar ¿cuál es el origen? / Mastoid abscess as congenital cholesteatoma presentation in a child what is the origin?

Resumen El colesteatoma congénito es una entidad que puede manifestarse con una amplia variedad de síntomas o ser silente durante largo tiempo y constituir un hallazgo incidental. Una vez diagnosticada es importante valorar su extensión y el compromiso de estructuras adyacentes, para lograr una adecuada planificación quirúrgica, eliminando la enfermedad y manteniendo la mejor funcionalidad posible. Se presenta un caso de colesteatoma congénito infantil.

Abstract Congenital cholesteatoma is an entity that can manifest with a wide variety of symptoms or be silent for a long time and constitute an incidental finding. Once diagnosed, it is important to assess the extension to apply the most efficient treatment, eliminating the disease and providing functionality if possible. A case of congenital cholesteatoma in a child is presented.

Mastoid and opisthion-bimastoid triangles for sex determination in a Brazilian sample / Triangulos mastoideo y opistión-bimastoideo para la determinación del sexo en una muestra brasileña

SUMMARY: Human identification involving mutilation, advanced decomposition, and skeletonized materials is a challenge for professionals in forensic medicine and dentistry. This study was aimed at a morphometric analysis of the mastoid and bimastoid triangles to determine sex in a Brazilian population. The sample included 80 human skulls (34 females and 46 males; age: 18 to 60 years) from individuals with death certificates. Linear measurements (mm) of the mastoid process - right (n=3) and left (n=3) - and the opisthion- bimastoid (n=3) triangles were taken (digital caliper) by two previously trained researchers. Three cranial points - asterion, porion and process - were determined for the right and left mastoid triangle and three others - (1) opisthion and (2) right and (3) left mastoid - for the bimastoid triangle. Heron's formula was used to calculate the area of the triangles assessed. Data were submitted to the Shapiro- Wilk normality test, followed by the unpaired Student's t test or the Mann-Whitney U test, depending on the data distribution verified in the normality test (GraphPad Prism 5.01; p<0.05). The ROC curve was used to measure the accuracy of the variables toward sex determination. The opisthion-bimastoid triangle showed high accuracy and significant differences in all the variables assessed and thus was considered a potential element for sex determination in the Brazilian population assessed.

RESUMEN: La identificación humana que comprende la mutilación, descomposición avanzada y materiales esqueletizados, es un desafío para los profesionales de la medicina forense y de la odontología. Este estudio tuvo como objetivo un análisis morfométrico de los triángulos mastoideo y bimastoideo para determinar el sexo en una población brasileña. La muestra incluyó 80 cráneos humanos (34 mujeres y 46 hombres; edad: 18 a 60 años) de sujetos con certificado de defunción. Se tomaron las medidas lineales (mm) del proceso mastoides - derecha (n = 3) e izquierda (n = 3) - y los triángulos opistion-bimastoide (n = 3) (caliper digital) por dos investigadores previamente entrenados. Se determinaron tres puntos craneales - asterion, porion y proceso mastoides - para el triángulo mastoideo derecho e izquierdo y otros tres - (1) opistion y (2) proceso mastoides derecho e izquierdo - para el triángulo bimastoideo. Se utilizó la fórmula de Heron para calcular el área de los triángulos evaluados. Los datos se analizaron con la prueba de normalidad de Shapiro-Wilk, seguida de la prueba t de Student para datos no apareados o la prueba U de Mann-Whitney, según la distribución de datos verificada en la prueba de normalidad (GraphPad Prism 5.01; p <0.05). La curva ROC se utilizó para medir la precisión de las variables hacia la determinación del sexo. El triángulo opistion-bimastoide mostró una alta precisión y diferencias significativas en todas las variables evaluadas, por lo que se consideró un elemento probable para la determinación del sexo en la población brasileña evaluada.

Sex determination by osteometric assessment of the mastoid process using Cone Beam Computed Tomography / Determinação do sexo em uma população Iraniana por avaliação osteométrica do processo mastóide em imagens de TCFC

Objective: Sex determination is one of the most important parameters to identify in forensic science. Because the mastoid process is the most resistant to damage due to its position in the skull base, it can be used for sex determination. The purpose of this study was to measure the dimensions and convexity and internal angles of the mastoid process to present a model of sex determination in Iranian population. Material and methods: This study was performed on three-dimensional images of 190 Cone Beam Computed Tomography (CBCT) of 105 women and 85 men. On each CBCT the distance between the porion and the mastoid (PM), mastoid length (ML), the distance between the mastoidale and the mastoid incision (M-I), the mastoid height (MH), the mastoid width (MW), intermastoidale distance (IMD) the lateral surfaces of the left and right mastoids (IMLSD) and the Mastoid medial convergence angle (MMCA) was measured on both the right and the left. The data were analyzed by descriptive statistics, t-test, and discriminant function analysis. Results: Significant differences were found for all variables except MMCA and MF in both sex. All measured variables except MW were greater for men than women. The discriminant model achieved a total accuracy of 93.7%. Among the measured factors IMD and IMSLD had the most influence on sex determination. Conclusion: Measuring the dimensions of the mastoid process is a very good method for sex determination with high accuracy of 90% (AU)

Objetivo: A determinação do sexo é um dos parâmetros mais importantes para identificação na ciência forense. Por ser o processo mastóide resistente a danos, devido a sua posição na base do crânio, este poderia ser usado na determinação do sexo. O objetivo deste estudo foi mensurar as dimensões, convexidade e ângulos internos do processo mastóide para apresentar um modelo de determinação do sexo em uma população Iraniana. Material e métodos: Este estudo foi realizado em 190 imagens de tomografia computadorizada de feixe cônico (TCFC), sendo 105 mulheres e 85 homens. Em cada TCFC foram realizadas medidas no processo mastóide em comprimento (ML), altura (MH), largura (MW) em ambos os lados direito e esquerdo, também foi medida a distância entre o Pórion e o processo mastóide (PM), distância até incisura mastoidea (M-I), distância entre as superfícies mediais (IMD) distância entre as superfícies laterais dos processos direito e esquerdo (IMLSD) e o ângulo de convergência medial (MMCA). Os dados foram analisados por estatística descritiva, teste t e análise de função discriminante. Resultados: Diferenças significativas foram encontradas para todas as variáveis, exceto MMCA e MF em ambos os sexos. Todas as variáveis medidas, exceto MW, foram maiores para os homens do que para as mulheres. O modelo de análise de função discriminante alcançou uma precisão total de 93,7%. Entre os fatores medidos, o IMD e o IMSLD tiveram a maior influência na determinação do sexo. Conclusão: Podemos concluir que as dimensões do processo mastóide constituem um método para determinação do sexo, em população Iraniana, com precisão de 90% (AU)

A 3D-Computed Tomography Angiography Study to Help in Surgical Planning for Retrosigmoid Craniotomies

Aims and Objectives: It is impossible to precisely anticipate the course of the transverse and sigmoid sinuses and theirindividual relationship to superficial landmarks such as the asterion during retrosigmoid approaches. This study was done todetermine the position of the asterion and the relationship between asterion and the transverse-sigmoid sinus junction (TSSJ)in making precise burr hole without damaging sinuses during retrosigmoid craniotomies.Materials and Methods: Computed tomography (CT) angiography was performed in 50 patients to obtain 3D-CT volumerendering images of cranial bone and dural sinuses. After delineating the sinuses, by simple restructuring using software andopacity modulation, bone image is reinforced. Asterion type, distance from the tip of mastoid process to asterion and root ofzygoma (ROZ) to asterion, and location of asterion in relation to TSSJ and distance between asterion and TSSJ were analyzedand measured.Results: The incidence of type 1 (presence of sutural bones) in our study was 24% and type 2 (absence of sutural bones) was76%. There was no statistically significance in the side and gender differences. The distance between the asterion and fromthe ROZ was 54.70 ± 3.68 on the right side and 54.32 ± 3.41 on the left side (P-0.612). The distance between asterion and tipof mastoid was 50.51 ± 2.67 on the right side and 50.12 ± 3.06 on the left side (P-0.716). The asterion was located on the T-Ssinus complex in 36 (72%) cases. The asterion was below the T-S sinus complex in 13 (26%) cases, and above the T-S sinuscomplex in only 1 (2%) cases.Conclusion: 3D-CT volume rendering imaging is capable of accurately visualizing the bony landmark and dural sinuses. Aneasy and simple restructured image provides precision and safety for the patient by ready and easy localization of asterionand TSSJ. This study was done to show that the previous cadaver-based anatomical studies can be done now in a moresophisticated and accurate manner with the latest technological advancements. This offers new options for anatomic researchand morphometric investigations.

Colloid cyst: unusual location of petrous temporal bone

Colloid cysts are benign, thin walled spherical neoplasms, composed of a collagenous capsule, underlying epithelium that arises from brain’s epidermal embryonic remnants and a viscous centre. They are shown to approximate 0.5% of all intracranial tumours with no recorded evidence of the petrous temporal bone involvement. Colloid cyst of the petrous temporal bone often presents with clinical symptoms of headache, hearing loss, facial palsy and imbalance/vertigo. Which is diagnosed on radiological and histological findings. Histologically, they are lined by ciliated cuboidal to pseudo stratified columnar epithelium resting on an eosinophilic basement membrane. Imaging Techniques are helpful in early diagnosis and preventing further complications. Here we will be discussing about a 24-year-old female, a known case of petrous apex osseous haemangioma presenting with unstable gait and tingling sensation on one side of face leading to an incidental finding of a colloid cyst on petrous temporal bone through histological examination.

Study to Determine the Incus Bone Erosion Ratio on Mastoid Exploration in Cases of Chronic Suppurative Otitis Media with Middle Ear Cholesteatoma

Aim: To evaluate the frequency of incus bone erosion during mastoid exploration in chronic suppurative otitis media with cholesteatoma of the middle ear. Study design: A cross-sectional descriptive study. Place and duration: In the ENT Department of Services Hospital Lahore for the one-year duration from January 2018 to January 2019. Methods: 70 chronic suppurative otitis media patients with the middle ear cholesteatoma were prospectively evaluated and selected with a non-probability purposive sampling technique. The operation was performed on 70 patients under general anaesthesia in the operating room. A standard questionnaire was prepared and history, examination, laboratory data, and treatment were recorded for each patient. Results: One of the usual common diseases of the ear, nose and throat is chronic suppurative otitis media. Previously this disease was called atticoantral type was considered usually unsafe, is mostly caused by marginal perforation with cholesteatoma, the distinguishing feature of this condition and is taken as a complicating element. A total of 70 patients with chronic suppurative otitis media with middle ear cholesteatoma were included in the study. Forty-five (64.28%) are men and 25 (35.71%) are women. 2: 1 was the M: F ratio. There were 10 patients in the first age group from 1 to 10 years 10 (14.28%), in the second age group patients from 11 to 20 years 35 (50%), in the third age group 21-30 years 12 (17.14%), in the fourth age group, 31 to 40 years of age 5 (7.14%), in the fifth age group, 41 to 50 years age 5 (7.14%), and in the sixth age group, 3 patients were >50 years (4.28%). The mean ± standard deviation in the age group was 21.2 ± 11.9 years. The mastoidectomy was performed in 64 patients (91.42%) and a modified radical mastoidectomy was performed in 6 patients (8.57%). Bone erosion due to suppurative otitis media with middle ear cholesteatoma was absent in 59 patients (84.28%) and 11 patients (15.71%) without bone erosion.

Sutural Bones: A Study On Incidence, Laterality And Co-relation With Cephalic Index In Dry Crania Of East Indian Ethnicity

Background: Sutural bones are supranumary bones occurring along the sutures and completely surrounded bysutures of the skull. Their number, morphology and location in skull vary in skulls. The knowledge of these bonesis imperative in surgery, medicolegal cases involving child abuse or fracture of skulls and for anthropologicidentification of human populations. This study was undertaken to examine incidence and pattern of distributionof sutural bones in dry skulls from Eastern India and compare the findings with similar studies across the world.Materials and Method: 180 dry crania were identified as male or female skulls and studied for the incidence andpattern of distribution of sutural bones. Also the Cephalic Index was measured for finding its correlation withthe number of sutural bones appearing in a skull.Results: 124 skulls were identified as male and 56 as female skulls. Overall incidence of sutural bone occurrencewas found to be 72.28% which was essentially similar across sexes. The most common sites for sutural bones,in descending order of occurrence, were found to be parieto-occipital suture, asterion, pterion and lambda.Bregma was the least common site where no sutural bone was encountered. A highly statistically significantfinding was in regard to laterality of sutural bone occurrence. Sutural bones occurring along coronal, parietotemporal, parieto-mastoid, occipito-mastoid sutures and pterion exhibited more than 80% tendency towardsunilateral occurrence while those occurring at asterion exhibited around 70% tendency towards unilateraloccurrence. All these findings, although displayed variable degree of sexual dimorphism, were statisticallyinsignificant for variation among sexes. No correlation between the number of sutural bones with cephalic indexwas found.Conclusion: The findings of this study are in agreement with the findings of many similar suitably poweredstudies across the world.

Hearing Outcome Following Canal Wall Down Mastoidectomy With And Without Mastoid Cavity Obliteration And Round Window Shielding- A Comparative Observational Study

INTRODUCTION- The accurate diagnosis of disease tissue is elementary to the precise diagnosis and proper management of central nervous system lesions. Although histopathology is gold standard, in neurosurgical practice intraoperative cytological diagnosis is now well established and emerge as a dependable standalone diagnostic tool. The rapidity at which sufficient preliminary information for optimal surgery is provided to neurosurgeons, help him take crucial decision regarding patients management. Overall soft nature of CNS lesions ,best suited for smear cytology, which in fact is the major restriction while performing intraoperative Frozen section consultation. So the present study was done to assess the utility of squash cytology in intraoperative diagnosis of CNS lesions. MATERIALAND METHODS-In this prospective study 142 patients with clinical diagnosis of CNS lesions were studied. Patients clinical and radio imaging findings were taken into account while evaluating squash smear preparation. Squash diagnosis was latter correlated with final histopathological diagnosis . RESULTS– Out of 142 cases, cytological diagnosis was offered in 136 cases. In 6 cases no opinion was possible on cytology. Cyto-histological correlation was seen in 127 out of 136 cases, 9 cases remained discordant. Thus overall diagnostic accuracy of squash cytology in intraoperative diagnosis of CNS lesions in our study was 93.38%. CONCLUSION- Intraoperative squash cytology is easy ,rapid, reliable and cost-effective technique for neurosurgical consultation with fairly high accuracy. Knowledge of clinicoradiological details help to further improve the diagnostic accuracy

Outcomes of Modified Canal Wall Down Mastoidectomy and Mastoid Obliteration Using Autologous Materials

OBJECTIVES: The traditional canal wall down mastoidectomy (CWDM) procedure commonly has potential problems of altering the anatomy and physiology of the middle ear and mastoid. This study evaluated outcomes in patients who underwent modified canal wall down mastoidectomy (mCWDM) and mastoid obliteration using autologous materials. METHODS: Our study included 76 patients with chronic otitis media, cholesteatoma, and adhesive otitis who underwent mCWDM and mastoid obliteration using autologous materials between 2010 and 2015. Postoperative hearing air-bone gap and complications were evaluated. RESULTS: During the average follow-up of 64 months (range, 20 to 89 months), there was no recurrent or residual cholesteatoma or chronic otitis media. No patient had a cavity problem and anatomic integrity of the posterior canal wall was obtained. There was a significant improvement in hearing with respect to the postoperative air-bone gap (P<0.05). A retroauricular skin depression was a common complication of this technique. CONCLUSION: The present study suggests that our technique can prevent various complications of the classical CWDM technique using autologous tissues for mastoid cavity obliteration. It is also an appropriate method to obtain adequate volume for safe obliteration.

Impact of single-pedicle muscle flap with bone pate on vestibular function after mastoid obliteration / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the impact of mastoid obliteration withsingle-pedicle muscle flap covered by bone pate on vestibular stimulation. METHODS A retrospective study was performed on 59 patients who were treated for chronic otitis media with or without cholesteatoma by two techniques: canal wall down tympano-mastoidectomy(CWD) and subsequent mastoid obliteration(MO). The postoperative vestibular functions of all the patients in both groups were assessed by vestibular function tests and questionnaires. Finally, the data of examination a nd symptoms were a nalyzed. RESULTS After a minimum follow up period of 12 months, the rate of ear dry was 84％(22/26) for MO group and 55％(18/33) for CWD group(χ2=4.72, P <0.05). The dry ear time were 5.46±1.39 weeks for MO group and 8.67±2.3 weeks for CWD group(t =6.2529, P <0.05). When compared latent period of Caloric testing in the MO group (10.3±2.57)s and CWD group (12.7±3.33)s, significant differencewas found(t =3.1639, P <0.05). The postoperative caloric vestibular tests revealed an average nystagmus count of 52.96±20.82 beats per minute in the MO group and 69.94±18.98 beats in the CWD group(t =3.2688, P <0.05). By analyzing the questionnaire, 30％(10/33) of the patients who received CWD treatment reported vertigo by caloric stimuli such as wind, water compared with MO group(0)(χ2=7.45, P <0.05). The rate of suction cleaning induced vertigo was 48％(16/33) in CWD group and 23％(6/26) in MO group(χ2=3.17, P =0.075). CONCLUSION Our technique of mastoid obliteration with single-pedicle muscle flap covered by bone pate results in small cavities with complete epithelialization of all surfaces. Furthermore, obliteration of mastoid cavities provides protection to the labyrinthine organ and reduces postoperative vertigo to caloric stimulation.

Extended Epitympanotomy for Facial Nerve Decompression as a Minimally Invasive Approach

For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.

Intramastoid Phosphaturic Mesenchymal Tumor Causing Hypophosphatemic Osteomalacia Detected on ⁶⁸Ga-DOTATATE PET/CT But Not on (99m)Tc-Sestamibi and ¹⁸F-FDG Scans / 대한핵의학회잡지

⁶⁸Ga-DOTATATE uptake in mesenchymal tumors causing hypophosphatemic osteomalacia has been recently described. Herein, we present a case of ⁶⁸Ga-DOTATATE uptake in an intramastoid phosphaturic mesenchymal tumor that had not been depicted in previous (99m)Tc-Sestamibi and ¹⁸F-FDG scans. The lesion was surgically removed and the phosphorus level increased to the normal range.

Application of Autologous Mastoid Cortical Bone in Canal Wall -down Tympanoplasty / 听力学及言语疾病杂志

Objective To investigate the clinical effects of autologous mastoid cortex in canal wall -down tympanoplasty .Methods From Jun 2015 to Jan 2016 ,40 patients with chronic suppurative otitis media were ran-domly divided into the experimental group and control group ,with 20 patients in each group .Patients in the experi-mental group were treated with autologous cortical bone on the tympanic cavity reconstruction surgery + opening tympanoplasty + mastoid cavity filling surgery ,the control group received opening tympanoplasty only .All cases were followed up for 1 year to compare postoperative dry ear and hearing improvement in the two groups .Results The dry ear rate of the experimental group was (100％ ) higher than that of the control group (70％ ) .The hearing of the two groups was significantly improved(23 .42 ± 0 .90 dB) in the experimental group ,higher than that in the control group (8 .43 ± 0 .04 dB) at 6 months after operation .Conclusion Using autologous cortical bone on the tympanic cavity reconstruction in the treatment of chronic suppurative otitis media is effective .The postoperative dry ear rate is high and the hearing improvement is excellent .

Bilateral sternocleidomastoid variant with six distinct insertions along the superior nuchal line / 대한해부학회지

Anatomical variations of the sternocleidomastoid muscle (SCM) have been observed to occupy multiple origins and insertion points and have supernumerary heads, sometimes varying in thickness. During routine dissection, a SCM was observed to have six distinct insertions that interface with the course of the superior nuchal line, ending at the midline, bilaterally. This variation was also seen to receive innervation from the accessory nerve as well as the great auricular nerve. To our knowledge, this variant of supernumerary insertions and nerve innervations has not yet been reported. These variants may pose as problematic during surgical approaches to the upper neck and occiput, and should thus be appreciated by the clinician. Herein we discuss the case report, possible embryological origins, and the clinical significance of the observed variant SCM.

Pneumocephalus caused by congenital mastoid dysplasia: A case report and literature review / 吉林大学学报(医学版)

Objective: To investigate the diagnosis and treatment of one patient with pneumocephalus caused by congenital mastoid dysplasia, and to clarify the clinical features, diagnostic methods and treatment strategies of intracranial accumulation of pneumocephalus. Methods: The patient with ineffective right upper limb activity accompanied stupid speech for 12 h was admitted to hospital. After admission, the head CT and MRI examination were performed again, and the patient was diagnosed as pneumocephalus. The paitent scheduled for stoma repair, neurotrophic treatment, infection prevention and other symptomatic treatments were performed after operation; the patient was instructed avoid cough forcefully, blowing nose, defecating and sneezing to increase the intracranial pressure. Results: Due to congenital dysplasia of mastoid wall, local thinning bones and intense swimming choking cough of the patient destroyed the intracranial pressure balance to form pneumocephalus, the patient scheduled for stoma and damaged dura repair; when discharged from hospital, the patient's right upper limb muscle strength and language function returned to normal; the head CT results showed that pneumocephalus disappeared completely. Conclusion: Pneumocephalus is common in clinic, and its reason is diversiform; it should be combined with the patient's history and imaging findings to explore the causes, the most reasonable treatment measures should be performed in order to relieve the patient's symptoms of increased intracranial pressure, and promote the recovery of neural function.

Long-term results of endolymphatic sac mastoid drainage for Ménière disease / 临床耳鼻咽喉头颈外科杂志

To investigate the long-term efficacy of endolymphatic sac mastoid drainage for Ménière disease.Data from 26 patients diagnosed with MD strictly meeting the criteria issued by " Guideline of diagnosis and treatment of Meniere disease(2017)" from 2006 to 2015 were analyzed in this study.Endolymphatic sac mastoid shunt surgery was performed for each patient.The therapeutic effect was evaluated against the " Guideline of diagnosis and treatment of Meniere disease(2017)".Vertigo control and auditory function were measured after at least two years follow up.In 26 cases,16 cases were male and 10 cases were femaleThe age ranged from 24 to 71 years old,with an average of 52.04 years.The disease duration ranged from 1 to 32 years.22 cases were diagnosed as unilateral Ménière disease,and bilateral involvement was identified in 4 cases,thus a total of 30 ears were included.According to the preoperative staging of hearing,there were 0 cases in stage one,5 cases in stage two,16 in stage three and 9 cases in stage four.15 cases(57.7%)achieved class A vertigo conrol(complete control),9 cases(34.6%)class B(substantial control)and 2 cases(7.7%)class D(no control).The severity of vertigo and its impact on daily life were improved in 24 cases(92.3%)with a score of 0 point,and 2 cases(7.7%)scored 2 points.Post-operative hearing was improved in 3 cases(11.5%),unchanged in 16 cases(61.6%)and worsened in 7 cases(26.9%).After operation,tinnitus disappeared in 5 cases(19.2%),reduced in 13 case(50%)and unchanged in 8 cases(30.8%).Endolymphatic sac mastoid drainage was an effective and safe management for intractable Ménière disease patients with pre-operative residual hearing.The occurrence of complication was unsual.The patients who are in stage four could gain benifits from the surgery.

Classification of the axial mastoid process and its clinical application / 中华创伤骨科杂志

Objective To explore a simple classification of the axial mastoid process and its clinical significance in improving the traditional screw insertion in the treatment of odontoid fracture with percutaneous anterior odontoid screwing. Methods The median sagittal CT images of 120 patients with cervical dis-ease were measured. They were 63 males and 57 females, aged from 31 to 59 years (average, 41.6 years). On their median sagittal CT images, line A was the connection of the lowest point of the anterior inferior boarder of the axis body to the vertex of the odontoid process and line B a parallel line to line A through the mastoid process. The distance between lines A and B was measured (the height of the axial mastoid process) and a complete statistical record was made to analyze the distribution and regularity of distances AB. The improved insertion points were indentified based on the above measurements (X25%and X75%) and clinical ex-perience. We reviewed 32 patients with odontoid fracture of Anderson&D' Alonzo typeⅡA, ⅡB or superficialⅢ. Of them 15 underwent percutaneous anterior screwing by the improved insertion points and 17 underwent percutaneous anterior screwing by the conventional insertion points. The 2 groups were compared in terms of incision length, operation time, bleeding, fluoroscopy frequency and hospital stay. Results Distance AB was 3.42 ± 0.68 mm. The distance AB <3 mm was classified as low-level mastoid process, the distance AB between 3 to 4 mm as slightly convex mastoid process, and the distance AB > 4 mm as convex mastoid process. Of the 120 patients, 32 (26.7% ) were classified as having a low-level mastoid process, 57 (47.5%) as having a slightly convex mastoid process, and 31 (25.8%) as having a convex mastoid process. Compared with the conventional insertion group, the improved insertion group had significantly shorter oper-ation time (31.32 ± 2.12 min versus 46.18 ± 3.63 min), significantly lower fluoroscopy frequency (18.20 ±1.57 times versus 21.27 ± 2.50 times) but significantly greater bleeding (43.22 ± 3.17 mL versus 31.22 ± 3.52 mL) (P <0.05). There were no significant differences between the 2 groups in incision length or hospital stay (P > 0.05). Conclusions In the treatment of odontoid fracture with percutaneous anterior odontoid screwing, the screw insertion can be improved according to our classification of the axial mastoid process. Our simple classification of the axial mastoid process may lead to more efficient operation and less radiation hazard.