Using the processus cochleariformis as a multipurpose landmark in middle cranial fossa surgery.

OBJECTIVE: To demonstrate that the anatomical structure known as the processus cochleariformis, with its intimate and constant relationships to inner-ear structures, can be used as a reliable landmark during middle cranial fossa surgery, alone or in conjunction with other landmarks. STUDY DESIGN: An anatomical study using cadaveric temporal bones to define six reproducible measurements that relate the processus cochleariformis to inner-ear structures, and to define 14 other measurements that relate inner-ear structures to adjacent structures within the intact bone. METHOD: Using 10 cadaver specimens, 20 reproducible measurements were defined. The first six of these defined the relation of the processus cochleariformis to inner-ear structures in the middle cranial fossa approach. The other measurements defined the exact location of the inner-ear structures and adjacent structures within the intact bone. RESULTS: The vertical crest lies at a 20 degrees angle from the processus cochleariformis to the coronal plane, and at a distance of 5 to 6 mm from the processus cochleariformis. The point at which the medial margin of the basal turn of the cochlea crosses the labyrinthine segment of the facial nerve lies at a 0 degrees angle from the processus cochleariformis to the coronal plane, and at a distance of 6.5 to 7.5 mm from the processus cochleariformis. The superior semicircular canal lies at a 45 degrees angle from the processus cochleariformis to the coronal plane. The other measurements obtained give important clues about the position of the cochlea, vestibulum, greater superficial petrosal nerve and labyrinthine segment of the facial nerve. CONCLUSIONS: If the classical landmarks are indiscernible during middle cranial fossa surgery, then the processus cochleariformis, with its intimate and constant relationships to inner-ear structures, is a safe and constant landmark.

Case report: bilateral vocal cord paralysis caused by cervical spinal osteophytes.

Thyroid and cervical surgery, tracheal intubation, trauma and neurodegenerative and neuromuscular diseases may cause bilateral vocal cord paralysis. There are only a few reported cases of bilateral cord paralysis associated with cervical hyperostosis in the English literature. We report the MR and CT findings of a case of bilateral vocal cord paralysis caused by cervical spinal osteophytes compressing the recurrent laryngeal nerves.

Surgical landmarks during mastoidal and petrosal operations.

This study was made on twenty-one formalin fixed, adult skull left-half specimens. Each of the measurements was made using callipers accurate to 0.1 mm. The dissection of the temporal bone was begun with simple mastoidectomy and completed when the endosteum of the semicircular canals were opened. During the temporal bone dissection step by step, eleven different measurements have been made with small size callipers, and mean, median, range and standard deviations have been determined. The following set of correlations was found to be significant; I--The correlation between the orbitomeatal length and the distance from the most lateral point of the tympanomastoid suture to the facial canal (r = 0.69, p < 0.001). II--The correlation between the orbitomeatal length and the distance from the tympanic ring to the facial canal (r = 0.49, p = 0.011). III--The correlation between the distance from the most lateral point of the tympanomastoid suture to the facial canal and the distance from the tympanic ring to the facial canal (r = 0.71, p < 0.001).

[Oral DMSO therapy in 3 patients with lipoidproteinosis. Results of long-term therapy]. / Orale DMSO-Therapie bei 3 Patienten mit Lipoidproteinose. Ergebnisse einer Langzeittherapie.

Lipoid proteinosis is a rare autosomal recessive disorder with a chronic, benign course. There is no generally accepted systemic therapy apart from the experimental oral use of dimethyl sulphoxide (DMSO) and etretinate in two single cases. We treated two sisters and an unrelated man with lipoid proteinosis with longterm oral DMSO (60 mg/kg/d). At the end of an average treatment time of 3 years, DMSO was withdrawn because it produced no beneficial effects with regard to their skin, mucosal lesions or hoarseness. Additionally, one patient showed progression of her disease with worsening hoarseness and onset of dyspnea, requiring surgical removal of vocal cord infiltrates. Three patients with lipoid proteinosis failed to show any beneficial response to long term treatment with DMSO.