Facial Paralysis in a Babylonian Plaque.

HYPOTHESIS: A terra cotta plaque [LMU 2551] from the Neo-Babylonian period (c.629-539 BCE), housed in the museum of the Archaeology Center at Loyola Marymount University, Los Angeles, is a representation of right peripheral facial paralysis. BACKGROUND: Ancient representations of pathology are rare and often difficult to identify. This is particularly true of Assyrian-Babylonian cultures where, despite numerous surviving medical texts, artistic examples of disease are almost non-existent. METHODS: Precise caliper measurements and archaeological analysis of LMU 2551 were used to confirm the authors' hypothesis. RESULTS: The facial distortions portrayed in LMU 2551 are not accidental. Measurements show a pronounced asymmetry of the lower face where the length from the mid-philtrum to the oral commissure and from the lateral edge of the ala nasi to the mid-ipsilateral nasolabial fold are twice as long in the left than in the right side. The left eye is closed, whereas the right is widely open. CONCLUSION: The described plaque is among the oldest representations of facial paralysis on record. It correlates with contemporary Babylonian texts describing neurological disorders but its function is unknown.

Congenital familial fixation of the malleus.

We present a familial association of radiographically and surgically demonstrated mallear fixation with concurrent stapedial abnormality and dehiscence of the facial nerve in a father and son, including history, physical findings, surgical findings, radiologic analyses, and a literature review. A 12-year-old boy presented with long-term left-sided conductive hearing loss, and was found to have mallear fixation and a dehiscent facial nerve on a computed tomographic (CT) scan of the temporal bone. Release of the malleus was performed at surgery, revealing hypermobility of the remaining ossicular chain. A repeat CT scan of the temporal bone showed successful release of the mallear head. The patient's father later presented with bilateral hearing loss, and a CT scan of the temporal bones showed bilateral osseous fixation of the mallear head to the tegmen and bilateral facial nerve dehiscences. He underwent right middle ear exploration, but release of the malleus was not performed because of the risk to the dehiscent facial nerve. The stapes crurae were found to be filiform at surgery. This is the first reported familial association of mallear fixation. Mallear fixation with facial nerve dehiscence and an abnormal stapes occurring in a parent and his child is interesting embryologically, and suggests that these anomalies may be genetically linked.

Hemangiopericytoma of the cerebellopontine angle: a case report and review of the literature.

BACKGROUND: Intracranial hemangiopericytoma represents a rare intracranial tumor that is typically difficult to distinguish from meningioma based on clinical presentation and radiographic findings. These inherently aggressive neoplasms have been observed to occur in numerous intracranial compartments; however, isolated involvement of the CPA is essentially unreported. The authors present a case of a young lady with presumed right acoustic schwannoma, which proved to be HPC on histopathology. The case is described; and a review of the literature pertaining to the diagnosis, optimal management, and follow-up for these lesions is provided. CASE DESCRIPTION: A 37-year-old Asian woman presented with a 7-month history of right ear and mandible numbness, as well as subjective hearing loss involving the right ear. Magnetic resonance imaging demonstrated the presence of a homogeneously enhancing extraaxial lesion in the right CPA, radiographically suggestive of an acoustic schwannoma. The lesion proved to be an intracranial HPC on histologic sections. Review of the neurosurgical literature yielded only one prior detailed account of HPC confined to the CPA. The patient underwent right retrosigmoid craniotomy for gross total resection of the mass, followed by stereotactic radiotherapy several weeks postoperatively. CONCLUSION: Given the fundamentally different treatment approach for HPCs over other more common CPA tumors, it is imperative that the treating surgeon consider this rare diagnosis when evaluating patients with lesions localized to this area. Specifically, gross total resection, followed by adjuvant SRT, provides patients with the highest probability for disease-free survival, based on current evidence in the neurosurgical literature.

Ceramic representations of facial paralysis in ancient Peru.

OBJECTIVE: To provide interested scholars with a historical perspective of facial paralysis as interpreted by the ceramists of the ancient Moche culture. METHODS: The authorities and curators of the Museo Arqueológico Rafael Larco Herrera, and the Museo Nacional de Arqueología, Antropología e Historia del Perú, in Lima, Perú, provided photographs of some of the more salient examples of facial paralysis in their Moche ceramic collections. Four of these were selected for inclusion in this article. CONCLUSION: Moche pathologic portraits establish a unique point of reference in the history of facial paralysis and its sequelae. They stand alone as a prehistoric record of this disorder, unsurpassed until the appearance of Bell's work and illustrations.

Congenital implantation cholesteatomas of the occipitoparietotemporal junction.

Two cases of cranial cholesteatomas centered at the occipitoparietotemporal junction are presented, and 12 similar cases reported as diploic cholesteatomas involving the temporal bone are reviewed. Among the reported diploic cholesteatomas, 3 involved the occipitoparietotemporal junction and had the same clinical characteristics as the ones presented here. These 5 lesions did not produce expansion of the cranial tables, they had a predominantly intracranial growth, and their matrix was bonded to the dura, so that their complete excision was prevented. It is proposed that cranial cholesteatomas involving the occipitoparietotemporal junction arise, not from within the tables of the skull, but from squamous cells trapped during closure of the mastoid fontanelle and formation of the suture. Hence, they should be recognized as having an origin different from that of diploic lesions, and termed congenital implantation cholesteatomas.