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Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The external surface of the temporal bone includes the zygomatic process, mastoid process (mastoid means “breast-like” in Latin, in reference to the rounded shape of this process), styloid process (“stick-like” or “pointed”), mandibular fossa, external acoustic meatus, articular tubercle, carotid canal (for internal carotid artery), the bony portion of the pharyngotympanic tube, the jugular fossa, and the stylomastoid foramen (Plates 3.8a and c and 3.10). The temporal fossa is a depression formed by the parietal, frontal, squamous part of the temporal bone, and greater wing of the sphenoid. It serves to expand the area for attachment of jaw closing muscles. The zygomatic arch (colloquially known as the “cheekbone”) is formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone. The infratemporal fossa lies inferior to the zygomatic arch and includes or adjoins the following structures: The pterygomaxillary fissure lies between the lateral plate of the pterygoid process of the sphenoid bone and the infratemporal surface of the maxilla; the pterygopalatine fossa lies at the superior end of the pterygomaxillary fissure, and the sphenopalatine foramen is an opening into the nasal cavity (Plates 3.8 and 3.9); the inferior orbital fissure lies between the maxilla and the greater wing of the sphenoid bone, which contains the foramen ovale and foramen spinosum.
Anatomy of the Skull Base and Infratemporal Fossa
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Inferiorly, medial to the base of the styloid process, the petrous bone is hollowed to form the jugular fossa, itself the lateral aspect of the jugular foramen. Divided into three compartments by two transverse septa of fibrous dura, this transmits the jugular vein in the posterior compartment; the middle compartment is shared by the vagus nerve (X) and cranial root of the accessory (XI); the glossopharyngeal (IX) and inferior petrosal sinus occupy the anterior compartment.
Test Paper 5
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 33-year-old man presents with conductive hearing loss, pulsatile tinnitus and hoarseness of voice. CT showed erosion of the jugular fossa with upward extension of soft-tissue mass into the middle ear cavity. MRI shows an intermediate signal mass on T1W images with high signal on T2W sequence interspersed with signal voids. Intense enhancement was seen on post gadolinium images. What is the diagnosis? Carotid body tumourNon-specified skull base tumourNeurofibroma of the XII nerveGlomus jugulareOsteoblastoma of transverse process of C2
Vestibular schwannoma extending into the tympanic cavity and jugular fossa by invasion of the petrous bone
Published in British Journal of Neurosurgery, 2023
Hideaki Matsumura, Masahide Matsuda, Keiji Tabuchi, Tetsuya Yamamoto, Eiichi Ishikawa, Akira Matsumura
Judging from hearing loss as the only symptom and mild heterogeneous enhancement on MRI, we considered vestibular schwannoma to be the most probable diagnosis. We surgically removed the tumour using a transmastoid-retrosigmoid approach with preservation of the facial nerve canal. First, a lateral suboccipital craniotomy was performed, and then the intracranial tumour was removed. The tumour seemed to have originated from the right vestibular nerve. The lower cranial nerves appeared to be compressed caudally by the tumour but were clearly separated from the tumour (Figure 2(A)). The surface of the petrous bone around the jugular fossa remained intact. Second, a mastoidectomy was performed and the tympanic cavity was opened. During the extensive drilling of the infralabyrinthine space to obtain a wider exposure of the tumour, the fallopian segment of the facial nerve was preserved with a thin layer of cortical bone. The tumour invading into the petrous bone was safely removed from the space above and below the facial nerve (Figure 2(B)). The tumour extending into the jugular fossa was removed with subcapsular dissection to preserve the lower cranial nerves. Subtotal removal was achieved except for portions that were tightly attached to the facial nerve in the internal acoustic meatus, and the capsule of the tumour that was located in the jugular fossa and extracranial space.
Tympanic floor reconstruction for conductive hearing loss due to a dehiscent high jugular bulb in the only hearing ear
Published in Acta Oto-Laryngologica Case Reports, 2021
Atsumu Teramura, Akinobu Kakigi, Tomonari Takano, Kazuo Yasuhara
The jugular bulb (JB) is a dilated region of the jugular vein, which is normally located below the inferior tympanic cavity. A high jugular bulb (HJB) is a vascular anomaly within the temporal bone, in which the jugular fossa is located higher than usual and protrudes into the tympanic cavity or pyramidal region. A dehiscent HJB (DHJB) refers to a defect in the bony wall covering the JB, resulting in a portion of the JB protruding into the tympanic cavity. The frequency of DHJB increases with age into adulthood and then stabilizes [1–3]. DHJB is often asymptomatic and can be detected incidentally by imaging examinations. Still, in some cases, they are known to cause various symptoms, such as tinnitus, conductive hearing loss, and sensorineural hearing loss. Tinnitus and sensorineural hearing loss are relatively rare symptoms of HJB. Conductive hearing loss occurs through contact with the tympanic membrane, interference with the ossicles, or the blocking of the round window niche [4].
Hyrtl’s fissures in cochlear implant surgery
Published in Cochlear Implants International, 2021
His preoperative radiology was reviewed in our CI multi-disciplinary meeting (MDM) in view of the intraoperative findings and with the benefits of retrospect. There were bilateral broad bony channels leading from the cochleae to the jugular fossae starting as single channels laterally but splitting medially with separated medial openings, representing enlarged cochlear aqueducts and persistent periotic and Hyrtl’s fissures (Figures 1–4). There were also enlarged vestibular aqueducts and sacs. In light of the increased risk of recurrent meningitis in the presence of patent periotic and Hyrtl’s fissures and the risk of subsequent meningitis secondary to middle ear infections, the patient was counselled with regards to an operation to occlude the patent fissures bilaterally. However, at the subsequent preoperative assessment for fitness for a general anaesthetic, it was found that his Diabetic control had deteriorated and subsequent surgery was delayed until adequate Diabetic control was achieved. This failed to occur after a year, during which he suffered no further meningitis episodes. As a result of this, a discussion was had with the patient in light of general anaesthetic risk and weighed up with the potential advantages of the surgery. As he did not suffer any further episodes and there was likely fibrosis from CI surgery and his previous infective meningitis episode, the team decided that they would manage him expectantly.