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Ear
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: skull/mastoid X-rays, CT or MRI scan, audiometry. Swab of ear discharge: helps guide treatment in refractory cases.Urine for glucose: to exclude underlying diabetes if infections are recurrent (especially boils).X-ray of the mastoid process will show a cloudy appearance in the mastoid air cells in mastoiditis.CT or MRI scan is the best way to investigate possible invasion of temporal bone by tumour, cholesteatoma.Audiometry may be required to assess baseline hearing loss in chronic OM, so improvement after definitive surgical treatment can be measured.Skull X-ray: may show middle cranial fossa fracture in CSF otorrhoea (performed in hospital after significant trauma).
Imaging in Head and Neck Endocrine Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
These tumours arise from epithelial remnants of Rathke’s pouch. In children these are the most common suprasellar mass. They have a bimodal age distribution with one peak at 5–10 years of age and another at 50–60 years. Most are suprasellar lesions but a quarter have an intrasellar component. Intrasellar craniopharyngiomas are rare. They can measure from a few millimetres to several centimetres. The large lesions can extend to the anterior and middle cranial fossa (Figures 57.7 and 57.8). Two types exist: 90% are adamantinomatous and 10% papillary.
Middle Fossa Surgery
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
Raghu N.S. Kumar, Sunil N. Dutt, Richard M. Irving
Sound- or pressure-induced vertigo caused by a bony dehiscence of the SCC into the middle cranial fossa is a rare cause of otologic symptoms including autophony and vertigo.37 Disabling vertigo in two of these patients from the initial series prompted plugging of the dehiscent canal via a middle cranial fossa approach with good results.37 Alternative approaches to address the dehiscence have been subsequently described, including the transmastoid and MF/transmastoid routes. Debate continues as to which is the most appropriate and effective although in some cases, especially where there is an associated encephalocoele the MF approach may be preferred.
Evaluating the perioperative analgesic effect of ultrasound-guided trigeminal nerve block in adult patients undergoing maxillofacial surgery under general anesthesia: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2023
Maha Misk, Abdelrhman Alshawadfy, Medhat Lamei, Fatma Khames, Mohamed Abd Elgawad, Hamdy A. Hendawy
The trigeminal nerve mediates both sensory and motor innervation to the maxillofacial region. It is divided into ophthalmic, maxillary, and mandibular branches. The sensory divisions of these branches travel to their cell bodies in the trigeminal or Gasserian ganglion found at the floor of the middle cranial fossa. From the Gasserian ganglion, the sensory nerve fibers synapse with the trigeminal nuclei in the brainstem [18,19]. Nader et al. [9] demonstrated that infusing just 2 mL of contrast dye into the pterygopalatine fossa under fluoroscopy guidance caused a backward flow of contrast into the middle cranial fossa and enabled the observation of the Gasserian ganglion. They attributed the dye’s retrograde spread to the small size of the pterygopalatine fossa and its connection to the middle cerebral fossa via the foramen rotundum. The USGTNB via pterygopalatine fossa was carried out in patients who had facial pain by injecting 4 ml of 0.25% bupivacaine [20]. The long acting anesthetic bupivacaine has been used for many years in nerve block procedures. Recent studies [21,22] have used bupivacaine alone to effectively manage trigeminal nerve pain. Nader and Kendall [23] assessed the effectiveness and safety of USGTNB using bupivacaine in patients with facial pain. Within 10 min of injection, 80% of the patients experienced complete sensory analgesia in one side of the face. In addition, the patients did not show any neurological adverse effects from the block after being observed for 6–12 months.
Simultaneous repair of bilateral temporal bone meningoencephaloceles by combined mastoid-middle cranial fossa approach
Published in Acta Oto-Laryngologica Case Reports, 2023
Kazuto Osaka, Takayuki Okano, Masahiro Tanji, Koichi Omori
The surgical approaches to MECs are chosen according to the size, location, and number of skull base defects and MECs. The transmastoid approach is generally used for a single, small dehiscence localized in the tegmen mastoideum or tegmen antri. If the bone defects or MECs are larger and/or multiple, as in the present case, the middle cranial fossa approach is preferable because it facilitates easier repair of bone or dural defects [14]. About half of patients with MECs have multiple lesions, limiting the indications for the transmastoid approach; this sometimes leads to a combination of both the transmastoid and middle fossa approaches [15]. Although there is no clear consensus regarding the indication for the combined approach, one of the advantages of the combined approach is that the lesion associated with otitis media in the middle ear can be simultaneously removed together with the MECs.
Cavernous sinus haemangioma masquerading as a pituitary macroadenoma: how the unexpected lurks in neurosurgery
Published in British Journal of Neurosurgery, 2023
Simon Lammy, Jennifer Brown, Patricia Littlechild
Common locations include the middle cranial fossa, pituitary fossa, optic chiasm, cavernous sinus, Vth and VIIth cranial nerves, cerebello-pontine angle and ventricles.1–3 Therefore, symptoms include headache, and those attributable to cavernous sinus and chiasmal syndromes.2–5 Signs are insidious due to their quiescent nature5 and include ptosis1,2, diplopia1,2, decreased visual acuity, visual field defects, obesity, amenorrhoea and facial numbness and neuralgia due to Gasserian ganglion involvement.2,4 Further anatomical sub-locations include Parkinson’s triangle between IVth and V1 and Mullan’s triangle between V1 and V22. This contrasts CCMs that usually present in a haemorrhagic fashion (25%) displaying both focal neurological deficits and seizures. Less than 1% of CSH present as a haemorrhage despite being highly vascular.1–5