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Anatomy and Embryology of the External and Middle Ear
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
The petrous apex lies at the most medial aspect of the temporal bone and is shaped like a foreshortened pyramid, pointing anteriorly and medially. The posteromedial surface of the petrous apex is part of the posterior cranial fossa, while the superior aspect of the bone forms the floor of the middle cranial fossa. The internal carotid artery and the internal auditory meatus run through the bony petrous apex. At the apex of the petrous bone is the trigeminal nerve running into Meckel’s cave with the abducent nerve passing close to its roof. Gradenigo’s syndrome is the result of infection at the petrous apex and comprises a lateral rectus palsy, facial pain and discharging ear. Historically, the petrous apex has been the most difficult to access surgically but this has been advanced by the development of endoscopically assisted trans-sphenoidal techniques.
Acute otitis media and its complications
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
In apical petrositis the infection in the middle ear cleft has spread into the apical region of the petrous bone. Patients may present with a triad of retro-auricular pain, otorrhoea and abducens nerve palsy, also known as Gradenigo’s syndrome. Imaging studies in the form of CT with contrast and/or MR scan are necessary to confirm the diagnosis (Figure 20.6).
An Interesting Case of Gradenigo Syndrome
Published in Journal of Binocular Vision and Ocular Motility, 2019
Kristen L. Suzich, Sarah Adelson, Catherine S. Choi
Gradenigo syndrome is defined as a triad of acute otitis media, facial pain in the fifth cranial nerve distribution, and ipsilateral abducens nerve palsy.1 It was first described in 1907 and affects about 2 in every 100,000 children who present with otitis media.1 The classic triad is triggered when the infection reaches the petrous apex of the temporal bone and starts to affect nearby structures, including the abducens nerve and trigeminal ganglion.2