Coalescent mastoiditis represents destruction of the mastoid trabeculae, which may extend to the inner or outer cortex either by means of enzymatic resorption or pressure erosion of inflamed mucosa (Fig 9) (11). On MR images, there is enhancement of cranial nerves VII and VIII, the labyrinth, and/or the pontine facial nucleus (25). Another important area of the middle ear is the Prussak space (superior recess) (Fig 5). CT and MR are the major tools for imaging evaluation. Image shows the tumor mass in the petrous apex causing displacement of the petrous carotid artery (arrow). The antrum is a large aircell superior and posterior to the tympanic cavity and connected to the tympanic cavity via the aditus ad antrum. The posterior wall of the middle ear cavity is irregular and includes the facial recess (also referred to as the facial nerve recess), pyramidal eminence, sinus tympani, and round window niche, from lateral to medial (Fig 3). 80, © 2020 Radiological Society of North America, Multidetector CT of temporal bone fractures, CT of the normal suspensory ligaments of the ossicles in the middle ear, Computed tomography of temporal bone pneumatization. It does not have expansile margins, distinguishing it from a petrous apex mucocele or a cholesterol granuloma. 2. 2, Journal of Family Medicine and Primary Care, Vol. 3, Current Problems in Diagnostic Radiology, Vol. Note the obtuse angles between the tumor and the bone surfaces (black arrowhead). Endolymphatic sac tumor.—Endolymphatic sac tumor is a locally invasive papillary cystadenomatous tumor (56,77,78).

Figure 2: Axial CT image shows: 1, mastoid air cells; 2, incus (short process); 3, incudomalleal joint; 4, malleus (head); 5, epitympanum (anterior epitympanic recess); 6, basal turn of the cochlea; 7, middle turn of the cochlea; 8, otic capsule; 9, IAC; 10, modiolus; 11, vestibule. When present, petrous apex air cells are connected to the mastoid air cells via numerous supra- and infralabyrinthine air channels that facilitate spread of infection from the mastoid air cells and middle ear to the petrous apex, resulting in petrous apicitis.

They do not enhance. The pars flaccida is the upper fragile part that is associated with eustachian tube dysfunction and cholesteatoma. In larger tumors, a “salt-and-pepper” appearance may be visible on T1- and T2-weighted MR images (Fig 26b) (63).

Glomus tumors in the temporal bone region arise from the jugulotympanic paraganglia along the nerves of Jacobson and Arnold (tympanic branch of the glossopharyngeal nerve and auricular branch of the vagus nerve, respectively). The tumor was resected by means of a translabyrinthine approach.

The patients present with severe otalgia and otorrhea, and there is a high mortality rate (10). 5. Introduction to Interactive Temporal Bone Anatomy.

1, p. 1-14, Appendicitis - Pitfalls in US and CT diagnosis, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, Esophagus: anatomy, rings and inflammation, Developmental Dysplasia of the Hip - Ultrasound. 132, No. It is thought to represent reactivation of varicella zoster virus latent in the geniculate ganglion. These tumors often grow among bone trabeculae and may form bone; in these cases the term ossifying hemangioma is sometimes used (86).

Image shows soft tissue along the inferior wall of the EAC (*), causing bone erosion (arrow). From here (anterior or first genu), the facial nerve turns posteriorly toward the medial aspect of the middle ear cavity (tympanic segment).

Approximately 20% are associated with the more tightly attached pars tensa of the tympanic membrane.

The footplate of the stapes attaches to the oval window of the vestibule (Fig 5). The temporal bone is one of the most important calvarial and skull base bones. Interactive Atlas: This atlas allows you to scroll through CT slices of the temporal bone in four different planes. This is the first of a two-part review that provides a practical approach to understanding temporal bone anatomy, localizing a pathologic process with a focus on inflammatory and neoplastic processes, identifying pertinent positives and negatives, and formulating a differential diagnosis. Interactive Digital Education (part I), F.J.A. There is also scattered mastoid opacification. On imaging studies, there is enhancement of the canalicular, labyrinthine, and geniculate portions of the facial nerve (Fig 18) (23,24). There is soft-tissue attenuation in the middle ear without adjacent bone erosion (arrow). (b) Axial gadolinium-enhanced T1-weighted image demonstrates the lesion to be nonenhancing (*). The breakdown of erythrocytes and tissue elements release cholesterol, which incites a foreign body giant cell reaction leading to formation of a chronic granuloma, termed cholesterol granuloma (16). Figure 33b: Axial T1-weighted MR images show perineural spread of tumor along the facial nerve in a 58-year-old woman with transient lower lip numbness and weakness. Facial schwannomas in the geniculate region can grow into the middle cranial fossa. A vertical crest (“Bill’s bar”) divides the superior compartment into anterior and posterior components. This patient initially presented at age 56 years with right ear fullness, hearing loss, and audible whooshing sound that correlated with heart beat. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. (a) Contrast-enhanced image shows expansile enhancement involving the geniculate ganglion and tympanic segment of the facial nerve (arrow). (1918) ISBN:1587341026.

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