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Clinico Radiological Series: Temporal Bone Imaging
Ashu Seith Bhalla, Manisha Jana, Suresh C Sharma
SECTION 1: NORMAL ANATOMY AND IMAGING
1:
Imaging Modalities and Techniques
INTRODUCTION
RADIOGRAPHS
Frontal/Transorbital View
Lateral View (Schuller's Projection) (Figs 1.3A and B)
Oblique (Stenver's) View (Figs 1.4A and B)
HIGH-RESOLUTION COMPUTED TOMOGRAPHY
Pöschl Plane (Figs 1.6A and B)
Stenver Plane (Figs 1.7A to D)
Unconventional Planes
CONE BEAM COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
ADVANCED IMAGING TECHNIQUES
Post-processing Tools
Magnetic Resonance Angiography (Figs 1.12A to D)
Diffusion-weighted (DW) MRI (Figs 1.13A to C)
Miscellaneous
2:
Normal Anatomy: Structure-wise
EXTERNAL EAR
External Auditory Canal (EAC) (Figs 2.1A and B)
Tympanic Membrane (Figs 2.2A to C)
MIDDLE EAR
Anterior Wall (Fig. 2.5)
Medial Wall (Figs 6A to D)
Posterior Wall (Figs 2.7A and B)
Roof (Figs 2.8A and B)
Floor (Fig. 2.9)
Ossicles (Figs 2.10 to 2.13)
Suspensory Ligaments
Muscles (Figs 2.15 and 2.16)
Recesses
Prussak's Space-superior Recess of Tympanic Membrane (Figs 2.17A and B)
Anterior Epitympanic Recess (Supratubal Recess) (Fig. 2.18)
Sinus Tympani
Facial Recess
INNER EAR
Vestibule and Semicircular Canals (Figs 2.19 and 2.20)
Cochlea (Figs 2.21 to 2.23)
Vestibular Aqueduct (Figs 2.24A and B)
Cochlear Aqueduct (Figs 2.25A and B)
Internal Auditory Canal (Figs 2.26 and 2.27)
Facial Canal (Figs 2.28 and 2.29)
Mastoid (Figs 2.30 and 2.31)
3:
Normal Anatomy: Section-wise
SECTION 2: CONGENITAL ANOMALIES OF EXTERNAL AND MIDDLE EAR
4:
Congenital Anomalies of External and Middle Ear: Imaging
INTRODUCTION
STRUCTURES INVOLVED
EMBRYOLOGY
IMAGING MODALITY
PINNA DEFORMITIES
EXTERNAL AUDITORY CANAL5
MIDDLE EAR SPACE
OSSICULAR ANOMALIES
ROUND WINDOW AND OVAL WINDOW
CHOLESTEATOMA
MASTOID PNEUMATIZATION
FACIAL CANAL ANOMALIES
INNER EAR/INTERNAL AUDITORY CANAL ANOMALIES
VASCULAR ANOMALIES
ASSOCIATIONS/SYNDROMES
CT GRADING SYSTEMS
CRITICAL STRUCTURES FOR SURGERY
MINOR CONGENITAL MIDDLE EAR MALFORMATIONS
MANAGEMENT ISSUES (DISCUSSED IN DETAIL IN CHAPTER 5)
5:
Congenital External and Middle Ear Anomalies: Surgical Perspectives
TERMINOLOGY
CONGENITAL AURICULAR/PINNA DEFORMITIES
Classification
Aims of Treatment
Treatment Options
Autogenous Reconstruction
Implant-retained Prosthesis
CONGENITAL AURAL ATRESIA
Classification
Treatment Options
Atresiaplasty/Canalplasty
Bone-anchored Hearing Aid
MINOR CONGENITAL MALFORMATIONS OF MIDDLE EAR
6:
Reporting Template with Illustrative Cases (Congenital Anomalies of External and Middle Ear)
REPORTING TEMPLATES
REPORTING TEMPLATE
Impression
Case 1 (Figs 6.1A to F)
Impression:
Case 2 (Figs 6.2A to F)
Impression
Case 3 (Figs 6.3A to F)
Impression
Case 4 (Figs 6.4A to F)
Impression
Case 5 (Figs 6.5A to F)
Impression
SECTION 3: INFECTIONS OF EXTERNAL AND MIDDLE EAR
7:
Infections of External and Middle Ear: Imaging
EXTERNAL EAR
Acute Otitis Externa
Necrotizing External Otitis
Imaging Findings
MIDDLE EAR AND MASTOID
Acute Infectious and Inflammatory Otomastoid Disease (Figs 7.3 and 7.4)
Chronic Infectious and Inflammatory Otomastoid Disease
Pathogenesis (Fig. 7.5)
NCSOM
Cholesteatoma
Imaging
Plain Radiography (Figs 7.6A and B)
High-resolution Computed Tomography Findings (Figs 7.7 to 7.9)
Granulation Tissue vs Cholesteatoma (Figs 7.13 to 7.16)
Complications of Chronic Suppurative Otitis Media (Table 7.3)
Postinflammatory Ossicular Fixation
Labyrinthitis Ossificans (Figs 7.21A to D) (see Chapter 21)
POSTCHOLESTEATOMA SURGERY IMAGING (FIGS 7.22 AND 7.23)
8:
External and Middle Ear Infections: Surgical Perspectives
INTRODUCTION
CLINICAL PRESENTATION
INVESTIGATIONS
Indications of Preoperative Imaging in CSOM
SURGICAL INTERVENTIONS FOR CSOM
Mastoidectomy
Different types of mastoidectomy
Types of modified radical mastoidectomy
SURGICAL INTERVENTION
9:
Reporting Template with Illustrative Cases (Infections of External and Middle Ear)
Case 1 (Figs 9.1A to F)
Any Other Finding
Impression
Case 2 (Figs 9.2A to D)
Any Other Finding
Impression
Case 3 (Figs 9.3A to D)
Any Other Finding
Impression
Case 4 (Figs 9.4A to F)
Any Other Finding
Impression
Case 5 (Figs 9.5A to E)
Any Other Finding
Impression
SECTION 4: INNER EAR, INTERNAL AUDITORY CANAL AND COCHLEAR IMPLANT
10:
Congenital Inner Ear Anomalies: Imaging
EMBRYOLOGY (FIG. 10.1)
Classification
MICHEL ANOMALY (COMPLETE LABYRINTHINE APLASIA) (FIGS 10.2A TO C)
Differential Diagnosis
Differentiating Features
COCHLEAR APLASIA (FIGS 10.3A TO G)
Differential Diagnosis: Labyrinthitis Ossificans
Differentiating Features
COMMON CAVITY ANOMALY (FIGS 10.4A TO D)
INCOMPLETE PARTITION TYPE I (FIGS 10.5 TO 10.7)
Differential Diagnosis: Common Cavity
COCHLEAR HYPOPLASIA (FIGS 10.8 TO 10.10)
INCOMPLETE PARTITION TYPE II (MONDINI DEFORMITY) (FIGS 10.11 AND 10.12)
INCOMPLETE PARTITION TYPE III (X-LINKED DEAFNESS) (FIGS 10.13A TO C)
VESTIBULE AND SEMICIRCULAR CANAL ANOMALIES (FIGS 10.14 TO 10.16)
Differential Diagnosis of Semicircular Canal Aplasia
Labyrinthitis Ossificans
INTERNAL AUDITORY CANAL ANOMALIES
VESTIBULAR AQUEDUCT ANOMALIES (FIGS 10.17 AND 10.18)
11:
Internal Auditory Canal Anomalies: Imaging
INTRODUCTION
STRUCTURES
Location of Nerves (Fig. 11.1)
Contents
NORMAL DIMENSIONS
Shapes
Length
Diameter (Fig. 11.2)
EMBRYOLOGY
CONGENITAL IAC MALFORMATIONS
Atresia/Stenosis of the IAC
Dilatation of the IAC
Abnormal Orientation of the Canal
Duplication of the IAC (Figs 11.10A and B)
VASCULAR LOOPS
TUMORS OF THE INTERNAL ACOUSTIC CANAL
Schwannoma
Vestibular Schwannomas
Cerebellopontine Angle Schwannomas (Figs 11.14A and B)
Typical IAC Schwannoma (Figs 11.15A and B)
Dumbbell Schwannoma of the IAC
Imaging Appearance of Vestibular Schwannomas
Meningiomas
Other Intrameatal Tumors
ABNORMAL ENHANCEMENT IN INTERNAL ACOUSTIC CANAL (APART FROM TUMORS)
Infectious Neuritis
Causes
12:
Cochlear Implant: Surgical Perspectives
INTRODUCTION
INDICATIONS FOR COCHLEAR IMPLANT
CONTRAINDICATIONS FOR COCHLEAR IMPLANT
CONDITIONS THAT MODIFY SURGICAL TECHNIQUE/TYPE OF COCHLEAR IMPLANT
CONDITIONS THAT INCREASE SURGICAL COMPLICATIONS
TYPES OF SURGICAL IMPLANTS
Middle Ear Implant
Cochlear Implant
Brainstem Implant
SURGICAL APPROACHES (FIGS 12.3A AND B)
Transmastoid-facial Recess Approach
Transcanal Approach
Middle Cranial Fossa Approach
PREOPERATIVE EVALUATION FOR COCHLEAR IMPLANT
INTRAOPERATIVE EVALUATION
POSTOPERATIVE EVALUATION
13:
Cochlear Implant: Imaging
PREOPERATIVE IMAGING
INTRAOPERATIVE IMAGING
POSTOPERATIVE IMAGING (FIGS 13.10A TO F)
14:
Reporting Template with Illustrative Cases (Inner Ear, Internal Auditory Canal and Cochlear Implant)
REPORTING TEMPLATE COMPUTED TOMOGRAPHY (CT)
Inner Ear
Impression
REPORTING TEMPLATE MAGNETIC RESONANCE IMAGING (MRI)
Inner Ear
Impression
Case 1 (Figs 14.1A to F)
Impression
Case 2 (Figs 14.2A to D)
Impression
Case 3 (Figs 14.3A to F)
Impression
Case 4 CT (Figs 14.4A to D)
Impression
Case 5 MRI (Figs 14.5A to F)
Impression
Case 6 CT (Figs 14.6A to D)
Impression
Case 5 MRI (Figs 14.7A to D)
Impression
SECTION 5: TUMOURS
15:
Tumors of Temporal Bone: Imaging
INTRODUCTION
CLASSIFICATION OF TEMPORAL BONE TUMORS
Based on location
External Ear Tumors
Middle Ear Tumors
Inner Ear Tumors
Based on the Benign and Maliganant Criterias
IMAGING
Computed Tomography
MRI
MRI Protocol
EXTERNAL EAR AND EXTERNAL AUDITORY CANAL TUMORS
Keratosis Obturans and Cholesteatoma
Keratosis Obturans (Figs 15.1 and 15.2)
Cholesteatomas
Exostoses and Osteoma
Exostoses
Osteomas (Figs 15.4 and 15.5)
Rare Benign Tumors of EAC include Myxoma and Adenoma
MALIGNANT TUMORS OF EAC
Primary Malignant Tumors of EAC (Figs 15.8 to 15.11)
The pathway of tumor spread and staging are described in Figure 15.12 and Table 15.1.
Differential Diagnosis
Secondary Tumors of EAC
MIDDLE EAR AND MASTOID TUMORS
Paragangliomas3
Classification
Glomus Jugulare
Imaging
Glomus Tympanicum Tumor (Figs 15.14A to C)
CT
MRI
Angiogram
Glomus Jugulotympanicum Tumor (Figs 15.15 and 15.16)
Tumor Mimickers
Facial Nerve Schwannoma (Figs 15.17 to 15.19)
Imaging
Facial Nerve Schwannoma involving Various Segments
Differentials of Intratemporal Facial Nerve Schwannoma
Meningioma
Differentials for Meningioma
Langerhan's Cell Histiocytosis (Figs 15.20 and 15.21)
Rhabdomyosarcoma
Other Tumors
Secondary Tumors
INNER EAR TUMORS
Endolymphatic Sac Tumor (ELST) (Figs 15.22 to 15.25)
Imaging
FIBRO-OSSEOUS LESIONS (FIGS 15.26 AND 15.27)
16:
Tumors of Temporal Bone: Surgical Perspectives
TEMPORAL BONE CARCINOMA
Introduction
Risk Factors
Spread (Fig. 16.2)
Surgical Interventions
Sleeve Resection
Lateral Temporal Bone Resection
Modified Lateral Temporal Bone Resection
Subtotal Temporal Bone Resection
Total Temporal Bone Resection
Indications for Postoperative Radiotherapy
Prognostic Indicators
JUGULOTYMPANIC PARAGANGLIOMAS
Introduction
Clinical Presentation
Staging
Imaging (See Chapter 15)
Management
Definitive (Curative) or Surgical (Figs 16.6A and B)
Type A Approach3
Type B Approach3
Type C Approach3
Preauricular Infratemporal Approach3
Complications of Surgery
17:
Reporting Template with Illustrative Cases (Tumors)
Case 1 (Figs 17.1A to F)
Impression
Staging
Case 2
Impression
Staging
Case 3
Impression
Staging
Case 4
Impression
SECTION 6: MISCELLANEOUS
18:
Lesions of Petrous Apex
INTRODUCTION
CLASSIFICATION OF PETROUS APEX LESIONS
Pseudolesions
Pneumatized Petrous Apex (Figs 18.2 and 18.3)
Asymmetric Marrow (Figs 18.3A and B)
Apical Cephalocele/Meningocele or Arachnoid Cyst of Petrous Apex (Figs 18.4A and B)
Congenital Cholesteatoma/Epidermoid Cyst
Effusion/Trapped Fluid (Fig. 18.3B)
Mucocele (Figs 18.5A to D)
Cholesterol Granuloma (Figs 18.6A and B)
Apical Petrositis/Petrous Apicitis (Figs 18.7 and 18.8)
Primary Neoplasms
Metastases (Fig. 18.9C)
Petrous ICA Aneurysm
Diffuse Bone Disease
Extension from Adjacent Diseases
Miscellaneous Lesions
IMAGING APPROACH
Expansile PA lesions
Nonexpansile PA Lesions
19:
Temporal Bone Trauma
INTRODUCTION
CLASSIFICATION
TYPES OF FRACTURES
Longitudinal Fractures (Ulrich)
Anterior Subtype (Figs 19.10A to C)
Posterior Subtype
Transverse Fracture (Ulrich)
Otic Capsule–Violating Fracture (Brodie)
Otic Capsule–Sparing Fracture (Brodie)
Petrous Fracture (Ishman and Friedland)
Nonpetrous fracture (Ishman and Friedland)
VARIANTS
Cochlear Cleft (Figs 19.14A and B)
Petromastoid canal (Fig. 19.15)
Cochlear Aqueduct (Fig. 19.16)
SPECIFIC SITUATIONS
External Auditory Canal
Ossicles
Facial Nerve
Cochlea
Vestibule
Semicircular Canals
TEACHING POINTS
20:
Reporting Template with Illustrative Cases (Miscellaneous)
Case 1 (Figs 20.1A to F)
Any Other Finding
Impression
Case 2
Any Other Finding
Impression
Case 3 (Figs 20.3A to F)
Any Other Finding
Impression
Case 4 (Figs 20.4A to E)
Any Other Finding
Impression
SECTION 7: CLINICO-RADIOLOGICAL APPROACH
21:
Approach to Hearing Loss
INTRODUCTION
TYPES OF HEARING LOSS
DEGREE OF HEARING LOSS
PATTERN OF HEARING LOSS
DIAGNOSIS
Audiological Tests
Subjective Tests
Objective Tests
IMAGING
Imaging of Conductive Hearing Loss (Table 21.3 and 21.4)
Imaging of Sensorineural Hearing Loss (Tables 21.5 and 21.6)
SPECIFIC CONDITIONS
Labyrinthitis Ossificans (LO)
HRCT
MRI
Cochlear Otosclerosis (CO)
Types
Grading System
Grade 1
Grade 2
Grade 3
Management
CONGENITAL HEARING LOSS (TABLE 21.7)
22:
Approach to Vertigo
INTRODUCTION
RELEVANT IMAGING ANATOMY
CAUSES
CLASSIFICATION OF VERTIGO (FIG. 22.1)
Peripheral
Central
CLINICAL PRESENTATION
DIAGNOSTIC APPROACH
MANAGEMENT
IMAGING
Peripheral Causes
Semicircular Canal Dehiscence Syndrome
Perilymphatic Fistula
Central Causes
Stroke/transient Ischemic Attack
CONCLUSION
23:
Approach to Tinnitus
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
CAUSES (FIG. 23.1)
DIAGNOSIS
MANAGEMENT
Psychological
Physical
Medications
Others
Alternative Medicine
Objective Tinnitus
PROGNOSIS
24:
Approach to Facial Nerve Palsy
INTRODUCTION
ANATOMY
TYPES
DIAGNOSIS
ROLE OF IMAGING
CT
MRI
TREATMENT
INDEX
TOC
Index
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