Postoperative Imaging of the Temporal Bone

[Temporal bone surgery and requirements for radiology]

BACKGROUND

Perioperative imaging plays a central role in otorhinolaryngology, particularly in procedures involving the complex temporal bone. Detailed understanding and precise depiction of its specialised anatomy are essential to minimise risks during surgical interventions and to optimise surgical planning.

MATERIALS AND METHODS

This article highlights the value of cross-sectional imaging, primarily computed tomography (CT) and magnetic resonance imaging (MRI), in the context of surgical challenges, critical aspects in the assessment of inflammatory conditions, the planning of middle ear procedures, and tumour diagnostics in the temporal bone. Surgical concepts are illustrated using common pathological conditions.

CONCLUSION

Close collaboration between radiologists and surgeons is crucial to minimise patient-specific risks and to optimise surgical outcomes in inflammatory diseases and neoplasms of the temporal bone.

Otosclerosis and the evolution of stapes surgery: A historical and otopathological study

Objective

To explore the historical evolution of surgical techniques for otosclerosis treatment, viewed through the lens of human temporal bone pathology to aid in understanding the disease and refining surgical interventions.

Data sources

A review of historical literature on otosclerosis, surgical techniques, and otopathological findings was conducted. Eight temporal bone specimens from the Paparella Otopathology & Pathogenesis Laboratory, University of Minnesota, and one from the University of California, Los Angeles, were analyzed.

Review methods

We selected two temporal bones from donors who underwent four different types of surgical procedures for otosclerosis: stapes mobilization, fenestration, stapedectomy, and stapedotomy. One successful and one complication case was selected for each procedure. Histopathological analysis was performed to assess the outcomes and complications associated with each technique.

Results

The study chronicles the progression of otosclerosis surgery from the stapes mobilization to modern stapedectomy and stapedotomy techniques. Initial procedures, like stapes mobilization and fenestration, yielded limited and temporary results with significant complications. The introduction of stapedectomy marked a significant improvement, with better long-term outcomes. Histopathological analysis revealed insights into the causes of surgical failures and complications.

Conclusion

Otosclerosis surgery has evolved significantly, driven by advances in otopathology and surgical technology. While earlier techniques offered limited success, modern procedures like stapedectomy and stapedotomy provide improved outcomes and fewer complications. Ongoing research promises further advancements in the field, improving patient care and surgical efficacy.

Level of evidence

NA.

Imaging of Vertigo and Dizziness: A Site-based Approach, Part 1 (Middle Ear, Bony Labyrinth, and Temporomandibular Joint)

The broad differential diagnosis of vertigo and dizziness passes through peripheral and central causes. Peripheral vestibular disorders, such as Ménière's disease and benign paroxysmal positional vertigo, are commonly diagnosed clinically, with imaging serving to exclude other conditions. Temporal bone trauma, cholesteatoma, third window syndrome, otospongiosis, jugular bulb variants, and temporomandibular disorders are identified as significant causes of dizziness and vertigo, each with specific diagnostic and management considerations. Advanced imaging techniques, including high-resolution computed tomography and magnetic resonance imaging, play crucial roles in diagnosing and differentiating these conditions. The management strategies vary depending on the underlying cause and often involve surgical or medical interventions tailored to the specific pathology.

Congenital cholesteatoma: what radiologists need to know

Congenital cholesteatoma is a rare, non-neoplastic lesion that causes conductive hearing loss in children. It is underrecognized and often diagnosed only when there is an established hearing deficit. In the pediatric population, hearing deficiency is particularly detrimental because it can impede speech and language development and, in turn, the social and academic well-being of affected children. Delayed diagnosis leads to advanced disease that requires more extensive surgery and a greater chance of recurrence. A need to promote awareness and recognition of this condition has been advocated by clinicians and surgeons, but no comprehensive imaging review dedicated to this entity has been performed. This review aims to discuss the diagnostic utility of high-resolution computed tomography and magnetic resonance imaging in preoperative and postoperative settings in congenital cholesteatoma. Detailed emphasis is placed on the essential preoperative computed tomography findings that facilitate individualized surgical management and prognosis in the pediatric population.