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Introduction, Material and Methods, Aim of the Study: Evaluation of the methods and results of treatment of 19 cases of malignant tumors of the external auditory meatus and/or temporal bone was performed., Results: In 10 cases planoepithelial carcinoma was diagnosed; in 7 cases basocellulare carcinoma; in 1 case rhabdomyosarcoma; and in 1 case malignant peripheral nerve sheath tumor were histopathologically established. In stage T1 were 8 cases, in T2 - 7, in T3 - 1 and in T4 3 patients were stated based upon clinical and radiological (HRCT and MRI) examination. Three patients in T4 stage were qualified to palliative therapy. In 2 cases radical mastoidectomy was performed, 8 patients underwent partial temporal bone resection. In 6 cases removal of cartilaginous and osseous external auditory meatus was done. In 9 cases local recurrence of tumor was observed during 2 years after surgery. The last 7 cases are under oncological observation., Conclusions: In conclusion we stressed that patients with malignant tumors of this region are treated in late stages of the disease; it is a main cause of poor diagnosis., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

This paper presents consecutive stages of the fronto-temporo-orbito-zygomatic approach (FTOZA). Two simulations of FTOZA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schematic diagrams. The starting point for FTOZA is a pterional craniotomy and osteotomy including the orbital rim, body of the zygomatic bone and zygomatic arch. In justified cases it is also possible to temporarily remove the upper and lateral walls of the orbit. Wide drawing apart of the Sylvian fissure is an important supplement of the approach. The fronto-temporo-orbito-zygomatic approach is a reproducible technique, which provides surgical penetration of the middle cranial fossa and related regions. This approach is particularly useful in the treatment of tumours of the above-mentioned anatomical areas as well as vascular malformation of the posterior part of the arterial circle of the brain.

Unlabelled: Round window's movability measurements with helping of LDV in evaluation of ossicular chain functioning., Aim of Study: Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study., Methods and Materials: In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours. Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz., Results: In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were significantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz., Conclusions: Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz

Introduction: To assess an effect of cochleostomy on hearing threshold in guinea pigs., Material and Methods: The authors performed animal experiments using five 3-month-old guinea pigs. Before experiment hearing threshold were evaluated. Surgery involved access to the temporal bone by a post-auricular incision. After a wide opening of the bulla cochleostomy was created (10,000 turn/min, diamond bur of 0.8 mm diameter). Hearing threshold was identified on the basis of presence of wave V in auditory brainstem responses (ABR) for click and frequency-specific stimulation. Also morphology and latency changes for wave V for this stimulation was assessed. Hearing status was evaluated before, just after and 1-, 2-, and 4-weeks after surgery. For surgical procedure and ABR examination all animals were anesthetized with an intramuscular injection of ketamine (50 mg/kg) mixed with xylazine (9 mg/kg) in the supplemental doses. After surgery the animal was treated by antibioticoterapy for 3 days--Enrofloksacyna 0.3 ml subcutaneouly and analgesic--Tolfedine 0.05 mg in second day., Results: Four week observation of ABR morphology and hearing thresholds for click and frequency-specific stimulation of 100 dB SPL intensity showed only temporary changes confirming that cochleostomy did not affect cochlear function., Conclusions: The correctly performed cochleostomy in guinea pigs did not affect persistently the cochlear function indicating that such an option of CI electrode insertion in patients is safe.

Aim of Study: Evaluation of usefulness new non-contact method--Laser Doppler vibrometry (LDV) in measurements of movability of ossicular chain during second look operation was aim of the study. We would like answer to questions: 1. Is LDV helpful in intraoperative conditions? 2. Which measurements points have the largest practical value? 3. Which measured parameters could be used to determination of effectiveness ossicular chain reconstruction?, Methods and Materials: In experiment there were taken 3 fresh temporal bones kept in 0,9% NaCl. In first stage were executed: antromastoidectomy with wide tympanotomy. The ossicular chain movability investigation was conducted on: back branch of stapes, front branch of stapes, round window, umbo of eardrum. Laser Doppler Vibrometer was used to measurement ossicular chain's movability. ER-2 loudspeakers were generated wave: 1000 Hz, 2000 Hz, 4000Hz. In second stage were executed: Malleus-Stapes Assembly (MSA) ossicular chain's reconstruction and repeated investigation in measured points., Results: The most convenient points to measurement were respectively: back branch of stapes, front branch of stapes, umbo of eardrum. In two cases round window was placed in deep niche and was partly covered by facial nerve. MSA performance didn't influence accessibility of measuring points. Theresholds of measured point's movability was useful to evaluation of reconstruction., Conclusions: Back branch of stapes, front branch of stapes and umbo of eardrum are useful to intraoperatve measurements ossicular chain movability. Delimitation thresholds of ossicular chain movability can help in reconstruction's evaluation. After next experiments LDV can be use in practice-intraoperative.

Eagle's syndrome associated with elongation of styloid process or mineralization of styloid complex is uncommon pathology. The etiology of this disease has not yet be known. Main symptom of Eagle's syndrome is cervical, facial and pharyngeal pain. The authors present a case of man who suffered from severe bilateral cervical pain. After the diagnosis of both side elongated styloid process syndrome, surgical treatment was conducted. Extraoral resection of syloid processes resulted in complete and lasting pain relief.

Introduction: Spontaneous meningocele or meningoencephalocele of the temporal bone are very rare. Mostly they are result from otologic surgery or head trauma. Spontaneous meningoencephalocele may occur mostly in the epitympanum or mastoid antrum. It could be a result of pathologic obesity. Often it could be misdiagnosed because of less symptomatic. The most expected symptoms could be: unilateral conductive hearing loss with meddle ear effusion, pulsatile tinnitus or CSF leak., Material and Methods: We present a case of 61 year old, obese woman with spontaneous meningoencephalocele of the left temporal bone. The patient presented symptoms of conductive hearing loss with fullness in the left ear and pulsatile tinnitus. The imagine study such as CT scan and MRI showed a dehiscent areas in the tegmen at the right side and meningoencephalocele protruding into the left mastoid cavity on the left side., Results: After complete diagnosis we preformed surgery. A mastoidectomy of the left temporal bone was done and the meningoencephalocele tissue was encountered. The bony defect and CSF leak was closure. The patient was released from pulsatile tinnitus and fullness in the ear, but a component of hearing dysfunction is still present., Conclusions: Spontaneous meningoencephalocele of the temporal bone may occur in an obese patient. The most finding will be a middle ear effusion and conductive hearing loss with pulsatile tinnitus. The combination of CT and MRI will help in proper preoperative diagnosis. The operation include transmastoid, middle cranial fossa repair or combination of both. The multi layer closure of bony defect is very important to avid CSF leak.

The authors describe the rare case of fibrous dysplasia in temporal bone. Dysplasia fibrosa is a benign osseous condition that may involve one or more bones in the cranial and extracranial skeleton. Temporal bone involvement occurs in 18 per cent of craniofacial diseases. Clinical, radiographic and histologic examinations are essential to confirm the diagnosis of fibrous dysplasia. Treatment of illness depends on the associated symptoms.

Fibrous dysplasia of the temporal bone is a rare disease which may lead to progressive stenosis of the external auditory canal with conductive hearing loss. Sensorineural hearing loss has usually been attributed to involvement of the otic capsule or inner auditory canal. The case of fibrous dysplasia of the temporal bone in 11 years old girl was described. The conductive hearing loss with sensorineural component improved after surgical treatment.

Elongated styloid process gives a complex of symptoms described by Eagle such as unilateral craniofacial and cervical pain, recurrent throat pain, dysphagia and foreign body sensation. Symptoms might be similar to those caused by calcified stylohyoid ligament. Diagnosis of the elongated styloid process is based on the palpation of the tonsillar area and should be confirmed radiologically. Surgical shortening of the elongated process is the only way to give symptomatic relief to the patient. The authors present a surgically treated case of bilaterally elongated styloid processes and unilateral symptoms.

Based on spiral computer tomography data three dimensional reconstruction of temporal bone have been made. Anatomical details of the middle ear on obtained images as above have been shown. Reviewed own material and literature the technical assumption and potential possibilities of the three dimensional middle ear reconstruction were presented. Emphasised that three dimensional CT is a valuable source of supplementary information on ossicular chain continuity.

Two cases of aneurysmal temporal bone cysts treated surgically are described.

A comparative analysis was made of three operative approaches used in cochlear implantations, regarding their safety for main structures of the temporal bone, simplicity and versatility. Anatomical and clinical data from literature were worked out. It was stated that the posterior tympanotomy approach is best because of its allows for good view on the round window niche and its risk for the facial nerve damage is not greater than that of the other routes. The posterior tympanotomy approach is safe for small children because the space between the facial nerve and tympanic ring is not smaller in them than in adults. This route to the tympanic cavity creates also possibilities for widening of the operating area if it is necessary, for example in obstructed and obliterated cochleas. The anterior tympanotomy approach is dangerous for children because of a great risk for facial nerve and jugular bulb. The mastoidotomy-tympanotomy approach is on the other hand very complex, requires special equipment and is not more protective for the facial nerve than posterior tympanotomy approach.

Cochleostomy is an opening of the perilymphatic spaces of the cochlea. It is the most important moment in intracochlear implant surgery. There are contradictory opinions in the available literature regarding this surgical intervention. Cochleostomy is performed through the round window, the oval window, the promontory or through the apical turn of the cochlea. A microanatomical study was performed to evaluate which kind of cochleostomy would be most effective and safe for the main structures of the temporal bone. The distances between round window and round window niche structures, the jugular bulb, internal acoustic meatus, posterior semicircular canal, internal carotid artery and cochlear canalicule were measured. It was stated that all the dimensions were smaller in children of up to four years of age and the differences were statistically significant. Cochleostomy through the promontory, especially using the "soft" technique of endosteum opening is safe for all the structures, and in children it also protects the cochlear canalicule.

The authors present the results of the treatment of 34 patients with chronic cholesteatomatous otitis media in whom the posterior wall of the external auditory meatus was reconstructed by remodelling the pedicel flap of the temporal fascia and by obliterating the mastoid process with Osteovit. The results of the operation were estimated with reference to the time of the postoperative cavity getting dry and compared with the control group of individuals in whom radical conservative operation was performed. The results proved that the epithelialization time was distinctly shorter and neither granulation nor otorrhea appeared during 24 months' observation.

A twelve year boy was admitted to the Otolaryngological Clinic of the Medical Academy in Cracow with a paralysis of the peripheral facial nerve and a tumor on the right zygomatic arc. A CT investigation revealed an expansive process in the central fossa of the skull, which continuously passed into the squama of the temporal bone and the are of the zygomatic bone on the right side, causing a paralysis of the nerve VII. A neurosurgical intervention was carried out as well as a subsequent treatment by radiotherapy. A remission of the tumor was achieved. Osteoclastoma was diagnosed histologically.

CT examinations of temporal bones were performed in 31 deaf patients from qualify diagnostic stage prepared for cochlear implants. Essential for surgical treatment anatomic details were estimated, especially canalis spiralis cochleae was paid to attention. In our group, 8 patients had some CT changes (abnormal findings) which corresponded to different stages of obliteration the cochlea. The majority of patients lost the hearing because of meningitis. In 6 implanted patients CT scan was compared with surgical findings. During the operation 1 patient with patent cochlea on CT scan had partially ossified basal turn.

The authors present a method of cranioplasty using super-acrylate type "O". Two approaches are used to this problem--copying of the own bone of the patient and use of an appropriate prosthesis made of plastic material used in maxillofacial surgery. The obtained results were favourable with respect to cosmetic effect and clinical outcome.

In the years 1980-1987 in the Neurosurgery Department, Medical Academy in Lódź in 21 patients aged 12 to 59 years covering of cranial vault bone defects over 100 cm2 of area was done using of cranioplasty polypropylene-polyester knitted fabric Codubix. The size of the implanted prostheses was from 100 to 430 cm2. The time from bone defect occurrence to cranioplasty was from 4 weeks to 18 years. Cranial defects resulted from treatment of trauma complications in 10 cases, treatment of intracranial tumours in 7, aneurysms in 2 and intracranial infections in 2 cases. The follow-up after cranioplasty was from 3 to 10 years. In 18 cases (85.7%) good and very good therapeutic results were obtained. Three patients required removal of prosthesis because of purulent complication, in 2 of these cases high risk of infection was present before the operation. Codubix prosthesis was particularly useful for filling giant of cranial bones.

Early and late results of surgical treatment of cranial vault defects with Codubix prosthesis in 46 cases are presented. Early after the operation purulent complications were not observed. The main problem of normal healing-in of the prostheses was at that time accumulation of subgaleal haematoma which was observed in five patients (10.8%). Late complications necessitating removal of Codubix prosthesis occurred in four cases (8.7%). In one patient Codubix treatment led to meningitis due to late cerebrospinal fluid rhinorrhoea and in the second case staphylococcal infection was diagnosed 4 month after the operation. In 2 remaining cases prosthesis became movable 5 and 21 months after operation and became depressed by several millimeters. The inquiry sent to the patients for obtaining information on their present health was answered by 70% of them, and four reported slight, stable depression of the plate. The remaining ones reported no complications. In 91% of cases the patients regarded the cosmetic effect of the operation as good and 9% as unsatisfactory. Codubix is good material for filling of bone defects. It heals in quickly, produces rarely purulent complications, but requires very careful fixation.

The authors describe in detail the technique of fronto-temporo-sphenoidal craniotomy of Yasargil and stress its advantages in surgical treatment of aneurysms of the circle of Willis. This method was used in surgical treatment of 82 patients with intracranial aneurysms, expanding lesions situated in the vicinity of the sella and ala parva of the sphenoid bone, and with other intracranial processes, and very good conditions for operation were obtained. The authors believe that fronto-temporo-sphenoidal craniotomy is the most favourable approach for the management of aneurysms of the circulus arteriosus.

Two cases of brain abscess as a complication of direct cranial traction have been presented. In the first case traction was used in the treatment of aneurysmatic cyst of the cervical spine, in the second case for cervical spine trauma. In the first case development of abscess was related with local infection in the site of localization of traction, and in the second case, most probably, with direct contamination of the brain tissue in the site of dura mater perforation. In both cases abscess was treated surgically; in the first case, a female patient was discharged with severe neurological deficit and in the second case, the male patient recovered without neurological deficit.

The results of surgical treatment in 19 cases of aneurysms of the anterior communicating artery from the approach described by Yasargil are described. In 16 patients the pedicle of the aneurysm was closed with a clip, in 2 cases the anterior communicating artery was excluded from the circulation by trapping, and in only 1 patient the aneurysm was enclosed in muscle and gazue. Control angiography demonstrated in 16 cases exclusion of the aneurysm from the circulation with maintenance of the patency of the main vessels, and in one case the sac of the aneurysm was partly shadowed. Good results were obtained in 80% of cases. One patient died (5%). Complications with development of Korsakoff's syndrome were observed in 3 patients (15%). The advantages of the approach described by Yasargil for the exposure and safe management of anterior communicating artery aneurysms are stressed.

The authors described a case of self inflicted gunshot wound. They stressed the necessity of immediate reconstruction.