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Hyperpneumatization of the temporal bone (HPTB) is a rare finding, and its clinical impact is poorly described in literature. We report the case of a 34-year-old woman with no previous otologic condition, complaining of paroxysmal vertigo and right pulsatile tinnitus shortly after a first scuba diving session. Clinical neurotologic assessment found a right vestibular impairment. Cranial tomodensitometry showed a bilateral hyperpneumatization of the petrosal air cell system. Brain magnetic resonance imaging to rule out any retrocochlear pathology was normal, although the cochleo-vestibular nerve (CVN) appeared to be over lengthened in a narrowed internal auditory canal (IAC), especially on the right-hand side. Pain was alleviated by administration of a low-dose anti-epileptic drug. The clinical, neurological, and radiological findings evoked a right vestibulopathy generated by a limited compression of the CVN; HPTB appeared to contribute to the narrowing of the IAC, especially on the right-hand side.

ObjectiveThis study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease.MethodsComputed tomography head scans from 1700 patients aged 0–16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex.ResultsPetrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule.ConclusionIn children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.

Introduction High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information and enhances more efforts for better dependent correlation and measurements of round window (RW). Objectives The aim of this study was to find an appropriate way by HRCT imaging for the prediction of the visibility of the round window during cochlear implant (CI) surgery. Methods The study was conducted using hospital information from patients referring the Khuzestan Cochlear Implant Center (2017–2018). 87 patients underwent cochlear implant surgery, 56 patients with high resolution CT scans were included in the study. All patients underwent surgical treatment via posterior tympanotomy approach. Results 56 patients were examined. Patients were divided into three groups: children (0–12 years) and adolescence (18-13 years) and adults (19–59 years), of whom 45 patients (80.4%) were children, and 3 patients were adolescence (5.4%) and 8 patients (14.3%) were adults. 22 patients (39.3%) were fully visible and 13 patients (23.2%) were partially visible and 21 (37.5%) patients were difficult to visualize. In high-resolution imaging studies, mastoid 2 cases (3.6%) were poorly aerated and 8 cases (14.3%) were moderately aerated and 46 (86.1%) were well aerated. The amount of round window overhanging in 43 patients (76.8%) was 4.4 and in 12 patients (21.4%) was 3.4%. Conclusion The presence of the air cell around the facial recess may provide easier access to the facial recess. There was a significant relationship between the RW in the operation and the angle between the RW and the facial nerve and the coronal axis. There is no significant relationship between the visibility of the RW and the facial recess, Vertical height RW and facial nerve (FN), the distance between the FN and the posterior canal in the axial, the angle between the FN and inner margin of RW, and the angle between the FN and the tympanic annulus with the inner margin RW in the Axial and FRL was not found.

The objective of this study is to determine the quality of quail eggs stored at room temperature and refrigerated. The variables evaluated are weight loss, shape index, air cell size, and the height of both the albumen and the yolk. Several factors, such as storage time and temperature could affect the quality of quail eggs. Therefore, we investigated the impact of both factors. The samples used for this experiment include 360 quail eggs. This research uses a completely randomized factorial design with two treatments. The treatments consisted of storage time (0, 7, 14, and 21 days) and temperature (room temperature and refrigerator). Each treatment was replicated 9 times. Analyses of variance had been applied to analyze the data and followed with Duncan’s test to see whether there was a significant difference between treatments. The result showed that storage time and temperature have significant effects on weight loss of the eggs, air cell size, and albumen and yolk height. The interaction between treatments had a significant impact on air cell size and yolk height. Refrigerated storage for 21 days showed the best result.

Patients with advanced- or terminal-stage cancer and persons receiving palliative care are at high risk for pressure ulcers (PUs). Purpose The purpose of this study was to examine the rate of PU development and levels of comfort of a dual-fit, air-cell mattress compared with an alternating, 2-layer overlay air-cell mattress in patients with advanced- or terminal-stage cancer receiving palliative care. Methods From January 2011 to December 2013, hospitalized patients with advanced- or terminal-stage cancer who were referred to a palliative care team, at least 20 years of age, able to communicate, experiencing pain, and did not have a PU were recruited to participate. Patients who consented were alternately placed on the intervention (dual-fit, air-cell) or control (2-layer air) mattress until hospital discharge or death. Demographic and clinical data, pain scores, performance status, Palliative Performance Scale scores, Braden Scale scores, tissue interface pressure, and comfort were assessed via interview using closed-end questions. If a PU developed, clinical characteristics were assessed using DESIGN-R. Descriptive statistics and the Mann-Whitney U, chi-squared, and Fisher's exact tests were used to analyze the data. Results Of the 123 eligible patients, 73 were randomized and 52 completed the study (23 intervention patients, median age 63 [range 27-80] years; and 29 control group patients, median age 61.0 [range 27-82] years). Mattresses were used a median of 17 (range 4-113) days in the intervention group and a median of 32 (range 3-270) days in the control group. The incidence of PUs did not significantly differ between the 2 groups (13% in the intervention and 17.2% in the control group). Interface pressures were significantly higher in the intervention group (27.0 mm Hg vs. 24.3 mm Hg). Comfort scores at rest were significantly better in the intervention than in the control group (sinking into bed [3 vs. 14, respectively]; slipping on bed [o vs. 16, respectively]; and feel pressure of air cell [2 vs. 14, respectively]), as were scores with movement (instability during movement [4 vs. 18, respectively] and feeling of floating of the buttocks [6 vs. 21, respectively]) (P Conclusion Dual-fit, air-cell mattresses may help prevent PUs and improve comfort at rest and during activity among patients with end-stage cancer receiving palliative care. Further research regarding mattress selection protocols for this patient population is warranted.

Background: The mastoid air cells are considered to develop better in children with congenital cholesteatoma but only a few quantitative studies have examined. Aims/objectives: The present study was undertaken in order to clarify the relationships between the development of the mastoid air cells in children with congenital cholesteatoma and clinical factors. Materials and methods: Mastoid air cell development was evaluated in 53 children with congenital cholesteatoma. The sizes of the mastoid air cells were measured on computed tomography scans of the temporal bone, and clinical factors, including age, the extent of invasion, and whether it was located close to the eustachian tube were evaluated. Results: The cross-sectional area of the mastoid air cells was significantly smaller on the affected side than on the unaffected side, especially in the older patients. The cases involving invasion into the mastoid portion also had smaller mastoid cells. Whether the cholesteatoma was located close to the eustachian tube had no effect. Conclusions and significance: The mastoid air cells on the affected side were less well developed. Our findings indicate that a high age and the presence of cholesteatoma in the mastoid region might be associated with suppressed mastoid pneumatization.

Concha bullosa (CB) is a pneumatized air cell within the nasal turbinates, often in the middle turbinate. CB is one of the most common anatomical variations found in the middle turbinate. It generally tends to be asymptomatic but can cause symptoms such as nasal obstruction, facial pain, and a decrease in the sense of smell. Moreover, CB can be involved in chronic rhinosinusitis, which can lead to its confusion with other lesions, as the radiographic picture might mimic other nasal pathologies. Here, we report a case of massive CB involved with allergic fungal sinusitis (AFS) and mimicking a bony tumor in order to highlight the diagnostic challenge of this clinical entity.

Mastoid air cell fluid is a commonly seen, but often dismissed finding. Given the location of the mastoid portion of the temporal bone and its location adjacent to vital structures, a careful evaluation is important for the emergency radiologist. While occasionally benign, fluid within the mastoid air cells can be an early sign of more severe pathology, and familiarity of regional anatomy allows for early identification of disease spread. This article describes the important anatomy, the common pathologies, and a radiologic approach to assessing the mastoid air cells in order to guide referring clinicians.

Guidelines for pressure injury prevention consider the use of pressure-redistributing pads to prevent tissue deformation. However, limited research exists to assess the pressure distribution provided by the operating tables and the effectiveness of pressure-redistributing pads in preventing pressure injuries. In this study, we compared the pressure distribution properties of two surgical table pads and identified parameters influencing pressure injury outcomes after a lengthy surgical procedure. Twenty-seven patients undergoing left ventricular assist device implantation surgery participated in the study. Participants were randomly assigned to use either an air cell-based pad or a gel pad. Interface pressure was recorded during the surgery. We analyzed the effect of surgical table pad type, interface pressure distribution and pressure injury outcomes and analyzed what characteristics of the patients and the interface pressure are most influential for the development of pressure injuries. Comparing the interface pressure parameters between the air-cell group and the gel group, only the peak pressure index x time was significantly different (p 0.05). We used univariate logistic regression analysis to identify significant predictors for the pressure injury outcome. The support surface was not significant. And, among patient characteristics, only age and BMI were significant (p ≤ 0.05). Among the interface pressure parameters, pressure density maxima, peak pressure index x time, and coefficient of variation were significant for pressure injury outcome (p ≤ 0.05). Peak pressure index, average pressure, and the surgery length were not statistically significant for pressure injury outcomes.

There are various surgical techniques for cochlear implantation, classical one being mastoidectomy and posterior tympanotomy which has some disadvantages and complications like extensive bone work, violation of mastoid air cell system and fear of injury to vital structures like facial nerve. To minimize these problems, various modifications in cochlear implantation surgery has been done which includes introduction of Veria technique which also has certain disadvantages like extensive dissection and prolonged surgical time. In this article we are introducing an innovative technique of cochlear implantation where we have modified the pre-existing Veria technique that has been described in detail in the coming sections. Total 9 cases have been done so far with this modified Veria technique. This technique includes postaural approach with minimal soft tissue and bone work, making the cochlear implantation simple, easily doable, with less operating time, with minimal morbidity, faster healing due to smaller incision and avoiding facial nerve injury.

Aim of the study A robotic mattress equipped with an interface pressure mapping system and an automatic inner air-cell pressure adjustment function had been developed to aid in the management of pressure ulcers, but its effects on comfort remained unclear. The present study aimed to investigate whether use of the mattress with continuous, automatic, interface pressure mapping-based regulation of inner air-cell pressure (i.e., robotic mattress) improves comfort over that provided by body weight-based pressure regulation (traditional approach) in healthy volunteers. Materials and methods A robotic mattress was used with two settings (i.e., interface pressure-vs. body weight-based regulation). First, 20 healthy volunteers were recruited, and the level of comfort, interface pressure distribution, body immersion, and tissue oxygenation were measured and compared between the two settings. Results The level of comfort (20.5 vs 47.5, p = 0.014), contact area (2263.9 vs 2145.2 cm2, p = 0.002), and body immersion for healthy participants were significantly larger when using the interface pressure-based setting. Conclusion The robotic mattress provided improved comfort, which might be caused by increased contact area, and improved body immersion. The robotic mattress is expected to be effective both for managing pressure ulcers and increasing comfort.

La microlitiasis alveolar pulmonar es una enfermedad rara cuya principal característica es la acumulación de sales de calcio dentro del alvéolo pulmonar, esto debido a la presencia de una mutación genética autosómica recesiva. Esta entidad se encuentra dentro del grupo de enfermedades pulmonares difusas y el diagnóstico principal es un reto para los profesionales de la salud. No existe un tratamiento hasta la fecha; se ha planteado el uso de bisfosfonatos, los esteroides y lavado bronco alveolar sin llegar a resultados concluyentes. Se prefiere llevar a cabo el trasplante pulmonar, para mejores resultados, antes de que se haya establecido el desarrollo de la insuficiencia ventricular derecha. El diagnóstico definitivo es histopatológico. De acuerdo con la literatura nacional publicada, a nuestro alcance, en Perú se ha reportado esta enfermedad tan solo con sospecha radiológica, sin publicar el diagnóstico histopatológico definitivo. Presentamos un caso diagnosticado en el Departamento de Cirugía de Tórax y Cardiovascular del Hospital Nacional Hipólito Unanue de Lima., Pulmonary alveolar microlithiasis a rare disease whose main characteristic accumulation of calcium salts within the air cell, this due to the presence of a genetic mutation autosomal recessive. This entity is within the group of diffuse lung diseases and primary diagnosis is a challenge for health professionals. There is no treatment to date, has raised the use of bisphosphonate, steroids and bronchoalveolar lavage without reaching conclusive results. It is preferred to perform the transplant before the development of right ventricular failure for best results. The definitive diagnosis is histopathological. In Peru it has been poorly described this disease as the only report found no definitive histopathological diagnosis. We report a case diagnosed in the Department of Thoracic and Cardiovascular Surgery Hipolito Unanue National Hospital in Lima, Peru.

Acute otitis media is a localized infection. Advanced cases demonstrate local spread and abscess formation in the mastoid, temporomandibular joint, and zygomatic root if anatomy allows. We present a case of acute otitis media complicated by an abscess of a pneumatized zygomatic root extending into the temporomandibular joint treated by incision and drainage.

This study was carried out to investigate the cytogenetic effect of Levofloxacin after In-ovo inoculation. Forty eight fertilized eggs were used, divided equally into eight groups and inoculated through shell puncture above air cell with materials in equestion and incubated for two different periods three and seven days. They were assigned as group one and group two 10 µg Levofloxacin, group three and group four 20µg levofloxacin, group five and group six considered positive control 0.05 µg Mitomycin-C, group seven and group eight (Phosphate Buffer Saline) considered negative control groups. All eggs from in-ovo experiments were subjected to cytogenetic tests, such as Mitotic Index, Replicative Index and Sister Chromatid exchange. Eighty fertilized eggs were handled with the same manner of in-ovo inoculation and used for calculation Hatchability index and weekly body weight. The results revealed significant (P˂0.05) increases in Mitotic Index and Replicative Index of all groups treated with levofloxacin compared to positive control, but there were significant (P˂0.05) decreases compared to control negative. There were no significant changes in Sister Chromatid exchange of all treated levofloxacin in–ovo. The hatchability index revealed significant (P˂0.05) decreases in group three which was inoculated 20 µg levofloxacin after three days of incubation compared to all Levofloxacin treated groups and both positive and negative control groups. In conclusion, levofloxacin in–ovo inoculation has no substantial cytogenetic effects.

Posterior tympanotomy is the avenue to the facial recess of the middle ear from mastoid antrum. The entry into the facial recess in many cases is heralded by a distinct air cell before approaching the facial-chordal plane. The current study was undertaken to determine the prevalence of this 'Herald Cell' in an adult cadaveric population. It was a human cadaveric temporal bone dissection study. The bones were dissected to carry out cortical mastoidectomy and posterior tympanotomy using standard otologic drills under microscopic visualization (Leica M320 F12). Appropriate snapshots were taken to document the presence or absence of Herald cell. A total of 51 temporal bones were dissected (26 right, 25 left sided). The Herald cell was found to be present in 22 bones (43.1%). Herald cell, when present, is a convenient and reliable landmark to carry out a safe posterior tympanotomy.

Osteoma of EAC is a rare tumour. Cholesteatoma of EAC associated with osteoma is consequence of osteoma of EAC. Its incidence is rare and very few cases have been reported in the literature. Its association with exuberant granulation tissue in the mastoid air cell system without extension of Cholesteatoma into middle ear cleft is even rare. This association has been reported for the first time as evident from review of literature.

The aim of this study was to compare mastoid air cell volumes in patients with or without a pneumatized articular tubercle (PAT) on cone-beam computed tomography (CBCT) images.The CBCT images of 224 patients were retrospectively analyzed for the presence of PAT. The Digital Imaging and Communications in Medicine data of 30 patients with PAT and 30 individuals without PAT were transferred to 3D Doctor Software. Mastoid air cell volumes were measured using semi-automatic segmentation on axial sections. Data were analyzed using SPSS version 20.0.The patients with PAT and those without PAT had a mean mastoid volume of 6.31±2.86 cmThe detection of PAT on routine dental radiographic examinations might be a potential prognostic factor that could be used to detect extensive pneumatization in the temporal bone. Clinicians should be aware that there may be widespread pneumatization of mastoid air cells in patients in whom PAT is detected. Advanced imaging should be performed in these cases, and possible complications due to surgical interventions should be considered.

Background: Mastoid development, tympanic sinus depth, and residual disease after surgery for congenital cholesteatoma are probably related, but these relationships have not been examined in detail...

This study aimed to investigate the prevalence of tympanic plate (TP) pneumatisation as well as the various potential patterns. A retrospective study involving the archived Cone-Beam Computed Tomography (CBCT) files of 70 patients was performed to investigate anatomical variations of TP pneumatisation. Forty-eight TPs were found to be non-pneumatised, while 92 were found to contain at least peritubal air cells. Twenty patients (28.5%) did not present any variety of TP pneumatisation, while 36 patients (51.4%) exhibited a symmetrical pattern of pneumatisation. Aside from those patients who lacked TP pneumatisation, the peritubal pneumatisation pattern was found to be the most common. Further, bilateral symmetry was found to occur in more than half of all cases. CBCT is a powerful diagnostic tool, although appropriate knowledge of the anatomical possibilities remains mandatory for adequate surgical planning.

Background Learning surgical anatomy of the petrous pyramid can be a challenge, especially in the beginning of the training process. Providing an easier, holistic approach can be of help to everyone with interest in learning and teaching skull base anatomy. We present the complex organization of petrous pyramid anatomy using a new compartmental approach that is simple to understand and remember. Methods The surfaces of the petrous pyramid of two temporal bones were examined; and the contents of the petrous pyramid of 8 temporal bones were exposed through progressive drilling of the superior surface. Results The petrous pyramid is made up of a bony container, and its contents were grouped into 4 compartments (mucosal, cutaneous, neural, and vascular). Two reference lines were identified (mucosal and external-internal auditory canal lines) intersecting at the level of the middle ear. The localization of contents relative to these reference lines was then described, and 2 methods of segmentation (the X method and the V method) were then proposed. This description was then used to describe middle ear relationships, facial nerve anatomy, and air cell distribution. Conclusions This new compartmental approach allows a comprehensive understanding of the distribution of petrous pyramid contents. Dividing it into anatomic compartments, and then navigating this mental map along specific reference points, lines, spaces, and segments, could create a useful tool to teach or learn its complex tridimensional anatomy.

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1 %), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4 %, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25 mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.

Objectives The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS). Methods First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from –700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm. Results No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately –200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did. Conclusion A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and –200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS.

Highlights • The authors successfully treated the antrochoanal polyp with turbinoethmoidal osteoma by endoscopic sinus surgery. • The mucosal continuity between the antrochoanal polyp and the osteoma was identified., Introduction Antrochoanal polyps (ACPs) have several unique features that distinguish them from other nasal polyps. Despite many investigations, the pathogenesis of ACP has not yet been elucidated. Sinonasal osteoma is the most common type of tumor of the sinonasal tract and can be caused by trauma, infection and developmental anomaly. Presentation of case We report the case of a 35-year-old man with left nasal obstruction for more than 20 years. Examination revealed ACP concomitant with an osteoma that arose from the middle turbinate and ethmoid sinus. The osteoma had an air cell in its anterosuperior area and was in a position of being pulled downward. The intranasal part of the ACP covered the posterior area of the osteoma. Discussion Considering the radiological and surgical findings, the intranasal part of the ACP seems to have affected the turbinoethmoidal osteoma during its growth. Conclusion The authors describe a very rare condition in which an ACP was connected with a turbinoethmoidal osteoma.

Dear Editor: In the article entitled “Facial Paralysis in Longitudinal versus Oblique and Otic-Sparing versus Non Otic-Sparing Temporal Bone Fracture” published in the Vol 34 No 2 issue of the Philippine Journal of Otolaryngology Head and Neck Surgery, the authors included an image (Figure 4) that was representative of an otic-disrupting fracture. The arrow clearly shows the fracture line running through the mastoid air cell system nearly parallel to the posterior external auditory canal wall and ending just posterior to the ossicular chain. However, the fracture line does not unequivocally appear to proceed medially towards the otic capsule, which is the densest portion of the temporal bone that surrounds the osseous labyrinth, and includes the cochlea, vestibule and semicircular canals. The otic capsule likewise is located within the petrous portion of the temporal bone.1 The otic capsule lies within the oval ring in the smaller figure above which is an enlarged image of the original figure in the article. This issue is relevant because the authors are classifying subjects according to the visual presence of a fracture that may or may not involve the otic capsule. Misidentification of the type of fracture in a representative image raises the question of a systematic misidentification in the entire data set, thus rendering the results of the study invalid.

A 31-year-old male presented with a history of chronic right-sided facial and mastoid tip pain with associated tinnitus and hearing loss. These symptoms were aggravated by the regular aeroplane trips he made to work as a “fly-in, fly-out” worker in regional Australia. Imaging revealed significant pneumocephalus secondary to mastoid air cell defects, which were repaired via a transmastoid approach. This is the fourth case of spontaneous otogenic pneumocephalus associated with air travel at altitude reported in the literature. This case is remarkable for the chronic nature of the symptoms, which were aggravated by the patient’s regular aeroplane travel. This has implications for occupations which require frequent flying in those patients who may be at risk.

Introduction: The environment of middle ear cavity gets regulated mostly by pneumatized mastoid air cell system (MACS). Many theories exist that details the process of pneumatization of this MACS. The nasal septal deviation (NSD) has been shown to be instrumental in influencing pneumatization of paranasal sinuses to varied degrees. The effect of NSD on the pneumatization of MACS remains questionable due to limited literature available. And so this study was done to find the relation between the side of NSD and extent of Pneumatization of MACS on that side by computerized tomographs of Paranasal sinus region. Subjects and Methods: 120 CT images of paranasal region from archives of radiology department were studied for NSD. The NSD was classified according to the nasal septal angle. The extent of pneumatization of mastoid region was studied and classified. The relation between severe NSD and extent of mastoid pneumatization was noted. Results: NSD was found to be right sided in 90% cases studied and 20, 45, 55 were seen belonging to group I, II and III NSD respectively. The mean NSA was found to be 13.5o. Mastoid region was observed to be hypo pneumatized in the side of NSD in 42 cases of group III NSD. Conclusion: The findings of the study puts forth the need for assessment of NSD and planning possible correction of NSD prior to middle ear and mastoid surgeries for successful results.

Summary The lateral nasal wall attaches the nasal turbinates, which could be, either pneumatized, or paradoxically curved. The turbinate pneumatization–concha bullosausually indicates the pneumatization of the middle turbinate. However, concha bullosasuperior (CBS) is also, although rare, anatomic possibility of variation. We report here a case of unilateral giant septated CBS, which was not, to our knowledge, previously reported. The case was documented in Cone Beam Computed Tomography (CBCT). Subtle pneumatizations of inferior turbinates were found bilateral, as also were the middle conchae bullosae. The left concha bullosasuperior was very large (17.43/5.34 mm), dropping down between the left middle turbinate and the contralaterally deviated nasal septum, and contacting the paradoxical curvature of the middle turbinate on that side. An incomplete oblique septum divided it incompletely into anterior and posterior chambers, it was communicating with a posterior ethmoid air cell, and was draining in the superior meatus. Care should be taken not to misdiagnose a giant CBS as a middle turbinate pneumatization, in order not to misjudge surgical corridors. Therefore, a careful anatomic CT or CBCT diagnosis would be of use for the plan of treatment.

Background To report an unusual case of compressive optic neuropathy secondary to a large onodi air cell. Method Case report. Results A 50 year-old gentlemen presented to the eye clinic with left eye painless loss of vision for one day. Visual acuity was counting finger in the left eye with a positive relative afferent pupillary defect (RAPD). Dilated left fundus examination revealed a pale optic disc. A computed tomography of orbit and brain showed a large left sphenoid sinus with onodi-cell-like projection on the left superior margin of left optic canal impinging on the left optic nerve. He was referred to the otorhinolaryngology team and subsequently underwent left optic nerve decompression. Post-operatively, his left visual acuity improved to 6/60 with reversal of RAPD. Conclusion There are many causes of optic neuropathy and compressive optic neuropathy due to large onodi air cell is uncommon. Acute unilateral loss of vision heralds from a multitude of sinister causes and junior residents should be vigilant that onodi air cell pneumotisation could be one of them.

Objectives/Hypothesis Current three-dimensional (3D) printed simulations are complicated by insufficient void spaces and inconsistent density. We describe a novel simulation with focus on internal anatomic fidelity and evaluate against template/identical cadaveric education. Study Design Research ethics board-approved prospective cohort study. Methods Generation of a 3D printed temporal bone was performed using a proprietary algorithm that deconstructs the digital model into slices prior to printing. This supplemental process facilitates removal of residual material from air-containing spaces and permits requisite infiltrative access to the all regions of the model. Ten otolaryngology trainees dissected a cadaveric temporal bone (CTB) followed by a matched/isomorphic 3D printed bone model (PBM), based on derivative micro-computed tomography data. Participants rated 1) physical characteristics, 2) specific anatomic constructs, 3) usefulness in skill development, and 4) perceived educational value. The survey instrument employed a seven-point Likert scale. Results Trainees felt physical characteristics of the PBM were quite similar to CTB, with highly ranked cortical (5.5 ± 1.5) and trabecular (5.2 ± 1.3) bone drill quality. The overall model was considered comparable to CTB (5.9 ± 0.74), with respectable air cell reproduction (6.1 ± 1.1). Internal constructs were rated as satisfactory (range, 4.9–6.2). The simulation was considered a beneficial training tool for all types of mastoidectomy (range, 5.9–6.6), posterior tympanotomy (6.5 ± 0.71), and skull base approaches (range, 6–6.5). Participants believed the model to be an effective training instrument (6.7 ± 0.68), which should be incorporated into the temporal bone lab (7.0 ± 0.0). The PBM was thought to improve confidence (6.7 ± 0.68) and operative performance (6.7 ± 0.48). Conclusions Study participants found the PBM to be an effective platform that compared favorably to CTB. The model was considered a valuable adjunctive training tool with both realistic mechanical and visual character. Level of Evidence NA Laryngoscope, 125:2353–2357, 2015

Pressure ulcers are hazardous to people with diminished sensory and motor functions who remain in the same position for a long time. An important reason for the occurrence of pressure ulcers is the inability of wheelchair users to make postural changes by themselves with no appropriate method of pressure release. In this study, we researched the effects of applying an air cell inflate-deflate alternating sequence cushion prototype to relieve pressure from tissue loaded areas. Moreover, the hypothesis that the alternating sequence could stimulate blood reperfusion in loaded tissues and redistribute interface pressure on support area was also tested. Ten healthy volunteers were recruited to try the prototype cushion for 65 min of continuous loading; 5 min on static mode and 60 min on alternating mode. This study was conducted on healthy people because their sensitivity allowed them to state clearly and in detail, in a feedback questionnaire, any discomfort experienced with the use of our cushion. In order to address our hypothesis, interface pressure, and bilateral ischial oxygenated and deoxygenated hemoglobin were measured. After applying the alternating cushion, the interface pressure was redistributed over a larger contact area. Besides, blood perfusion was improved according to increments in oxygenated hemoglobin and decrements in deoxygenated hemoglobin of ischial regions during loaded condition. Feedback questionnaire showed that the participants did not feel pain or discomfort using the alternating cushion. The overall results showed positive effects on healthy tissue which has encouraged us to design a study involving subjects who use wheelchairs for mobility.

RESULTS: Mastoid air cell volume, as well as maxillary sinus volume, of the deviated side was smaller than that of the contralateral side, but these were not statistically significant. There was no correlation between NSA and volumes of mastoid air cell and the maxillary sinus. There also was no correlation between NSD/NC ratio and mastoid air cell and maxillary sinus volumes. Significant linear and growth regression was found between age and volume of the mastoid air cell and maxillary sinus but not between age and NSA and NSD/NC ratio. CONCLUSION: Mastoid air cell volume and maxillary sinus volume of the deviated side tended to be smaller than those of the contralateral side, which suggests that NSD can influence both aerations. However, because the degree of NSD did not correlate with the volumes of the mastoid air cell and maxillary sinus in this study, we should consider that further possible factors may be involved in both aerations.

SUMMARY – The aim of the study was to analyze zygomatic air cell defect (ZACD) incidence using magnetic resonance imaging (MRI) and validity of panoramic radiograph as a comparative method of ZACD diagnostics. The connection between ZACD incidence, age, left/right temporomandibular joint (TMJ) and comorbidity with diagnosis of TMJ disorder was analyzed. Panoramic radiographs and MRIs of 140 TMJs of 70 consecutive patients with previously confirmed TMJ diagnosis were compared in the study. A grading system (4-point scale from ‘0’ for absence to ‘3’ for most extended pneumatization) was used to determine low signal on MRIs as pneumatization of temporal bone. ZACD was diagnosed in 22 joints of 15 patients (incidence, 20.4%), with seven patients having bilateral appearance. In the joints of nine patients, ZACD was identified as extensive according to the grading scale. The validity of ZACD findings on panoramic radiographs compared with MRI findings yielded 0.45 sensitivity and 0.98 specificity. There was no relation (p>0.05) between comorbidity of ZACD and TMJ disorder, either by age or side of the body. More prevalent ZACD in our MRI analysis than in other researches based on panoramic radiographs could be explained by the expected superimposed osseous structures in the area of articular eminence.

Dacryocystorhinostomy (DCR) is common surgery employed for the management of nasolacrimal duct obstruction and chronic dacryocystitis with a high success rate [1–8]. However, the failure rates can occur from 4 to 13 % [1, 9–11]. Many causes of failures can be attributed to ostium, the most common being scarring and cicatricial closure of the osteotomy site [9–12]. The other causes related to ostium include inadequate size, inappropriate location, intervening ethmoids, DCR to air cell, membranes over the internal common opening, granulomas, and sump syndrome [10, 12, 13]. Numerous studies in the past have focused on the size and measurement techniques of the ostium and patency tests [14–22]. It is amply evident that many finer physical and functional details of the ostium need to be evaluated postoperatively in an orderly manner to appreciate pathological behaviors early on and institute corrective measures toward prevention or treatment. This chapter presents a DCR ostium protocol for a detailed evaluation and also the DCR ostium or the DOS to standardize the evaluation.

Congenital cholesteatomas of mastoid origin are extremely rare. We reported one in 2007 and experienced an additional case. A male presented with a 5-month history of right-sided ear dis- charge. Computed tomography of the temporal bone showed a soft tissue density occupying the mastoid tip. At surgery, the cholesteatoma sac was completely isolated from the mastoid antrum and lateral air cell in the mastoid tip area. We now doubt the rarity of this entity. With a brief literature review, we consider how the cholesteatoma localizes to the tip of the mastoid bone. Korean J Audiol 2014;18(2):85-88

Background Zygomatic air cell defect (ZACD) is a normal radiographic occurrence and the clinical importance has been sparsely evaluated.

Dental panoramic radiograph serves as a radiograph to visualize the maxillae, the mandible and the surrounding structures fairly well. This radiograph depicts the normal anatomy as well as its variations. One among the many anatomical landmarks and their variations noted on this radiograph is the zygomatic air cell defect (ZACD). zygomatic air cell defect is the extension of mastoid air cells into the articular eminence and the zygomatic process of temporal bone, not crossing anteriorly, the zygomatico-temporal suture. This variant of normal anatomy was recognized as early as 1934 but recognition of the same on a dental panoramic radiograph was not until 1985 by Tyndall and Matteson. Following its recognition, a few case reports and systematic studies have been conducted. In spite of its recognition early in the century, not many anatomists, radiologists are aware of this entity and its importance.

Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty.Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20–35.09% female and 37–64.91% male) with a mean age of29.69±SD(range 12–56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program.Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months(P>0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains(P>0.05).

Background and Aim: The aim was to determine the prevalence of zygomatic air cell defect (ZACD) among children of Indian origin and also to determine the dominant form of ZACD. Materials and Methods: One thousand six hundred and eighty-eight routine panoramic radiographs of subjects between 7 and 18 years, processed between January 2006 and January 2009 were screened, recorded and analyzed for ZACD. Results: Of the 1688 panoramic radiographs examined, 768 were of males and 920 of females. The radiographs were divided into two groups, Group I comprising of subjects in the age 7-12 years and other Group II in the age range 13-18 years. ZACD was found in 50 subjects, accounting for prevalence of 2.96%. Other occurrences found were unilateral 38 cases, bilateral 12, unilocular 20 and multilocular 42 respectively. Conclusion: This study described the prevalence and characteristics of ZACD among selected Indian children. It is essential to know and determine this variant of normal anatomy and differentiate it from pathologies.

Objectives To evaluate the effect of the degree of the mastoid pneumatization on the success rate of cartilage type 1 tympanoplasty. Study design A retrospective clinical chart review. Methods In total, 90 patients (44 females and 46 males; average age, 38.40 ± 11.12 years; age range: 21-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The mastoid air cell volumes of each groups were compared. Results The mean mastoid pneumatization in groups A and B was 5.32 ± 1.96 and 5.06 ± 2.12 cm, respectively. The mastoid pneumatization of diseased ears did not differ between the groups (P > 0.05). The mastoid pneumatization of diseased ears did not differ between males and females (P > 0.05). The mastoid pneumatization of normal ears did not differ between the groups (P > 0.05). The mastoid pneumatization of normal ears did not differ between males and females (P > 0.05). Conclusions The degree of mastoid pneumatization did not affect the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to evaluate the relationship between the degree of the mastoid pneumatization and anatomical outcomes after placement of various graft types.

This study describes the changes in mastoid air cell system (MACS) geometry with age in ears with a history of otitis media (OM), without (GR-I) or with (GR-II) middle ear fluid on the CT scan.Thirty-seven (74 MACSs) CT scans were selected to approximate 4 MACSs/year between 1 and 18 years. For each MACS, the volume, surface area and surface area/volume ratio were reconstructed using standard procedures. Correlation analysis was used to define the left-right relatedness for the geometric parameters, and regression analysis was used to determine the effect of age on those parameters for each group.Twenty scans were from female and 17 from males. Fluid was observed in 12 left, 4 right and 10 bilateral MACSs. The MACS volume and surface area of GR-I increased with age, were significantly greater than those for age-matched MACSs in GR-II, but show large variability. Those measures in GR-II were independent of age and a large percentage of these MACS volumes was5 ml. The surface-area/volume ratio for MACSs in both groups was independent of age and group assignment. The left-right correlations for the three geometric parameters of the MACS were significant for all MACS in the two groups, and for bilateral MACS concordant for group assignment. The left-right correlations for surface area and volume were not significant for bilateral MACSs discordant for group assignment.These results suggest that: the growth of MACS volume and surface area is genetically programmed but that this is disrupted by long-lasting OM; the effect of OM on MACS growth may depend on the duration and timing of the disease, and the MACS surface area/volume ratio does not explain the effect of MACS volume on the rate of gas exchange between middle ear and blood.

AimTo determine the prevalence, radiographic appearance and characteristics of patients with zygomatic air cell defect (ZACD).Materials and MethodsRoutine panoramic radiographs of 400 patients who were visited the dental outpatient of our institute were examined retrospectively.ResultsOut of 400 study subjects, ZACD was found in 11, giving an overall prevalence of 2.75%. Out of 11 ZACD subjects, six were males and five were females. The mean age of subjects with ZACD was 33.9 (±15) years and a range of 18 to 65 years. The bilateral involvement of ZACD was seen in only one subject.ConclusionThe overall prevalence of ZACD is relatively low in present study population. Knowledge of ZACD may be helpful in interpreting panoramic radiographs, in planning surgical treatment of the temporomandibular joint and in understanding the spread of pathological processes into the joint.How to cite this articleGadda R, Patil NA, Salvi R. Zygomatic Air Cell Defect: Prevalence and Characteristics in Dental Outpatient Population. J Contemp Dent 2012;2(3):69-72.

Introduction.Osteoma of the temporal bone is a very uncommon benign tumor of bone. Osteomas may occur in the external auditory canals but are reported to be very rare in the mastoid bone.Case Report.A 36-year-old male presented to our department with a hard swelling behind the right ear diagnosed as osteoma. Complete excision was done through a postauricular approach. Histopathology confirmed the diagnosis of osteoma.Conclusion.Osteomas, although rare, should be considered when dealing with any hard mastoid swelling. Complete removal can be ensured by drilling till the normal cortical bone is reached to avoid recurrence. A cortical mastoidectomy should be done if the mastoid air cell system is involved.

Objective To clarify the position, occurrence rate, and configuration of the suprapyramidal fossa (SF) through surgical observation and 3-dimensional reconstruction. Methods SF of 300 ears with chronic otitis media were observed during surgery. The air cell and its abutting structures, including the facial nerve (FN), were reconstructed using high-resolution computed tomography (HRCT) data. Results In 68.3% (n = 205) of patients, the SF was observed in surgery. It is situated at the posterior wall of the facial recess of the retrotympanum. This air cell, usually the only one present on the surface of the pyramidal segment of the FN canal (FNC), is usually the largest if small air cells are found nearby. Its delineated location is as follows: pyramidal eminence and the pyramidal segment of the FNC medially, the deeper external acoustic meatus laterally, the aditus ad antrum superiorly, the posterior part of the tympanic annulus, and the chordal ridge anterior-inferiorly. Its configuration varies between rounded (11.7%, n = 35), curved-rod (52.7%, n = 158), and irregular (4%, n = 12). Additionally, the sensitivity and specificity of HRCT in detecting the SF were 79.0% and 88.4%, respectively. Conclusion Occurrence and configuration of the SF is not a rule; however, the positive positional relationship between the SF and the second genu of the FNC is a rule, if the SF is detected. Considering this, the SF may be an important anatomic landmark to identify the FN during otosurgery. However, HRCT has a limited diagnostic value when the SF is atypical.

The performance of three different alternating pressure air mattresses with different geometries of air cell were compared (Nimbus 3, Heritage, Tamora Plus), using simple performance indices based on pressure mapping. The aim of this study was to examine the effect on performance of elevating the backrest and thigh section of the bed into sitting position. Ten healthy volunteers of various sizes were pressure-mapped over the full pressure cycle on three alternating pressure air mattresseses with differing cell geometries. This was then repeated with the beds profiled to a sitting position. Performance of the alternating pressure air mattresses in terms of their ability to redistribute pressure dynamically was assessed in the different positions. The different alternating pressure air mattresses performed similarly with the bed in the lying flat position, but smaller cells appeared to be more effective in the sitting position. A conclusion was made that cell geometry may have an effect on the ability of the mattress to achieve alternating behaviour in the sitting position.

Objective The aim of this study was to investigate the developmental relationship between adenoid tissue volume and mastoid air cell volume, using a 3D reconstruction technique. Study design Cross-sectional retrospective study. Subjects and methods Multislice computed tomography (MSCT) images were obtained using three-dimensional (3D) reconstruction and volume-rendering techniques (VRT). The subjects were 63 boys and 37 girls, 3–16 years of age. The volumes of bilateral mastoid air cells and adenoids marked in axial–coronal–sagittal planes were calculated. The patients were grouped into three categories according to adenoid tissue volume, total mastoid volume (TMV), and age. Results No significant difference was noted between the right mastoid volume (RMV) and the left mastoid volume (LMV) or between age and sex ( p = 0.368; p = 0.549; p = 0.454). The incremental increase in adenoid tissue volume did not correlate with TMV ( r = −0.161, r = −0.279, r = 0.015). The incremental increase in TMV did not correlate with the volume of adenoid tissue ( r = 0.024, r = 0.148, r = 0.017). Conclusions No significant correlation was obtained between the incremental increase in adenoid tissue volume and TMV or the incremental increase in TMV and adenoid tissue volume. There does not seem to be a developmental relationship between adenoid tissue volume and TMV.

Udgivelsesdato: 2010 HYPOTHESIS:: Middle ear pressure (MEP) is actively regulated by both the Eustachian tube and the mastoid air cell system. BACKGROUND:: MEP is a highly significant factor involved in many clinical conditions related to otitis media. Basic knowledge on its overall regulation remains insufficient, but the Eustachian tube and mastoid gas exchange are important factors. The main focus has been aimed at the tube; however, evidence points to the mastoid as equally important. More detailed methods are demanded to study their complementary functions. METHODS:: A catheter was inserted into the mastoid of 12 human volunteers (patients for parotidectomy). This enabled monitoring MEP directly, and experiments were performed with volume displacements of +/-50, 100, and 200 mul resulting in a range of overpressure and underpressure. The following counter-regulation was recorded over 10 minutes. RESULTS:: In some cases, MEP counter-regulation presented as Eustachian tube openings with steep and fast pressure changes toward 0 Pa, whereas in others, gradual and slow pressure changes presented related to the mastoid; these changes sometimes crossed 0 Pa into opposite pressures. In many cases, combinations of these distinct mechanisms were found. CONCLUSION:: The human mastoid as well as the Eustachian tube was capable of active counter-regulation of the MEP in short-term experimental pressure changes in healthy ears. Thus, these 2 systems seemed to function in a complementary way, where the mastoid was related to continuous regulation of smaller pressures, whereas the tube was related to intermittent regulation of higher pressures.

The middle ear (ME) surface area/volume ratio (SA/V) is greater than that of the tympanum. The rate of ME pressure decrease is proportional to the ME SA/V. The mastoid air-cell system (MACS) will not function as an ME gas reserve unless the blood perfusion/surface area is much greater for the tympanum than the MACS and decreases as MACS volume increases.To measure the MACS and tympanum surface areas and volumes and ascertain whether the MACS could function as an ME gas reserve.Twenty adult subjects with a wide range of MACS volumes underwent CT of their MEs. The left and right surface areas and volumes of the tympanum and MACS were reconstructed and entered into a simple perfusion-limited model of transmucosal gas exchange. In this model the MACS would be a gas reserve if ME SA/V was less than the tympanum SA/V or equivalently, if their ratio was less than a critical value of 1.Both MACS and tympanum SA were linearly related to their volumes. MACS SA/V and the ME SA/V were significantly greater than those for the tympanum. Inputting the measured values into the model yielded a critical value of 1.4, which was significantly greater than 1.