No abstract available.
Incus* ; Malleus*

In order to study the effect of middle ear malformations on energy absorbance, we constructed a mechanical model that can simulate the energy absorbance of the human ear based on our previous human ear finite element model. The validation of this model was confirmed by two sets of experimental data. Based on this model, three common types of middle ear malformations,
Ear Ossicles ; Humans ; Incus ; Malleus

OBJECTIVES: In tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not. METHODS: The 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens. RESULTS: Squamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens. CONCLUSION: In tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.
Cholesteatoma ; Epithelium ; Humans ; Malleus ; Manubrium ; Tympanic Membrane Perforation ; Tympanoplasty

OBJECTIVES: In tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not. METHODS: The 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens. RESULTS: Squamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens. CONCLUSION: In tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.
Cholesteatoma ; Epithelium ; Humans ; Malleus ; Manubrium ; Tympanic Membrane Perforation ; Tympanoplasty

BACKGROUND AND OBJECTIVES: Absence of incus is one of the most common ossicular anomalies and also frequently found in chronic otitis media or chornic otitis media with cholesteatoma. Ossiculoplasty with malleus footplate assembly (MFA) can be an excellent option in the above situations. We reviewed our procedures and evaluated the hearing results of ossiculoplasty using the MFA. SUBJECTS AND METHODS: This study retrospectively reviews a series of 32 patients who underwent MFA ossiculoplasty between September 2001 and March 2010 in an academic tertiary referral center. The autologous incus or hydroxyapatite (HA) was used as materials for reconstruction. RESULTS: Thirteen of 32 patients (40.6%) had ossicular chain anomaly, 9 patients (28.1%) had congenital cholesteatoma and 8 patients (25.0%) had chronic otitis media with cholesteatoma and 2 patients (6.3%) had chronic otitis media. The patients with ossicular chain ano-maly showed the greatest air-bone gap (ABG) closure. Overall, postoperative ABG was 17.7+/-11.7 dB at postoperative 6 months and 19.7+/-14.3 dB at postoperative 1 year, compared with preoperative ABG of 37.9+/-9.3 dB. There was no statistical difference of ABG at postoperative 12 months, 24 months between MFA using incus (n=17) and HA (n=15)(p=0.300, and p=0.563). There was no meaningful difference of postoperative ABG between the patients with combined mastoidectomy (n=10) and those without mastoidecmoy (n=22)(p=0.555). No extrusions occurred. CONCLUSIONS: MFA can be an effective option in the case of absent incus expecting good postoperative hearing results.
Cholesteatoma ; Durapatite ; Hearing ; Humans ; Incus ; Malleus ; Ossicular Prosthesis ; Otitis Media ; Retrospective Studies ; Tertiary Care Centers

Various types of ossicular chain interruption may occur in temporal bone fractures. The most common type is incudostapedial joint disruption. Incus is the most vulnerable to traumatic injury as compared with malleus or stapes, because it is suspended only by ligamentous structures and connected to the incudomalleolar and incudostapedial joints. Incus may rarely be pushed through tympanic membrane or pass through a fracture of posterosuperior external auditory canal. However, a case of complete extrusion of incus into the external auditory canal has not been reported. The author presents a rare case of incus extrusion into the external auditory canal with temporal bone fracture after head trauma.
Craniocerebral Trauma* ; Ear Canal* ; Head* ; Incus* ; Joints ; Ligaments ; Malleus ; Skull Fractures ; Stapes ; Temporal Bone ; Tympanic Membrane

PURPOSE: This study was conducted to know the applications and limitations of three dimensional volume rendering virtual endoscopy of the ossicles using a multi-row detector CT. MATERIALS AND METHODS: This study examined 25 patients who underwent temporal bone CT using a 16-row detector CT as a result of hearing problems or trauma. The axial CT scan of the temporal bone was performed with a 0.6 mm collimation, and a reconstruction was carried out with a U70u Sharp of kernel value, a 1 mm thickness and 0.5-1.0 mm increments. After observing the ossicles in the axial and coronal images, virtual endoscopy was performed using a three dimensional volume rendering technique with a threshold value of -500 HU. The intra-operative otoendoscopy was performed in 12 ears, and was compared with the virtual endoscopy findings. RESULTS: Virtual endoscopy of the 29 ears without hearing problems demonstrated hypoplastic or an incomplete depiction of the stapes superstructures in 25 ears and a normal depiction in 4 ears. Virtual endoscopy of 21 ears with hearing problems demonstrated no ossicles in 1 ear, no malleus in 3 ears, a malleoincudal subluxation in 6 ears, a dysplastic incus in 5 ears, an incudostapedial subluxation in 9 ears, dysplastic stapes in 2 ears, a hypoplastic or incomplete depiction of the stapes in 16 ears and no stapes in 1 ear. In contrast to the intra-operative otoendoscopy, 8 out of 12 ears showed a hypoplastic or deformed stapes in the virtual endoscopy. CONCLUSION: Volume rendering virtual endoscopy using a multi-row detector CT is an excellent method for evaluation the ossicles in three dimension, even though the partial volume effect for the stapes superstructures needs to be considered.
Ear ; Endoscopy* ; Hearing ; Humans ; Incus ; Malleus ; Stapes ; Temporal Bone ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: There are several factors affecting the result of the ossiculoplasty such as the severity of the pathology, the operating technique and the reconstruction material, etc. So far, most of the ossicular materials that have been developed were not perfect and some of the commercialized materials are not suitable for Koreans. We investigated the dimensions of the Korean ossicles and the space between the handle of the malleus and the plane of the stapes in order to standardize the artificial ossicles to fit Koreans. MATERIALS AND METHODS: Sixteen cadaveric Korean temporal bones which did not have any pathology of tympanic membrane and ossicles were used for this study. We dissected the temporal bones and measured the related dimensions of ossicles under a surgical microscope. RESULTS: The dimensions of the part of ossicles are as follows: (1) length (mm),1) malleus head 3.46+/-0.57, neck 0.91+/-0.17, handle 4.40+/-0.29: 2) incus short process 2.42+/-0.35, long process 3.31+/-0.57: 3) stapes head and neck 0.79+/-0.19, height of crura 2.24+/-0.34: (2) diameter (long, short) (mm), stapes head 0.95+/-0.20, 0.73+/-0.11, footplate 2.91+/-0.20, 1.38+/-0.16. The distance between the stapes head and the malleus handle was 3+/-0.3 mm, and between the stapes footplate and the malleus handle 5.1+/-0.4 mm. The angle between a line from the malleus handle to the head of stapes and a perpendicular line of stapes footplate passing the center of stapes head was 29+/-7 degree. The angle between a line from the malleus handle to the stapes footplate and a perpendicular line of stapes footplate passing the center of stapes head was 17+/-5 degree. CONCLUSION: We collected normal data of dimensions of the Korean ossicles from cadaveric temporal bones. The differences in the dimensions between ossicles of the Korean and the non-Koreans were observed. The observed data from this study should be useful in the development of the artificial ossicular materials suitable for the Koreans.
Cadaver ; Head ; Incus ; Malleus ; Neck ; Pathology ; Stapes ; Temporal Bone ; Tympanic Membrane

The anterior process of the malleus (process of Folius) in the middle ear develops through an intramembranous ossification center that appears in the human embryo of 26.5 mm crown-rump length at a caudomedial position in relation to Meckel's cartilage. We present one case of an ossicular anomaly considered to consist of an abnormality of the anterior process and manubrium mallei (malleus handle). In this case, a thick bony bar was found extending from the neck of the malleus and abnormally developed an anterior process of the malleus to the posterior bony wall or the tympanic bone. In the anterior part, a thick bony bar was also found in the anterior bony wall connecting with the malleus neck and the anterior process of malleus, which was abnormally developed by fibrous tissue. The manubrium mallei and the umbo were not identified and the anterior process of the malleus was recognized as an abnormally developed bony fragment. On the basis of these findings, the bony bar was assumed to represent an abnormally developed mesenchyme bone (os goniale), which later developed into the anterior process of the malleus.
Cartilage ; Crown-Rump Length ; Ear, Middle ; Embryonic Structures ; Hearing Loss, Conductive* ; Humans ; Malleus ; Manubrium ; Mesoderm ; Neck

BACKGROUND AND OBJECTIVES: Anatomical knowledge of microsurgical anatomy of the perigeniculate ganglion area is essential to the exploration of the facial nerve via translabyrinthine approach or middle fossa approach. This study was designed to investigate the surgical anatomy of the perigeniculate ganglion area of the facial nerve in view of translabyrinthine and middle fossa approach. MATERIALS AND METHOD: We dissected 15 human cadaveric temporal bones under a microscope and measured the lengths of the proximal part of tympanic segment, the labyrinthine segment, and the angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach. We dissected 20 human temporal bones under a microscope using a middle fossa approach, and measured the angle between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion. RESULTS: The distance of facial nerve from the cochleariform process to the geniculate ganglion was 3.8+/-0.7 mm. The length of the labyrinthine segment of facial nerve was 4+/-0.8 mm. The angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach was 26+/-5degrees. The angles between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion were found to be 23+/-2degreesand 6.5+/-0.3 mm, respectively. CONCLUSION: Precise knowledge about the microsurgical anatomy of the perigeniculate ganglion area of facial nerve is imperative for facial nerve decompression by a translabyrinthine and middle fossa approach.
Cadaver ; Cranial Fossa, Middle ; Decompression ; Facial Nerve* ; Ganglion Cysts* ; Geniculate Ganglion ; Head ; Humans ; Malleus ; Temporal Bone