Osteitis of the Petrous Pyramid of the Temporal Bone: Associated With Paralysis of the External Rectus

In modern surgical operations on the mastoid one of the prime considerations of the operator is the complete exenteration of all the cellular structure. It is an accepted fact that the incomplete operation prolongs the morbidity greatly, and also that the incidence of otitic complications is much higher in the incompletely performed operations than in the complete ones. By complete operation we mean the type first popularized by Schwartze1 and later modified by Gruening,2 Whiting3 and Friesner.4 At the end of the complete operation the surgeon should be able to see clearly the external semicircular canal, a clean initial groove, a clean sinus plate, the middle fossa plate, the digastric muscle, the mastoid tip removed and a cleanly exenterated zygoma. In this communication we are concerned chiefly with the consideration of the zygoma. ANATOMYThe zygomatic (old term, malar) bone forms the prominent part of the cheek ; it is located lateral to and below the orbit, and it forms the lateral border of the orbital cavity. It rests on and is united to the maxilla below. Behind, it enters into the formation of the zygomatic arch. The zygomatic bone has three surfaces, namely, the malar, the orbital and the temporal ; and two processes, the frontosphenoidal and the temporal. The temporal process projects backward and articulates From the otologic service of Dr. I. Friesner, Mount Sinai Hospital.

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