Surgical Anatomy of the Temporal Bone

Abstract

Numerous neurological lesions and tumors of the paranasal sinuses and oral cavity may spread into the middle and posterior cranial fossae through the anatomical apertures. For the appropriate management of these pathologies, many extensive surgical approaches with a comprehensive overview of the anatomical landmarks are required from the maxillofacial surgery's point of view. The surgical significance lies in the fact that iatrogenic injury to the petrous segment of the temporal bone including the carotid artery, sigmoid sinus, and internal jugular vein, can lead to surgical morbidity and postoperative pseudoaneurysm, vasospasm, or carotidcavernous fistula. To simplify understanding complex anatomy of the temporal bone, we aimed to review the surgical anatomy of the temporal bone focusing on the associations between the surface landmarks and inner structures. Also, breaking down an intricate bony structure into smaller parts by compartmental approach could ease a deep concentration and navigation. To identify the anatomic architecture of the temporal bone by using reference points, lines and compartments can be used to supplement anatomy knowledge of maxillofacial surgeons and may improve confidence by surgical trainees. Especially, this systematic method may provide an easier way to teach and learn surgical spatial structure of the petrous pyramid in clinical applications.

Spring-Assisted Surgery of Unilambdoid Craniosynostosis

“…This can be explained by the normal development of the mastoid processes, which are absent at birth but undergo rapid growth during the first year of life. [25][26][27] Furthermore, the most inconsistent measurement was FT due to the difficulty in defining the chin point, which led to inconclusive results. Contrary to Ploplys et al, 4 who described the chin point as always pointing away from the closed suture, the chin points of patients in the present study varied greatly from pointing away from or toward the closed suture.…”

“…In addition, the mastoid processes were not always present (especially on the preoperative scans), which could lead to inconclusive results regarding the change in SBC. This can be explained by the normal development of the mastoid processes, which are absent at birth but undergo rapid growth during the first year of life 25–27 . Furthermore, the most inconsistent measurement was FT due to the difficulty in defining the chin point, which led to inconclusive results.…”

Improved Facial and Skull-base Symmetry Following Osteotomy and Distraction of Unilateral Coronal Synostosis

“…Regarding skull base cant, because of the natural development of the mastoid processes, which are absent at birth but grow rapidly during the first year, the extent of ACFC was sometimes hard to calculate, especially using preoperative CT scans. [41][42][43] Moreover, given that these measurements represent visual estimates and are subsequently prone to inconsistencies, a potential compensation could involve several observers performing the same measurements. However, ICC analysis showed that the variability within the same patient was much lower than that between patients, suggesting the reproducibility of the measurements and the adequacy of the previously defined reference points used for the measurements.…”

Morphometric and Topographic Evaluation of the Suprameatal (Macewen) Triangle

“…Bu iki yapının uçlarını birleştiren hayali bir çizgi üçgeni tamamlar. Suprameatal üçgenin üst sınırını (üst kenarını) oluşturan suprameatal tepe, fossa cranii media tabanını ve bu noktada yer alan dura mater cranialis'in açılanmasını temsil etmektedir (1)(2)(3)(4). Linea temporalis, fossa cranii media'da dura mater'in hemen altında ve cellulae mastoideae üzerinde kemikli bir plaka olan tegmen tympani'ye karşılık gelmektedir.…”

“…Suprameatal (Macewen) üçgendeki kribriform alanı, antrum mastoideum mukozasının damarları için bir geçit görevi gören çok sayıda küçük foramenle delinmiştir. Bu nedenle üçgenin kenarlarındaki diseksiyon nörovasküler yapıların olmaması nedeniyle daha güvenli görülmektedir (1,6). Suprameatal çıkıntının temel işlevi cartilago auricularis'lerin yani kulak kıkırdaklarının tutunma yerini oluşturmaktır (8).…”