HRCT Temporal bone anatomy
Planes of scanning Axial
30 Degrees to anthropological base line Parallel to lateral SCC. Best displays inner & middle ear. Sections parallel to the hard Palate
Direct Coronal plane patient head extended in prone or supine with 105 degree plane is perpendicular to the lateral SCC Sections are parallel to posterior wall of maxillary sinus
Saggital plane
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105
0
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Temporal Bone
1.Squamous
2.Petrous
3.Mastoid
4.Tympanic
5. Styloid
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Lateral wall of MCF
Mastoid air cells
Encloses Labyrinth
Forms bony EAC
Forms Styloid process
EAR IS DIVIDED INTO 3 PARTS
• EXTERNAL EAR
• MIDDLE EAR
• INTERNAL EAR
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EAC
Tympanic cavity
Bony & membranous labyrinth
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EXTERNAL EAR
External auditary canal- 2.5 cms in length
Cartilaginous Lateral 1/3rd
Osseous Medial 2/3rd
Tympanic membrane-makes 55 degree angle With floor of the meatus
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Boundaries & Communications Of Middle Ear
Roof- Tegmen tympani Separates from MCFFloor-thin convex bone separating from superior bulb of IJVLateral wall-tympanic membraneMedial wall – separates from inner ear
Anteriorly -auditory tube
Posteriorly –mastoid antrum
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1)PROMOTARY- Round bulge produced by basal turn of cochlea
2)FENESTRA OVALIS -Lies postero- superior to promontory & connects middle ear with vestibule and is occupied by footplate of stapes
3)FENESTRA ROTUNDA- Posteroinferiorly to oval window & connects ME with scala tympani of cochlea.
4)PROMINENCE OF FACIAL NERVE CANAL -Runs backwards just above the oval window to reach the lower margin of aditus.
Medial wall of middle ear:
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ANTERIOR WALL
1) Superior-opening of canal for tensor tympani.
2) Middle –opening of auditory tube.
3) Inferior-thin plate of bone separating from carotid canal.
POSTERIOR WALL
1) Aditus to mastoid
2) Fossa incudis-lodges the short process of incus.
3) Pyramidal eminence-attachment for stapedial tendon.
• The scutum is normally thin and sharply edged; and is an important bony landmark as it is one of the bony structures eroded early by a cholesteatoma.
• • Scutum, the tympanic membrane and the tympanic
annulus are best demonstrated on coronal images at the mid bony portion of the external auditory canal.
Middle Ear
• three compartments in coronal plane.
• A line drawn from lower edge of the scutum to the tympanic portion of the facial nerve -epi/mesotympanum.
• parallel to the floor of the external auditory canal meso/hypotympanum
Epitympanum
It contains :• Head of the malleus• Malleo–incudal
articulation• Body and short process
of the incus,• Short process of Incus
projects posteriorly towards aditus.
These structures are best demonstrated on axial images.
• Tegment tympani – roof of epitympanum – barrier between middle cranial fossa and middle ear cavity.
• Best evaluated on coronal images
• Posteriorly the epitympanum opens into the mastoid antrum via the aditus ad antrum; demonstrated on both the axial and coronal images
Mesotympanum
• The mesotympanum contains the ossicular chain
• Oval and round window
• Long process of the Incus
• Stapes • Handle of Malleus • Facial nerve Canal
• The ice-cream cone sign represents the normal appearance of the malleus and incus on an axial high-resolution CT scan (HRCT) image of the temporal bone .
• The ball (scoop) of the ice cream is formed by the head of malleus and the cone is formed by the body of the incus.
• The space between the ice-cream cone and the scutum is called Prussak's space.
• On coronal images the long process of incus is vertically oriented parallel to the long process of malleus, continuing as the rounded lenticular and the facet to articulate with the head of the stapes
• The stapes hub and crura are best demonstrated on axial images at the level of the oval window
• The stapes footplate sits in the oval window niche and cannot always be discretely identified on CT.
MALLEUS
• Epitympanum: Headarticulates with body of Incus( Ice Cream Cone )
• Mesotympanum: Neck andHandle.
INCUSžMesotympanum: Longprocess
(LPI) articulates with head of Stapes.
žEpitympanum: Short process is the most posterior part and points towards aditus.
Body
and Shortprocess ofIncus
Stapes
The stapes is the smallest bone in the body.
Head ,neck, crura (anterior and posterior) and a footplate.
St T- Stapedius tendon
Axial Section at Mesotympanum
• Two parallel structures
• Anteriorly: Neck and Handle ofMalleus(H)
• Posteriorly: Long process ofIncus (LPI)
• Anteriorly: Head andhandle of Malleus
• Posteriorly: Long processof Incus (LPI)
Coronal section Mesotympanum
At the posterior wall of the mesotympanum
• bony protuberance - pyramidal eminence- stapedius muscle exits to its attachment at the neck of the stapes
• Lateral to it - facial recess for descending (mastoid) segment of the facial nerve
• Medial to it - sinus tympani - a blind spot for the surgeon during transmastoid surgery and so cholesteatoma at this site may be overlooked
Medial Wall• Promontory - a bony
prominence on the medial wall of the mesotympanum - protrusion of the basal turn of the cochlea.
• Above the promontory is the oval window and posteroinferior to which is the round window niche
Anterior wall•
The anterior wall has a thin plate of bone which separates this portion from the internal carotid artery as it enters the skull.
• Always look for bone covering ICA.
• 2 openings in anterior wall • Upper : canal for tensor
tympani (Stt) • Lower : Eustachian tube (Et) • Axial section is best for
Eustachian tube, semi canal and carotidcanal.
Semi canal for tensortympani (Stt)
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Inner ear- Osseous & Membranous
Osseous- vestibule Semicircular canals Cochlea
• Cochlea• The perilymphatic space of
vestibule is continuous with the cochlea anteriorly.
• The cochlea is a conical structure,extends for 2.5-2.75turns
• Promontory (P) is the projection raised by the basal turn of cochlea.
• The basal turn opens into the round window niche
Coronal
Middle turn
Axial
• The vestibule consists of the superior utricle and the inferior saccule.
• The semicircular ducts open into the utricle.
Axial coronal
• SSC
PS
PSC
SSC
• The cochlear aqueduct contains the perilymphatic duct while the vestibular aqueduct contains the endolymphatic duct and the intraosseous portion of the endolymphatic sac.
• The internal auditory canal shows considerable individual variation in size and configuration but should be symmetrical in any one person
• The medial opening - porus acousticus. • Divided at its most lateral end by the horizontal
crista falciformis and vertical crests into four compartments.
• The facial nerve is in the anterosuperior compartment, the cochlear nerve is in the anteroinferior compartment while the superior and inferior vestibular nerves are in posterior superior & inferior compartments,
Facial Nerve
• VII n:-– Intracranial segment– Labyrinthine segment– Tympanic segment– Mastoid portion– Parotid segment
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• The facial nerve, from the lateral end of the internal auditory canal enters the petrous bone as the labyrinthine portion running anterolaterally, superior to the cochlea and towards the anterior genu (geniculate ganglion).
• Then it makes an abrupt turn to run posterolaterally along the medial attic wall beneath the lateral semicircular canal as the tympanic portion towards the posterior genu.
• And finally turns inferiorly as the descending (mastoid) portion to exit at the stylomastoid foramen.
How to identify Facial nerve canal?
• Axial: at level of Epitympanum, it is seen as a linear structure medial to ice-cream cone.
• Coronal: At level of OW, it is seen as a round structure with bony outline between OW inferiorly and Lateral Semicircular canal (LSC)superiorly.
Coronal: A
Sigmoid plate -thin bone separating the sigmoid sinus from adjacent structures (especially mastoid air cells).
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Axial sections- caudal to cephalad
1.Axial hypotympanic-jugular foramen level
1)carotid canal & jugular Fossa forming snowman Configuration
2)opening of auditary Tube
3)petrooccipital fissure
4)TM joint and mandibular Condyle
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Carotid canal
Jugular fossa
Auditory tube
Temporo mandibular jt
Petro occipital fissure
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2.Axial inferior tympanic level
1)ant &post walls of EAC
2)descending facial nerve canal
3)carotid canal
4)cochlear aqueduct
5)long process of Malleus.
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Descending facial nerve
Cochlear aqueduct
EAC
Promontory
canal For tensor tympani
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3.Axial mid tympanic level
1)neck of malleus ,long process of incus and stapes
2)semicanal for tensor tympani
3) 3 turns of cochlea
4)facial nerve canal
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malleus
incus
stapes
Round window
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Oval windowIAC
Scala tympani
Facial recess
4. Axial Epitympanic IAC level
• Ice-cream cone appearance-head of malleus and body of incus
• Stapes –occasionally seen articulating with oval window.
• Internal auditory canal
• Descending facial nerve canal
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Ice cream cone appearance
Facial nerve canalInternal auditory canal
5. Axial lateral semicircular canal level
• 1)mastoid antrum and its aditus & Koerner’s septum
• 2) lateral semicircular canal and vestibule
• 3) post semicircular canal &vestibular aqueduct
• 4) IAC
• 5) sq part of temporal bone.
• 6) geniculate ganglion55
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LATERAL SC CANALVESTIBULE IAC
PROXIMAL LIMB OF 7TH N
ADITUS TO MASTOID ANTRM
VESTIBULAR AQUEDUCT
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CORONAL SECTIONS1. Coronal anterior tympanic level
-Head of malleus-Tegmen tympani-Basal & 2nd turn of Cochlea-Geniculate ganglion- scutum
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COCHLEAIAC
HEAD OF MALLEUS
SCUTUM
GENICULATE GANGLIASQ TEMPORAL BONE
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2.Coronal mid-tympanic level
-L shaped incudo-stapedial articulation
-Stapes
-Oval window
-Tegmen tympani
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IAC
Oval Window
Incus in aditus
Stapes
Tegmen tympani
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3.CORONAL OVAL WINDOW LEVEL
•IAC
•Oval window
•Stapes
•Lateral SCC
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Vestibule
IAC
Sup SCC
Antrum
Lateral SCC
Oval window
Middle earEAC
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5.Coronal jugular foramen level
•Jugular foramen
•Descending facial Nerve
•Mastoid antrum
•Occipital bone and atlas
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Jugular fossa
Descending facial nerve
Mastoid Air Cells
Role of MRI
• Excellent in studying Inner ear– Membranous labyrinth– Vestibule– Saccule & utricles
• Preoperative evaluation in pts for Cochlear implants• To evaluate CP angle tumors• To evaluate Neurovascular bundles• Functional assessment – Nerve stimulation• Virtual scopy
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7 & 8th nerve complex
Cochlea