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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4399_Библиотеки_им_академика_М_И_Перельмана
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Temporal Bone Histology and Radiology Atlas146
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VERTICAL SECTION 5
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Temporal Bone Histology and Radiology Atlas150
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VERTICAL SECTION 6
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Temporal Bone Histology and Radiology Atlas154
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VERTICAL SECTION 7
Moving further anteriorly, the reader will see that the
anterior tympanomeatal angle is at its end. The protympanum is coalescing into the osseous Eustachian
tube. The facial nerve is at its geniculate ganglion. Just
inferior to that on the histologic section is seen the tensor tympani muscle just as it turns at the cochleariform
process to become the tendon that will then attach to
the neck of the malleus. The cochlear promontory is
seen with the dense bone of the otic capsule around
the cochlea. The transverse crest of the lateral internal
auditory canal, which separates the superior structures
from the inferior structures, is seen clearly in the histologic section. On the CT scan, the carotid artery is seen
anteromedially and its relationship to the medial wall
of the bony Eustachian tube is clear, while the jugular
bulb is seen posteriorly.
VERTICAL SECTION 8
portion of the IAC. In this cut, the nerves seen separated by the transverse crest are the superior and inferior vestibular nerves. The singular nerve, supplying
the crista of the posterior semicircular canal, is seen
just before it joins the main vestibular nerves.
On the CT image, the relationship between the ET,
the tensor tympani muscle, the carotid artery, and the
cochlea is seen. The jugular bulb is seen rising inferior
to the IAC.
CLINICAL CAVEAT: The jugular bulb may be highriding. In the middle ear, a high-riding jugular bulb
can be seen rising from the hypotympanum behind
an intact tympanic membrane. It must be appreciated in order not to be mistaken for an effusion and
should not be incised with a myringotomy blade.
The jugular bulb can also be high-riding at the IAC
and must be considered when planning surgical approaches to the IAC.
Proceeding further anteriorly, the histologic images
show the large bony opening of the Eustachian tube
from the protympanum. The tensor tympani muscle
occupies its semicanal superiorly and medially in the
bony ET. The facial nerve is seen just distal to and just
medial to the geniculate ganglion. The section through
the lateral internal auditory canal (IAC) shows the
transverse crest of the IAC which separates the superior (superior vestibular and facial) from the inferior
(inferior vestibular and cochlear) nerves in the lateral
CLINICAL CAVEAT: For cochlear implant planning where there is concern regarding possible ossification of the cochlear lumen, MR imaging will
establish whether there is cochlear patency. It is likewise useful when there is question regarding presence or absence of the cochlear nerve in the IAC. The
gantry angle can be configured such as to obtain an
imaging “cross-section” of the IAC and count the
nerves inside it.
8. Vertical Temporal Bone Sections with Corresponding Radiographic Images 155
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VERTICAL SECTION 9
Even more anteriorly, in the histologic section, the Eustachian tube, with iter chordae anterior (the anterior
bony canal of the chorda tympani nerve) anteriorly and
the tensor tympani muscle posterosuperiorly, is seen.
All 2¾ turns of the cochlea are visible. The ganglion
of the cochlear nerve is found in the modiolus, and
that structure is demonstrated here. The internal auditory canal is seen, as are the jugular bulb and hypotympanic air cells. MRI of the cochlea and internal
au ditory canal delineates the fluid density inside the co chlea, the structures inside the internal auditory canal,
and the relationship to the cerebrum and cerebellum.
VERTICAL SECTIONS 10 AND 11
As we come to the most medial vertical histological
sections, we conclude with the cochlea and end up
at the petrous carotid artery and osseous Eustachian
tube. This would not be seen surgically other than in
cases of transcochlear lateral skull base surgery for either malignancy or severe vascular tumor.
The anterior-most section through the cochlea and
IAC show its relationship to the ET and tensor tympani
muscle. The iter chordae anterior continues to be visible.
The jugular bulb is also seen.
Anterior to the cochlea, the carotid artery is seen.
The medial wall of the bony ET is the carotid artery.
CLINICAL CAVEAT: The bone can be dehiscent
leaving only soft tissue between the lumen of the ET
and the carotid. This is of concern when manipulating the ET; however, surgical, laser or balloon dilatation of the ET for ET dysfunction is performed in
the cartilaginous ET and not past the isthmus between the cartilaginous and bony ET.
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