fm 1/7/09 12:23 PM Page i Imaging of the Temporal Bone Fourth Edition fm 1/7/09 12:23 PM Page ii fm 1/7/09 12:23 PM Page iii Imaging of the Temporal Bone Fourth Edition Joel D. Swartz, MD President Germantown Imaging Associates Gladwyne, Pennsylvania Laurie A. Loevner, MD Professor of Radiology and Otorhinolaryngology—Head and Neck Surgery Department of Radiology Neuroradiology Section University of Pennsylvania School of Medicine and Health System Philadelphia, Pennsylvania Thieme New York • Stuttgart fm 1/7/09 12:23 PM Page iv Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Executive Editor: Timothy Hiscock Editorial Assistant: David Price Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Production Editor: Heidi Pongratz, Maryland Composition Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Thomson Digital Printer: The Maple-Vail Book Manufacturing Group Library of Congress Cataloging-in-Publication Data Imaging of the temporal bone / [edited by] Joel D. Swartz, Laurie A. Loevner.– 4th ed. p. ; cm. Rev. ed. of: Imaging of the temporal bone / Joel D. Swartz, H. Ric Harnsberger. 3rd ed. 1998. Includes bibliographical references and index. ISBN 978-1-58890-345-7 1. Temporal bone—Imaging. 2. Temporal bone—Diseases—Diagnosis. I. Swartz, Joel D. II. Loevner, Laurie A. [DNLM: 1. Temporal Bone—radiography. 2. Magnetic Resonance Imaging. 3. Temporal Bone—pathology. 4. Tomography, X-Ray Computed. WE 705 I31 2008] RF235.S93 2008 617'.514–dc22 2008026874 Copyright © 2009 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher's consent is illegal and liable to prosecution. 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However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in the United States 5 4 3 2 1 ISBN 978-1-58890-345-7 fm 1/7/09 12:23 PM Page v To Mrs. Charles Zale Swartz. —Joel D. Swartz To Joel Swartz—your passion, persistence, pride, and patience made this important project happen. To my family, immediate and extended—thanks for your love and support. —Laurie A. Loevner fm 1/7/09 12:23 PM Page vi fm 1/7/09 12:23 PM Page vii Contents Preface . ix Contributors . xi 1. Temporal Bone Imaging Technique . 1 Paul A. Caruso, Jennifer L. Smullen, Robert Liu, Mary Beth Cunnane, and Hugh D. Curtin 2. The External Auditory Canal and Pinna . 25 Valerie L. Jewells, Mauricio Castillo, and Craig Buchman 3. The Middle Ear and Mastoid . 58 Joel D. Swartz 4. Temporal Bone Vascular Anatomy, Anomalies, and Disease, with an Emphasis on Pulsatile Tinnitus . 247 Gul Moonis, Ann Kim, Douglas Bigelow, and Laurie A. Loevner 5. The Inner Ear and Otodystrophies . 298 Joel D. Swartz and Suresh K. Mukherji 6. Temporal Bone Trauma . 412 Edwin Y. Wang, Deborah Shatzkes, and Joel D. Swartz 7. Anatomy and Development of the Facial Nerve . 444 C. Douglas Phillips, George Hashisaki, and Francis Veillon 8. The Vestibulocochlear Nerve, with an Emphasis on the Normal and Diseased Internal Auditory Canal and Cerebellopontine Angle . 480 Christine M. Glastonbury Index . 559 fm 1/7/09 12:23 PM Page viii fm 1/7/09 12:23 PM Page ix Preface Well, it wasn't easy! But then again, very few things that Chapter 1 has accomplished that objective. Paul Caruso are worthwhile come easily. Losing a renaissance man was the lead author and he and his colleagues Jennifer such as Ric Harnsberger as an editor/contributor would Smullen, Robert Liu, Mary Beth Cunane, and Hugh Curtin certainly be expected to make any task more difficult, but provided us with a highly detailed contribution useful to 10 years between editions was more than we could have radiologists, otolaryngologists, and technologists alike. possibly anticipated! Paul was also very helpful by providing us with many Production was complicated by a number of foresee- images utilized in this book, especially those pertaining to able and unforeseeable events and was not without high normal anatomy and congenital malformations. levels of drama and anxiety as well as an obligatory high- Our good friend, Doug Phillips, spearheaded an out- wire act. But after all is said and done, this story has a standing contribution on the facial nerve for Chapter 7 happy ending. We are very proud of this authoritative with a very tight deadline and we are deeply indebted to monograph. him and his coauthors George Hashisaki and Francis Imaging of the Temporal Bone continues to evolve as a Veillon. Doug was also very helpful to us in procuring a comprehensive reference book. The text has been number of images used in this book. The editors also wish rewritten and expanded throughout, the illustrations to to thank Lucianna Ramos Taboada, Maher Abu Eid, and a large extent have been replaced by more cutting edge Sophie Riehm for their outstanding contributions. high resolution CT and MR images, and the bibliography Mauricio Castillo is a productive neuroradiologist, has been extensively updated. The index has been author, editor, administrator, and friend who took time expanded as well and is now on par with other contem- from his increasingly busy schedule along with lead porary reference books. Our main focus is centered on author Valerie Jewells to produce Chapter 2 on the external the imaging specialist, but we continue to hope that our auditory canal. clinical colleagues find our contribution of interest and Tim Larson provided considerable help with the postop- importance as well. The chapter organization remains erative middle ear and mastoid in Chapter 3. His experience identical to previous editions. If it's not broken, why and support allowed us to successfully update and expand fix it? this important section. This edition has substantially more contributors than Gul Moonis, Ann Kim, and clinical colleague and friend the previous editions. This was necessitated by a number Douglas Bigelow did a wonderful job with the subject of of factors, not the least of which are the exploding ad- vascular anatomy and tinnitus in Chapter 4, and our vances in imaging technology, as well as the increasing friend Christine Glastonbury provided an outstanding subspecialization within neuro-otology which results in contribution on imaging the cerebellopontine angle and certain facilities seeing specific types of cases more than internal auditory canal in Chapter 8. We are also indebted others. to Deborah Shatzkes and Edwin Wang for their contribution Comments from dedicated readers were the driving to temporal bone trauma, Chapter 6. force behind many of the changes in this fourth edition. We would like to take this opportunity to thank our Foremost among these suggestions was the request for superb medical illustrator, Lori Goldstein Motis, for many the introductory chapter to expand the “cookbook” of the beautiful drawings found throughout this book. approach to evaluating and imaging the temporal bone. And an enormous thank you to the entire staff at Thieme fm 1/7/09 12:23 PM Page x x Preface for their support, patience, and hard work in completing this and images that follow interesting and educational. project. And last, but not least, we especially want to thank We are greatly interested in any of our readers' our families, spouses Nina and Steve, and children Matthew comments or suggestions. Please feel free to e-mail us at and Laura, Daniel, Chuck, Benjamin, and Alexander. Where [email protected] or [email protected]. would we be without you? To the readership, we especially thank you for your Joel D. Swartz continued support. We hope that you find the information Laurie A. Loevner fm 1/7/09 12:23 PM Page xi Contributors Douglas Bigelow, MD Hugh D. Curtin, MD Associate Professor of Otorhinolaryngology—Head and Professor of Radiology Neck Surgery Department of Radiology Department of Otorhinolaryngology—Head and Neck Harvard Medical School Surgery Massachusetts Eye and Ear Infirmary University of Pennsylvania School of Medicine Boston, Massachusetts Philadelphia, Pennsylvania Christine M.