Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries

BACKGROUND AND PURPOSE

The prevalence of tympanic plate fractures, which are associated with an increased risk of external auditory canal stenosis following temporal bone trauma, is unknown. A review of posttraumatic high-resolution CT temporal bone examinations was performed to determine the prevalence of tympanic plate fractures and to identify any associated temporal bone injuries.

MATERIALS AND METHODS

A retrospective review was performed to evaluate patients with head trauma who underwent emergent high-resolution CT examinations of the temporal bone from July 2006 to March 2012. Fractures were identified and assessed for orientation; involvement of the tympanic plate, scutum, bony labyrinth, facial nerve canal, and temporomandibular joint; and ossicular chain disruption.

RESULTS

Thirty-nine patients (41.3 ± 17.2 years of age) had a total of 46 temporal bone fractures (7 bilateral). Tympanic plate fractures were identified in 27 (58.7%) of these 46 fractures. Ossicular disruption occurred in 17 (37.0%). Fractures involving the scutum occurred in 25 (54.4%). None of the 46 fractured temporal bones had a mandibular condyle dislocation or fracture. Of the 27 cases of tympanic plate fractures, 14 (51.8%) had ossicular disruption (P = .016) and 18 (66.6%) had a fracture of the scutum (P = .044). Temporomandibular joint gas was seen in 15 (33%) but was not statistically associated with tympanic plate fracture (P = .21).

CONCLUSIONS

Tympanic plate fractures are commonly seen on high-resolution CT performed for evaluation of temporal bone trauma. It is important to recognize these fractures to avoid the preventable complication of external auditory canal stenosis and the potential for conductive hearing loss due to a fracture involving the scutum or ossicular chain.

Septation and differentiation of the embryonic human cloaca

BACKGROUND/PURPOSE

Limitations in methodologies have fostered controversy regarding the septation of the human embryonic cloaca. The aim of this study was to evaluate the septation of the human embryonic cloaca.

METHODS

Using the Carnegie Embryological Collection and specimens at Johns Hopkins, Baltimore, MD, the authors studied 12 embryos and five fetuses. Embryo photomicrographs were reconstructed using three-dimensional modeling.

RESULTS

In Carnegie stage 13 the authors observed a cloaca, distinct primitive urogenital sinus, and anorectum separated by the urorectal septum. The primitive urogenital sinus and anorectum enter the cloaca separated from the amniotic space by the cloacal membrane. As the embryo becomes a fetus it lengthens, grows, expands and rotates through a process called transformation. Transformation gives rise to a loss of caudal curvature and a decrease in distance between the septum and membrane, but these structures do not fuse. Disintegration of the cloacal membrane produces openings for the urogenital sinus and anorectum.

CONCLUSIONS

The observations suggest that the urogenital sinus and anorectum form early and are separated by the urorectal septum as a passive structure. There does not appear to be septation or differentiation of the cloaca itself.