Osteoma of Temporal Bone: A Case of Post Aural Swelling

Osteoma of Temporal Bone: A Case of Post Aural Swelling Introduction:- Osteomas are benign tumours of the lamellar bones. In routine ENT practice they are commonly seen as dense radio opaque shadows arising from within the paranasal sinuses. Osteoma of the temporal bone occurs infrequently, and when they occur, are seen most common in the external ear canal. Osteoma originating from the middle ear is very rare. That from the mastoid are rarer. We document such a rare presentation of osteoma arising from the mastoid. Case report:- Presenting case of a previously healthy 32-year-old woman, referred to the ENT clinic for assessment of a left retroauricular mass that had been slowly increasing in size for past 1 year. This patient was asymptomatic, but reported unsightly appearance of this mass. On examination, she was found to have a 3 cm X 3cm globular hard bony swelling above and behind the left mastoid process fixed to the underlying bone. It was non tender. Detailed ENT examination including facial nerve function was normal. There were no bony exostoses in the external ear canal. CT scan of the petrous temporal bones demonstrated a bone tumour arising from the left mastoid cortex with no other associated abnormality of the petrous temporal bone, suggesting a typical mastoid osteoma (Fig. 2). Surgical resection was performed under local anaesthesia via a retroauricular incision. Following skin dissection and exposure of the bone tumour, the tumour was completely resected by a mastoid drill with cutting burr(fig 3a,b,c). Finally the edges of the bone were polished with a round burr and the incision closed in layers. She had an uneventful postoperative period(fig 4). Histopathology confirmed an osteoid osteoma(fig 5). Discussion:- Osteoma is a slow growing tumor formed by mature bone tissue. Osteoid osteoma is a primary bone tumor accounting for 10% of all primary bone tumors.1  It mostly occurs in long bones. In the skull it mainly affects the  frontoethmoid region. Very uncommonly it affects the temporal bone.  They are rare in the sphenoid sinus and extremely rare on temporal and occipital squama.2 In the temporal region, osteomas are essentially reported in the external auditory canal, or more rarely in the middle ear,along the auditory canal or the styloid process, in the temporomandibular joint, in the apex of the petrous temporal bone or in the internal auditory canal 3 and only exceptionally in the mastoid 4. It has higher incidence in female patients,predominantly in the 2nd and 3rd decade of life and is rare in puberty. 6 As illustrated by the case reported here, osteomas arising from outer cortex of the mastoid are associated with minimal or no symptoms. They are essentially responsible for unsightly deformity of the retroauricular region, or even detachment of the external ear in the case of a very large, anterior tumour. Mastoid osteomas can cause local tenderness and interfere with wearing glasses. Even though it is normally asymptomatic it may produce pain by invasion of surrounding structures or widening of periosteium.If located in the external auditory canal it may lead to occlusion progressing to chronic otitis externa (30% of cases) and conductive hearing loss7,8.In the present case patient did not have any complaints and swelling was removed for cosmetic reasons. While the exact etiology of osteomas is not well understood, they are thought to arise from preosseus connective tissue. There is some evidence that osteomas are of congenital nature 9. The most widely accepted theories for the etiopathogenesis of osteomas include embryogenesis and metaplasia following recurrent local irritation and trauma. Three types of mastoid osteomas have been described, based on structural characteristics.10,11,12 †¢ Compact: The most frequent one. Comprising dense, compact and lamellar bone, with few vessels and Haversian canals system. Those with dense sclerotic bone are called ivory osteoma. Compact osteomas have a wider base and are very slow growing †¢ Cartilaginous: Comprising bone and cartilaginous elements †¢ Spongy: Rare type. Comprised by spongy bone and fibrous cell tissue,with tendency to expand to the diploe and involving the internal and external lamina of the affected bone, have bone marrow and also known as cancellous or osteoid osteomas. They are more likely to be pedunculated and grow relatively faster. †¢ Mixed: Mixture of spongy and compact types. It is important to differentiate osteomas from exostoses. They should be considered separate clinical entities. Osteomas are bony growths that are single,unilateral and pedunculated and arise from the tympanosquamous or tympanomastoid suture lines laterally, whereas exostoses are multiple, usually bilateral and broad based and are found medial to the sutures of the temporal bone 13. Osteomas are true bone tumors and exostoses are thought to be a reactive condition secondary to multiple cold-water immersions or recurrent otitis externa. Disagreement still exists whether external auditory canal exostoses and osteoma should be considered as separate histopathological entities. JE Fenton et al in their study have concluded that they cannot be differentiated on routine histopathological examination 14. Osteoma occurrence may be syndromic or non syndromic. They may occur as a feature of Gardener’s syndrome, which is characterized by multiple intestinal polyps, epidermoid inclusion c ysts, fibromas of the skin and mesentery and osteomas. Osteomas in Gardener’s syndrome have a predilection for membranous bones and as such the mandible and maxilla are more commonly involved 15. Non-contrast computed tomography of the petrous temporal bones is the examination of choice for diagnosis and staging. It reveals a rounded bone lesion of the outer cortex of the mastoid, with regular margins, with a pedunculated or sessile implantation base. Superficial mastoid osteoma presents no signs of intrapetrosal extension and the mastoid air cells remain perfectly aerated. In rare cases, the osteoma can extend medially into the petrous temporal bone adjacent to the facial nerve, lateral semicircular canal or ossicles. In these cases, imaging can define the anatomical relations with these structures before considering surgical resection 3,4,16-18. Imaging is also useful to define the differential diagnosis between osteoma and other mastoid bone tumours, especially osteosarcoma, bone metastases, multiple myeloma, giant cell tumour, lesions encountered in Paget’s disease or fibrous dysplasia 3,4. Signs suggestive of a malignant lesion are rapid growth, pain and a poorly delimited, heterogeneous, osteolytic appearance on CT. Treatment is indicated for osteomas that are symptomatic or cosmetically unacceptable. Excision or drilling of superficial lesions of the mastoid and squama is a simple procedure. At surgery, since the lesions are always limited to the external cortex a cleavage plane is always encountered when tumor meets normal bone19. In mastoid osteomas extending into the fallopian canal and bony labyrinth, complete excision is not indicated since there may be damage to these structures .Follow up is needed in cases where partial excision is  done or where expectant treatment is adopted. Surgical resection usually raises few technical problems: retroauricular incision adapted to the size of the lesion, exposure of the osteoma, then resection with a bone chisel or curette or by reaming, depending on the size of the osteoma and its sessile or pedunculated implantation. A retroauricular subcutaneous depression may be observed after the operation 20. Conclusions:- Osteomas are tumors predominantly arising from the long bones and rarely from the flat bones of the skull. When present they should be treated as per the symptoms of the patient. Osteomas present within the ear need to be dealt carefully, for fear of damage to vital structures.Osteomas present on the mastoid or squamous portion of the temporal bone need to be dealt for cosmetic purposes or if they are causing symptoms. References:- 1. Kransdorf MJ, Stull MA, Gilkey FW, et al. Osteoid osteoma. Radiographics 1991; 11:671 -96 2. Sente M, Topolac R, Peic-Gavran K, Aleksov G. Frontal sinus osteoma as a cause of purulent meningitis. Med Pregl 1999;52(3-5):169-72 3. Dominguez Pà ©rez AD, Rodrà ­guez Romero R, Domà ­nguez Durà ¡nE, Riquelme MontaËÅ"no P, Alcà ¡ntara Bernal R, Monreal Rodrà ­guezC. El osteoma en la mastoids, ActaOtorrinolaringol Esp 2011;62:140—3. 4. KimCW, Oh SJ, Kang JM, Ahn HY. Multiple osteomas in the middle. Eur Arch Otorhinolaryngol 2006;263:1151—4. 5. D’Ottovai LR, Piccirillo E, De Sanctis S, et al. Mastoid osteomas: review of the literature and presentation of two clinical cases.Acta Otorinolaringol Ital 1997;17:136—9. 6. Dugert E, Lagleyre S, Brouchet A, Deguine O, Cognard C, Bonneville F. Osteoid Osteoma Invading the Posterior Labyrinth of the Petrous Bone AJNR Am J Neuroradiol. 2010 Oct;31(9):1764-6 7 .Gupta OP, Samant IC. Osteoma of mastoid.laryngoscope 1972;82:172-6 8. Bruton DM,Gonzalez C.Mastoid osteoma.Ear Nose Throat J 1991;70:161-2 9. Yamasoba T, Harada T, Okunao T, Nomura Y. Osteoma of themiddle ear. Report of a case. Arch Otolaryngol Head Neck Surg 1990;116:1214-6. 10. Varshney S. Osteoma of temporal bone. Indian J of Otol 2001;7:91-2. 11. Probost LE, Shanken L, Fox R. Osteoma of the mastoid bone. J Otolaryngol 1991;20:228-30. 12. Singh I, Sanasam JC, Bhatia PL, Singh LS. Giant osteoma of the mastoid. Ear Nose Throat J 1979;58. 13 Sheehy JJ. Diffuse exostoses and osteomata of the external auditory canal: A report of 100 cases. Otolaryngol Head Neck Surg 1982;90:337-42 14. Fenton JE, Turner J, Fagan PA. A histopathological review of temporal bone exostoses and osteoma. Laryngoscope 1996;106:624-8. 15. Earl H Harley, Robert G Berkowitz. Imaging case study of the month, Osteoma of the middle ear. Ann Otol Rhinol Laryngol 1997;106:714 16. Quesnel AM, Lee DJ. Extensive osteomas of the temporal parietaloccipital skull. Otol Neurotol 2011;32:e3—4. 17.Ben-Yaakov A, Wohlgelernter J, Gross M. Osteoma of the lateral semicircular canal. Acta Otolaryngol 2006;126:1005—7. 18. Gungor A, Cincik H, Poyazoglu E, et al. Mastoid osteomas: reportof two cases. Otol Neurotol 2004;25:95—7. 19. Antonio Denia, Fransisco Perez, Rinaldo R, Canalis R, Malcolm D Graham. Extracanalicular osteomas of the temporal bone. Arch Otolaryngol 1979;105:706-9. 20. Probst LE, Shankar L, Fox R. Osteoma the mastoid bone. J Otolaryngol 1991;20:228—30

Learning importance and a example of essay in learning Essay

Learning is a major part of life. People tend to learn in every steps of their life. Learning does not necessarily involve complex terms, it can also be primitive things that keeps happening in day to day life of an individual. Everybody has different interest, likewise they have a different pattern of learning things. Some people learn faster through visual medium, some through audio, and some just writing down the things depending upon what the subject matter is. I believe that learning process does not start when one settles in a formal environment but it start right from the birth of an individual. Walking, talking, decision making etc. are some examples including every other primary things are the result of learning. Every time anyone has to acquire a new skills, they need to be focused and scrutinize the subject matter thoroughly, that is how learning happens. Learning affects the confidence of a person as well. If someone learn things quickly than they have higher confidence in doing things and learning new things as well. After going through the video couple of times I realized that one who puts hard work and devotion in learning new things can automatically adapt into the ways the things are done and will become successful. I myself am very much interested in music and vaguely inspired by the beauty of it. I think music can be the most influential thing in an individual life. Music can make a person relax after a hard day at work, cure the illness, provides maximum level of comfort to an individual. Being so much influenced on music I have managed to learn a very few instruments and it always gives me pleasure and comfort when I am playing them. But I do not want to stop here. I want to learn more about music. I want to be able to read the music and understand every keys and notation in it. I want to be a musician like David Gilmour from the greatest band ever, â€Å"Pink Floyd,† who is able to play any string musical instrument that exists in planet today. I am currently doing my major in Business with Information Technology however in order to fulfill my ambition in music I have also planned to take music as my minor subject and later on carry it as my profession along with my  Business major degree. It is very much important to me because of my vague interest in it, but mostly it makes me very happy. Finally, I am profoundly inspired from the video that I just watched and it helped me to boost up my morale. I do have much respect for the people attempting to make things happen and these people are just one of those few who dare to take the challenges and do something that makes difference to others.

Cicero On Duty Essay

Cicero’s definition of duty is a term in which in this course, is far reached than what we would have ever thought duty would stand for. Defining duty can be said to be a commitment or obligation to someone or something that causes them to pursue a certain action. Duty is split into two parts which consist of dealing with what is the â€Å"supreme† good and second, practicing rules which are strictly regulated in all means of daily life. Another classification of duties are duties which are middle or complete. Complete duty is link to being what is â€Å"right†. Middle duty is the reasoning behind why has it been done. When Cicero writes about individual activism we consider the duties that are honorable and dishonorable. What is honorable or dishonorable? People’s spirits are often pulled between opposing opinions. The individual then has to see whether or not it will offer him an advantage in life. Cicero discusses the major principal thought on duty which is based on a conservative standpoint. The different forms of duty happened due to human nature. Civic duty takes different forms. Civic duty will always leads back to the people that live in the society. Questions asked is what do we owe? What can I do? Cicero writes how the nature of a person will influence his decisions based on what is the â€Å"honorable† thing to do at a certain time. A individual showing wisdom towards the publics concern is part of the action. Cicero uses a strong example when he speaks about promising to be at a appointment but not showing up due to someone close to you getting ill. He explains how not making the appointment would not be contrary to your duty because you abandoned what you promised. This shows your neighbor that your character can’t be trusted. The fellowship you keep with the community is a responsibility. Fellowship is so important to the form of civic duty according to cicero. He explains how one should be able to share, give advice, and cause no evil to their neighbor. Justice is the foundation of duty. Justice in a society emphasizes on the civic duty to ones state. As a citizen you should never find yourself on an omission state but to be contributing in honest forms towards society. Other principles is that of carrying a great spirit. It would help you have courage in your actions and for that reason you will hold honor towards yourself. When Cicero writes about the reasons for why people have duties towards the public sphere he believes that the individual is part of the community. He contributes it all the to belief of Stoicism. Aristotelian is another close source in which we can speak about duties, but Cicero’s true belief was that virtues is key to duty. Stoicism is the school of thought that holds the belief that the only way we can make sense of our own existence is by devoting ourselves to virtues. People who follow this pathway believe that the majority things of daily life are stuff we can’t control, but yet we can contribute our life to society in a better way. Honor is another reason why individuals choose certain choices that lead you to be seen as a noble person in your society. The wide picture is seen towards how the community sees the individuals actions according to the standards in which have been placed. It doesn’t seem like an individual would ever perform a duty if honor wasn’t the reward. An individual who doesn’t care for much pleasure would mostly likely seek out honor in the public sphere. In conclusion Cicero comes up with the belief that the main stance on duty should always be honor, because honor is the only thing that really brings out the obligations that we owe to ourselves and the society you live in.

The Wind in the Willows Questions for Discussions

The Wind in the Willows is a famous book about animals, by Kenneth Grahame. Here are a few questions for study and discussion. What is significant about the title?What are the conflicts in The Wind in the Willows? What types of conflict (physical, moral, intellectual, or emotional) do you see?How does Kenneth Grahame reveal character in The Wind in the Willows?What are some themes in the story? How do they relate to the plot and characters?What are some symbols in The Wind in the Willows? How do they relate to the plot and characters?Is Badger (Mr. Badger) consistent in his actions? Is he a fully developed character? How? Why?Does Badger change and/or develop as a character?How does Badger relate to other characters in the book?Do you find the characters likable? Are the characters creatures you would want to meet?Does the story end the way you expected? How? Why?What is the central/primary purpose of the story? Is the purpose important or meaningful?How does the past figure into the novel?How essential is the setting to the story? Could the story have taken place anywhere else?Would you recommend this book to a friend?​