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Auris, Nasus, Larynx Aug 2011Isolated malleus fracture is a rare ossicular injury with less than 80 cases published in the literature. The aim of this paper is to present a series of 3 patients with... (Review)
Review
OBJECTIVE
Isolated malleus fracture is a rare ossicular injury with less than 80 cases published in the literature. The aim of this paper is to present a series of 3 patients with isolated malleus handle fracture, to review the literature and to discuss clinical presentation, imaging findings and treatment options.
METHODS
We retrospectively a case series of 3 patients with isolated malleus handle fracture managed at a tertiary referral otologic center.
RESULTS
The three patients related the same history of digitally manipulating the external auditory canal, leading to a sudden hearing loss and feeling of aural fullness. Meticulous otomicroscopy revealed the broken malleus with excessive movement of the distal part of the malleus on pneumatic otoscopy. High-resolution CT scan with multiplanar reconstruction along the axis of the malleus confirmed the fractures and displacements. One patient was treated conservatively and two underwent ossiculoplasty.
CONCLUSION
Malleus handle fracture should be systematically suspected in case of hearing loss and aural fullness of sudden onset after digital manipulation of the external auditory canal.
Topics: Ear Canal; Female; Fingers; Fractures, Bone; Hearing Loss; Humans; Image Processing, Computer-Assisted; Malleus; Massage; Middle Aged; Otologic Surgical Procedures; Otoscopy; Rare Diseases; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 21216115
DOI: 10.1016/j.anl.2010.11.011 -
Journal of Anatomy Feb 2016The anterior fixation of the anterior process of the malleus has been studied in a number of Cetartiodactyla. This anterior process, also known as processus gracilis, is... (Review)
Review
The anterior fixation of the anterior process of the malleus has been studied in a number of Cetartiodactyla. This anterior process, also known as processus gracilis, is provided by the prearticular (gonial), a dermal bone, whereas the cartilage of Meckel becomes resorbed in perinatal ontogenetic stages. Posteriorly, the prearticular fuses with the cartilaginous caput of the malleus; rostrally, the prearticular (= processus gracilis) is always fixed to the anterior crus of the ectotympanic by an extremely thin splint (thickness < 50 μm). From the rostral part of the processus gracilis all studied cetartiodactyls develop a processus internus of considerable size. This process was known as 'ossiculum accessorium mallei' in former times, and its homology has been disputed; from our microscopic-anatomical study we can definitely state that it is always a 'processus internus praearticularis'. This process contacts the fascia of the tensor tympani muscle. In non-ruminants, it articulates dorsally with the tegmen tympani and dorsolaterally with the ectotympanic; whereas the processus gracilis becomes more and more slender, the processus internus may grow to considerable size and normally is fused to the adjacent bones already in juveniles. However, in ruminants, the tegmen tympani tends to disappear and the processus internus praearticularis appears as relatively small bony knob at the floor of the medial cranial cavity, and it seems not to be fused to the surrounding bones; in later age stages, it may become secondarily overgrown by the petrosal. This dorsally exposed processus internus praearticularis seems to be a synapomorphy of the Ruminantia. The functional meaning of this internal process of the prearticular, which is also developed to a minor degree in Carnivora, remains unclear at the moment - but we present some speculations about this.
Topics: Animals; Malleus; Mammals; Ruminants; Swine
PubMed: 26510377
DOI: 10.1111/joa.12393 -
Otology & Neurotology : Official... Dec 2021Isolated malleus shaft fractures are rare cases. A commonly reported cause is a finger pulled out from a wet outer ear canal after a shower or bath. The objective was to...
BACKGROUND AND HYPOTHESIS
Isolated malleus shaft fractures are rare cases. A commonly reported cause is a finger pulled out from a wet outer ear canal after a shower or bath. The objective was to investigate experimentally the mechanism and forces needed to establish an isolated malleus shaft fracture.
METHODS
Ten fresh-frozen human temporal bones were adapted to allow visual inspection of the structures involved while negative pressure trauma was applied. Thirty malleus bones were broken and the required forces were measured. Measurements from 60 adult test subjects were used to create mathematical and physical models to calculate and measure the forces necessary for generating trauma. To calculate the maximum muscle force developed by the tensor tympani muscle, the muscle area and fiber type composition were determined.
RESULTS
The temporal bone experiments showed that applied negative pressure in a wet ear canal could not fracture the malleus shaft with only passive counterforce from supporting structures, although the forces exceeded what was required for a malleus shaft fracture. When adding calculated counteracting forces from the tensor tympani muscles, which consisted of 87% type II fibers, we estimate that a sufficient force is generated to cause a malleus fracture.
CONCLUSION
The combination of a negative pressure created by a finger pulling outward in a wet ear canal and a simultaneous counteracting reflexive force by the tensor tympani muscle were found to be sufficient to cause an isolated malleus fracture with an intact tympanic membrane.
Topics: Adult; Ear Canal; Humans; Malleus; Temporal Bone; Tensor Tympani; Tympanic Membrane
PubMed: 34353981
DOI: 10.1097/MAO.0000000000003306 -
JPMA. the Journal of the Pakistan... Feb 2023To determine gender-based morphological variations in malleus.
OBJECTIVE
To determine gender-based morphological variations in malleus.
METHODS
The cross-sectional descriptive study was conducted at the Ear-Nose-Throat and Radiology departments of a public-sector hospital in Karachi, from January 20 to July 23, 2021, and comprised subjects of either gender aged 10-51 years who had intact ear ossicles. They were divided into equal male and female groups. After history and a thorough examination of the ear, high-resolution computed tomography scan of petrous temporal bone was done. The images were studied for malleus, to measure the parameters of its head width, length and shape of manubrium, and total length of malleus for possible morphological variations along gender lines. Data was analysed using SPSS 23.
RESULTS
Of the 50 subjects, 25(50%) were males with mean width of the head 3.04±0.34mm, mean length of manubrium 4.47±0.48mm, and mean total length of malleus 7.76±0.60mm. The corresponding values in 25(50%) females were 3.00±0.28mm, 4.31±0.45mm and 7.41±0.51mm. The total length of malleus between both genders was significantly different (p= 0.031). The shape of manubrium was straight in 10(40%) males and 8(32%) females, and curved in 15(60%) males and 17(68%) females.
CONCLUSIONS
Width of head, length of manubrium and total length of malleus were different in gender terms, but the total length of malleus was significantly different.
Topics: Female; Humans; Male; Malleus; Cross-Sectional Studies; Hospitals, Public; Public Sector; Social Group
PubMed: 36800718
DOI: 10.47391/JPMA.6307 -
Vestnik Otorinolaringologii 2021The isolated malleus handle and neck fractures are rare pathology which demands detailed diagnosis and individual treatment plan in every case. Sometimes it could heal... (Review)
Review
The isolated malleus handle and neck fractures are rare pathology which demands detailed diagnosis and individual treatment plan in every case. Sometimes it could heal without surgery, but in most part of cases surgical treatment is indicated. The short literature review and 2 clinical cases of this pathology are presented in this article. We describe our own variants of surgery repair with autologous cartilage with good results.
Topics: Fractures, Bone; Hearing Loss, Conductive; Humans; Malleus
PubMed: 34964336
DOI: 10.17116/otorino20218606187 -
The Laryngoscope Mar 2024To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide... (Review)
Review
OBJECTIVE
To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management.
DATA SOURCES
PubMed, Embase, Cochrane Library.
REVIEW METHODS
Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre- and post-treatment audiograms, and imaging were obtained. Systematic review of the literature was performed.
RESULTS
Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4 months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air-bone gap (ABG) at initial presentation ranged from 16 to 26 dB, and was greater at higher frequencies. Thirty-six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (p < 0.05), while not at any frequency for those who were observed.
CONCLUSIONS
Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. Laryngoscope, 134:1032-1041, 2024.
Topics: Humans; Malleus; Hearing Loss, Conductive; Retrospective Studies; Hearing; Hearing Tests; Fractures, Bone; Treatment Outcome
PubMed: 37584374
DOI: 10.1002/lary.30962 -
Ear, Nose, & Throat Journal Dec 2010
Topics: Aged; Audiometry, Pure-Tone; Follow-Up Studies; Hearing Loss, Conductive; Humans; Male; Malleus; Otologic Surgical Procedures; Recovery of Function; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 21174268
DOI: 10.1177/014556131008901207 -
International Journal of Pediatric... May 2022Establish normal reference values for the human malleus during the second and third trimesters of pregnancy, and describe its growth dynamics and ossification process.
OBJECTIVES
Establish normal reference values for the human malleus during the second and third trimesters of pregnancy, and describe its growth dynamics and ossification process.
METHODS
Thirty spontaneously aborted human fetuses, 12-36 weeks of age, were examined. Temporal bones were obtained en bloc and processed using the skeletal clearing and staining technique. Each malleus was obtained by microdissection. Measurements of anatomical points of the malleus were performed. Ossification was recorded. Statistics were applied.
RESULTS
Sixty mallei were obtained. At the end of development, the following measurements were obtained in millimeters: head length, 2.87 (2.30-3.44); neck length, 1.15 (0.92-1.38); manubrium length, 4.45 (3.75-5.16); total length, 8.51 (8.02-8.99); neck width, 1.33 (0.70-1.97); manubrium width, 0.84 (0.82-0.86); and Meckel cartilage width, 0.43 (0.06-0.95). The angle of the longitudinal axis of the malleus was 160° (156-164°). The ossification process of the malleus followed a stereotyped pattern that began at week 16, at the level of the neck, with a single center that expanded to the head and then to the manubrium. Toward the end of development, only the umbo remained cartilaginous. There were no sex-based differences in human malleus size during prenatal development. From the beginning of the second trimester of pregnancy, the longitudinal axis of the malleus acquires dimensions comparable to adults.
CONCLUSION
The study of the malleus development provides clues that would explain some anomalies in its development, and can influence decision-making during the placement and design of prostheses in the malleus.
Topics: Adult; Humans; Malleus; Temporal Bone
PubMed: 35314375
DOI: 10.1016/j.ijporl.2022.111113 -
The American Journal of Otology Jan 1999Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to... (Review)
Review
OBJECTIVE
Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases.
STUDY DESIGN
Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture.
SETTING
The study was performed partly at a private practice and partly in an academic tertiary referral center.
PATIENTS
At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied.
RESULTS
The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal.
CONCLUSIONS
This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.
Topics: Acoustic Impedance Tests; Adult; Craniocerebral Trauma; Female; Foreign Bodies; Fractures, Bone; Hearing Loss, Conductive; Humans; Male; Malleus; Medical History Taking; Middle Aged
PubMed: 9918166
DOI: No ID Found -
The Laryngoscope Jun 1994A simply prepared and implanted ossiculoplasty prosthesis is described for use when the malleus is suited to assembly procedures. The one versatile hydroxylapatite and...
A simply prepared and implanted ossiculoplasty prosthesis is described for use when the malleus is suited to assembly procedures. The one versatile hydroxylapatite and Teflon model is suitable for both the malleus-stapes and malleus-footplate role. Clinical trials of 80 prostheses in place for 5 to 18 months have confirmed excellent surgical handling properties combined with optimal audiological results.
Topics: Ear Ossicles; Humans; Hydroxyapatites; Malleus; Ossicular Prosthesis; Polytetrafluoroethylene; Prosthesis Design; Stapes
PubMed: 8196459
DOI: 10.1288/00005537-199406000-00024