Temporal bone x-ray is a method of noninvasive study of the external structure of the temporal bone, the internal structure of its various parts, as well as obtaining data on the bone components of the outer, middle and inner ear. The procedure is carried out during the diagnosis of inflammatory processes in the ear area, to confirm fractures. It is used to identify benign and malignant formations. It is carried out natively without preliminary preparation. It is performed in three projections: lateral (according to Schueller), oblique (according to Stenvers) and axial (according to Mayer). The lateral projection is considered an overview, the rest are required for the targeted visualization of some parts of the temporal bone.
Temporal bone x-ray can be prescribed in the presence of the following indications:
- bruises, blows, injuries, fractures of the temporal bone;
- ear diseases: acute otitis media with complications, inflammation of the middle ear of a chronic nature, cholesteatoma and others;
- suspicion of tumor neoplasms in the temple area.
To date, CT and MRI are more effective and safer methods than X-rays. That is why there is such a narrow spectrum of indications for X-rays. However, this study helps to reliably identify the presence of pneumatization in the patient (in other words, cavities filled with air), as well as to study the position of intra-ear implants.
A simple radiography, or X-ray, of the temporal bones according to Schueller, Mayer, Stenvers is a non-invasive procedure and does not cause the patient any discomfort or pain. It does not require preparation, except perhaps following simple rules: take off all metal jewelry and tell the radiologist about the presence in the jaw, for example, a metal implant or other foreign body (if there is one).
Methodology of conducting
Extraoral, or they are also called “extraoral”, X-rays of the facial bone can be done with dental or stationary devices. Using an extra-oral technique, they diagnose the bones of the facial skeleton: zygomatic, temporal, as well as the upper and lower jaw. In practice, three types of radiography techniques are most often used.
X-ray imaging to obtain a picture in the lateral projection of the Schueller is performed in the patient’s lying on his side. It projects the area of the mastoid process, helps to clearly display the middle ear cavity, the bulb of the jugular vein, the tympanic part of the pyramid of the temporal bone. Laying according to Schueller reveals tumor, inflammatory, bone-destroying processes.
With the help of the Mayer projection, an axial view of the visualization of the temporal bone is obtained in the image. Pathologies of the tympanic cavity, the entrance area to the antrum and adjacent structures can be detected. Also, such an examination helps to diagnose purulent-inflammatory diseases and identify foci of destruction in the temporal bone area.
The Stenverse projection is an overview method of research, performed in a transverse projection. The X-ray image clearly projects the upper part of the pyramid of the temporal bone. The internal auditory canal, structural units of the inner ear are revealed. This method of research makes it possible to detect purulent-inflammatory diseases, destructive changes on the part of the hearing organs. In addition to the above-mentioned methods of laying and shooting, clarifying ones are also used:
- A two-stage isolated or tangential snapshot. The mastoid process is visualized on it (in fact, it is a modified oblique projection of the Reverse).
- A two-stage side shot with a downward displacement of the maze – laying along the Lisholm.
- A side shot with the displacement of the maze anteriorly is the Lange-Sonnenkalb method.
Temporal bone x-ray has no complications, since it does not require making incisions on the patient’s body, introducing contrast or performing other traumatic manipulations.
It is not recommended to examine the ear with an X-ray if:
- The patient is a pregnant woman (regardless of the gestation period).
- The patient is a child under 3 years old. The radiation effect on the child’s body is much stronger than on an adult. An X-ray can theoretically cause a malignant change in the cells of any organs of the child.
- Excess body weight
Severe general condition of the patient or his inappropriate behavior associated with a mental disorder, taking narcotic drugs, etc.
Interpretation of temporal bone x-ray
According to X-ray images taken in various projections, the following indicators are estimated:
- the integrity of the temporal bone;
- symmetry of the temporal joint;
- the size of the articular gap;
- the size, shape and structure of the articular surfaces of the temporal bone and mandible;
- the presence of formations.
Most pathologies of the temporal bone have certain X-ray symptoms:
- Ankylosis (fibrous/bony). The picture shows how the articular process of the lower jaw is connected to the temporal bone without a section of reduced density (disc).
- Flattening. The loss of convexity and congruence (spatial correspondence) of articular surfaces will be noticeable in the image. Such a local defect can develop due to thinning of the compact layer of bone tissue. Flattening is quite often the first sign of degenerative diseases.
- Osteophytes. The images show a pathological proliferation of bone tissue due to degeneration of articular cartilage.
- Subchondral cyst. With such pathology, the images will show the cavity formation of osteolysis (dissolution of bone tissue) of a regular round shape with localization under the articular surface.
In order to obtain the most accurate and complete information about the condition of the temporal joint, in addition to X-ray examination, previously performed CT and MRI can be taken into account. Other specialists, for example, an otolaryngologist and a surgeon, can take part in the decoding together with a radiologist.