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

The Media Should NOT Define our Self-Image Essays -- Adverts, Advertis

Do we choose to define ourselves? Everyday we turn on the television; we are subjected to advertisements about what we are supposed to be, what we are supposed to wear, and even what we are supposed to drive. Ultimately we choose the vehicles we drive, but the media has a huge influence on us. Three television advertisements reveal the vehicles women and men are believed to drive. The Honda Odyssey is shown in advertisements with a woman driving around kids to their daily functions. The Ford F150 and the Chevy Silverado are shown with men four wheeling through the hills. Advertisements tell us what roles we are â€Å"supposed† to play in society. In reality men and women’s roles in society have greatly changed from the past, but television advertisements do not represent these changes. Vans are depicted as â€Å"mom vehicles† and trucks are â€Å"dad or man vehicles.† When a vehicle manufacturer comes out with a new model of van they usually depict a women driving around, with a vehicle full of kids. She drops the kids off and picks them up, she then proceeds to move around all of the seats illustrating to the consumer all that this new van has to offer. It is all work and no play for moms in the working world. When a new model of the Ford F150 or the Chevy Silverado comes out, advertisements usually depict a man four-wheeling through the hills demonstrating the durability and power of the vehicle. Ford’s motto is â€Å"Built Ford Tough† and Chevy’s motto is â€Å"Like a Rock.† Thes...

Direct Foreign Investment in Bangladesh

â€Å"Direct Foreign Investment in Bangladesh- Challenges and Prospect† Introduction: This is era of globalization, here all of the country are linked together. Thereby we get different opportunity to be benefited from beyond the country. DFI (direct Foreign investment) is one of them. It is a very important issue for toddy’s government, business people and concerned community of the world. Bangladesh is not far from it . Like any other developing country, the economic development of Bangladesh is also significantly depend on foreign direct investment.Bangladesh government and business community of Bangladesh is concerned enough to attract increasing number of DFI in Bangladesh. To draw the attention of foreign investor and make them interested to do invest in Bangladesh, government take lot of initiatives, like branding the Bangladesh, giving incentives on DFI, improving the infrastructure etc. However, this is fact too that, still we have some challenges and difficult ies to get satisfactory amount of direct foreign investment. In this report, we are covering the most lucrative industry in Bangladesh.It is the garment industry of Bangladesh, which has been the key division and main sources of foreign currency of Bangladesh for a very long time. Objective of the study: Primary Objective †¢To know the DFI situation in Bangladesh and its future. Secondary objective †¢To Know the Factors affecting DFI in Bangladesh †¢To evaluate the Garment industry in Bangladesh from the perspective of current DFI situation in Bangladesh, Government incentives, socio-political situation and other financial facilities, entry-exit barriers etc. †¢To know the challenges currently faced by the existing foreign investors in the industry. In addition, to give our opinion about the feasibility of the industry to attract DFI in Bangladesh. Methodology: To make this term paper we mainly give emphasize on secondary sources of data. We go through different organization’s website like, Bangladesh Bank, Bangladesh Board of Investment etc to collect the necessary information. Moreover, we take some knowledge from daily newspaper and television talk shows. Apart from these, we use our textbook and class lecture as a secondary source of information. http://www. orion-group. net/career. php http://banglar-jobs. blogspot. com/2010/10/ministry-of-health-and-family-welfare. html Related article: Padma Bridge

The Wuthering Heights Review

The 'Wuthering Heights' Review When Emily Brontes Wuthering Heights was first published in 1847, under the name of Ellis Bell, it received mixed reviews. Although some critics saw the potential evident in the cyclical plot and other literary devices, many others were shocked and dismayed by the unashamedly dark storyline. Different for the Era To be sure, Wuthering Heights was a very different book than what was generally considered acceptable during that era. In direct contrast to Emily Brontes novel, Susannah Rowsons Charlotte Temple (1828) tells the story of a young lady who permits her beau to steal her away in the middle of the night. Predictably, he impregnates her and then abandons her, after which she dies of a broken heart. As was common in novels of the era, Charlotte Temple used a fictional story to instruct its readers―primarily young ladies―in what was expected of them. Flawed Characters In Wuthering Heights, one of the main female characters dies of what could also be considered a broken heart, but the effect is a very different one from that of Charlotte Temple. Instead of presenting an overly sentimental worst-case scenario meant to frighten its readers onto the straight-and-narrow, Wuthering Heights seduces its readers with its dark passion and misguided characters. Both Heathcliff and Catherine are flawed characters, but their flaws intrigue the reader just as surely as they repel. If there is any lesson to be learned after Catherines death, it is the folly of denying your hearts greatest passion―a mistake completely at odds with the cause of Charlotte Temples downfall. Controversy Obscurity Due to the novels tumultuous passion, the book received a mixture of responses. Eventually, those who were scandalized by the books inappropriateness won out, and Emily Brontes only novel was buried in literary obscurity. Decades later, when Wuthering Heights was revived by the interest of modern scholars, the unique literary devices used in the work began to earn more attention than its soap opera-like tale of obsession and loss. Although the second part of the novel―the part that chiefly concerns Catherine and Heathcliffs respective children―is frequently overlooked in retellings and screen adaptations, many contemporary critics believe it holds the key to Emily Bronte’s real literary genius. The first generation of children―Catherine, her brother Hindley, and the gypsy child Heathcliff―had led miserable lives, and both Catherine and Hindley died young as payment for their misguided passions. As a result of Heathcliffs scheming prior to Hindleys death, he has inherited the Earnshaw home, as well as the care of Hindleys son, Hareton. After the death of Heathcliffs estranged wife―Catherine’s husband’s sister, his own son, Linton, comes to live with him as well, setting in motion his final push for revenge. Generations The highlight of the second part of the book is when Heathcliff effectively kidnaps Catherines daughter, who is called Cathy. With the three children now all under one roof, the latter half of the book parallels the beginning, when Catherine, Hindley, and Heathcliff were all children together in the same house. However, whether by a twist of fate or Heathcliffs mistreatment of the boy, Haretons demeanor and place in the household resembles Heathcliffs childhood persona more than that of his own father, while Linton is so weak and sickly that he is the perfect opposite of Heathcliff.Despite the clear similarities to the old rivalries, though, the children begin to converge, rather than to follow in the footsteps of their parents. Maddened by a desire for revenge, Heathcliff attempts to play them against one another, forcing Cathy to marry Linton so that he may inherit the neighboring property that belongs to his rival, Catherines widower. Linton dies soon after. After Heathcliffs own death, the tale comes full circle: the estates return to their rightful heirs, Hareton and the younger Cathy fall in love, and Heathcliff’s legacy of revenge disappears almost without a trace. Complex Storytelling Despite its early reception, the combination of unbridled passion and a complex storytelling form makes Wuthering Heights a favorite in many modern literary circles. The darkness of the story and the lack of accompanying moral teachings shocked many of its contemporaries, while the intricacies of the cyclical plot―the destruction and ultimate reunification of the families―were overlooked until recent decades. A novel that combines masterful literary devices with all of the scandals of a soap opera, Emily Brontes Wuthering Heights was a drama far ahead of its time.

The eNotes Blog Happy Birthday Bukowski

Happy Birthday Bukowski There are so many quotes I could draw from that would be emblematic of the character of Charles Bukowski, the larger-than-life poet, novelist, alcoholic, and grim prophet of love. But today, on the day he would have turned 92, I choose two nights before my 72nd birthday. Written exactly two decades ago, shortly before his death of leukemia, the poem calmly, almost ambivalently, reflects on aging and death. Bukowski seems drained of all the lingering angst from his difficult childhood, only amazed at the fact hes lasted this long and grateful for his glass of cabernet and the warm night. Its pleasant to think of him admiring lifes simplicities, not really wanting or regretting, merely enjoying what would be his second-to-last birthday. That night, I think, a secret bluebird gave a little whistle somewhere. sitting here on a boiling hot night while drinking a bottle of cabernet sauvignon after winning $232 at the track. theres not much I can tell you except if it werent for my bad right leg I dont feel much different than I did 30 or 40 years ago (except that now I have more money and should be able to afford a decent burial). also, I drive better automobiles and have stopped carrying a switchblade. I am still looking for a hero, a role model, but cant find one. I am no more tolerant of Humanity than I ever was. I am not bored with myself and find that I am the only one I can turn to in time of crisis. Ive been ready to die for decades and Ive been practicing, polishing up for that end but its very hot tonight and I can think of little but this fine cabernet, thats gift enough for me. sometimes I cant believe Ive come this far, this has to be some kind of goddamned miracle! just another old guy blinking at the forces, smiling a little, as the cities tremble and the left hand rises, clutching something real. Happy Birthday Bukowski.

Research/ Detail Paper of the Religion of the Sunni Muslim People Research

/ Detail of the Religion of the Sunni Muslim People - Research Paper Example Although several branches of Islam exist, Sunni Muslims are the largest by followership, accounting for about 80 percent of the world’s Muslim population, followed by the Shi’a at approximately 10 percent. As a branch of Islam, the Sunni emerged in the 7th century C.E. in the Middle East after disagreements arose over who would succeed Prophet Muhammad. At the height of the disagreement, the Sunni advocated for the selection of a successor (also referred to as caliph) by the entire Muslim community, but the Shi’a believed that Ali, Muhammad’s son-in-law and also cousin, had been chosen by the prophet to succeed him. This paper will research specific features and viewpoints of the Sunni Muslim and describe their past, present and future. It will further highlight their conflicts and where they stand on the worldview and in the eyes of the US government and the Taliban. At this point, it is important to mention that the defining belief of the Taliban is Sunn i Islam; however, their interpretation and practice of Islam, including Sharia law and female brutality, informed scholars’ decision to refer to them as fundamentalists or extremists (Goodson, 2002). The term Sunni is derived from the word Sunnah, which is an Arabic term that translates into â€Å"the traditions of Prophet Muhammad†. The Sunni Muslims agree with the other Islamic branches on many practical and theological aspects. This is because Islamic life stems from and is defined by Sharia (or Islamic) law. However, the areas that are unique to Sunni Muslims and set them apart from the start include the fact that they developed and grew from a controversy; they do not agree with claims that a successor was named by the prophet; they believed that companions of the prophet had authoritative leadership; and they relied on the consensus of scholars and religion. More contemporarily is their typical emphasis of Allah’s power and how he determines human fate. Th eir definition of what it entails being a Muslim is more inclusive, and that is why their tradition places prominence on the functions of religion in family (such as marriage, inheritance, divorce), political and public life (Goodson, 2002). For a better insight into Sunni Muslims, the research will be split into sections. Further, because the essence of Sunni Muslims is founded on their differences with the Shi’a Muslims, comparisons between the two will be used for the purpose of emphasis. History Although the Sunni would later develop theological and legal traditions and structures over the centuries, its fundamental origins are embedded in the caliph succession dispute. The 632 C.E. death of Muhammad pitted the Muslim community into a leadership wrangle because Muhammad did not have living heirs, who were required to be male. Without one that the community could agree upon, it followed that they split along the lines of choice of a leader, ending up with the Sunni and Shi ’a. Each sect had several subdivisions, but the Sunni and the Shi’a still represent the key divide in Islam (Johnson, 2010). Those who did not back the leadership of Ali adopted the name Sunni, which is a term that derives from ahl al-sunna wa al-jamaa. This is an Arabic phrase referring to a group of people who consider themselves to follow the ways of the prophet and are people of the community. They decided that the next caliph should come from the Quraysh tribe, to which the prophet belonged. Literature on Sunni history indicates that while the prophet

Child and the Law Case Study Example | Topics and Well Written Essays - 3000 words

Child and the Law - Case Study Example The multiple needs of the child, together with the fact that he has been acting as a caregiver for his mother, make the case a multifaceted one in which several different agencies need to be involved. The basic duty of care towards Justin involves assuring he receives parental care or in loco parentis care, adequate educational opportunities and medical provisions for the "signs of depression" that might incapacitate him or even put his life in risk if they were allowed to develop into full-blown depression. All these facets need to be taken into account. Taking each part of the account of Justin in turn, this analysis will first consider the "education supervision order" which he is under and also the fact that he has been "taken into care on a voluntary basis by Hoppingdean Social Services on a number of occasions". An education supervision order is an order that is granted by a family court under the provisions of section 36 of the Children Act, 1989. The Education Supervision Order (ESO) has a clear and compelling reasoning behind it. The ESO is designed to "ensure that the child receives an efficient full-time education, suitable to his or her age, ability and any Special Educational needs; and that the Child benefits fully from the education received" (cumbria, 2006). At the present time it appears as though the general provisions of such an order are not being met for Justin. Thus the fact that his "frequent absences" have left him without the peer group vital for social development at this age, and that despite the "remedial work" being offered by the school he "has fallen far behind on his schoolwork" shows that he is clearly not receiving an efficient education. The blame for this cannot be put at the school's door, as they appear to be meeting Justin's needs as far as is feasible for a general Comprehensive school. Neither, under the exceptional circumstances within which the family is living, can the blame be put on the mother who is suffering from depression and alcoholism. Normally the parents/parent would be required to attend a magistrate's court to discover why the elements of the ESO are not being met, but this would not be appropriate in this case. The question arises as to whether the fact that Justin has been taken into care on a number of occasions on a voluntary basis should offer the way forward: should Justin be taken into care on a full-time basis, thus transferring responsibility for the ESO onto the Local Authority Social Services Department. As it is the child exists in a kind of limbo in which no one agency, or his mother, is fully responsible for what is occurring to him. He clearly is not thriving within this situation, as his educational problems and initial signs of depression graphically illustrate. Some other action is needed. The case of Justin could be seen as an embodiment of the need for some kind of integrated services for at risk children in the United Kingdom. It was the realization of this need that led to the creation of the Children's Trusts. The Trusts were created in order to keep up with the Children Act of 2004. As the National Evaluation of the Trusts suggests, English Local Authorities and National Health Service organizations serving children, young people and families are expected to take steps to unify or co-ordinate these services . . . .Children's Trusts are the emerging framework in which improvements in outcomes for children and young people are to be brought