From Big Medical Encyclopedia

PETROSITIS (petrositis; lat. petrosus is stony, rocky + - itis) — an inflammation of the sites of a pyramid of a temporal bone which are not occupied with a bone labyrinth.

The item represents a complication purulent, usually acute, inflammations of a middle ear and develops preferential at a pneumatic structure of a pyramid of a temporal bone. Contagiums get from a drum cavity of a pla of a mastoidal cave of a middle ear and extend to the sites of a pyramid of a temporal bone which are not occupied with a bone labyrinth. In rare instances P. develops in the absence of a perforation opening in a tympanic membrane of a pla at the closed perforation opening — the so-called closed P. Vozmozhen also hematogenous way of distribution. Inflammatory process at P. usually has character osteomyelitis (see).

Development of the isolated inflammatory centers is promoted by division of bone mass of a pyramid of a temporal bone by channels and irregularity or limitation of a pnevmatization of a pyramid. Inflammatory process is more often localized in the field of a top of a pyramid of a temporal bone and from there quite often extends to one of surfaces of a pyramid — intracranial (verkhneperedny or back) or glotochnosheyny (lower). Various localization of process at P., especially in relation to surfaces of a pyramid of a temporal bone, and reactivity of an organism define a wedge, a picture.

The general symptoms at P. are a little characteristic, body temperature usually subfebrile. Disease is mostly long, with remissions. Suppuration from an ear belongs to the main symptoms of P. plentiful long (with breaks).

Due to the topographical proximity of a pyramid of a temporal bone to the majority of cranial nerves often there are neurologic symptoms: pains on the course of a trifacial (in a face or only a forehead, in an eye and an eye-socket, in upper or a mandible and teeth). Pains can sometimes be felt in occipital area and a neck. Severe pains also quite often have pristupoobrazny character, periodically amplify, especially at night. Are noted hypo - or an areflexia of a cornea, a dermahemia, increase or, on the contrary, decrease in its sensitivity. Are much less often observed a lockjaw (see) or droop of a mandible and shift it aside.

At paralysis of the taking-away nerve the doubling in eyes amplifying at a look of a knaruzha and restriction of mobility of an eyeglobe of a knaruzha is noted. Defeat of other cranial nerves passing over the upper edge of a pyramid of a temporal bone is sometimes observed: paralysis of a block nerve (doubling at a look down) and full or incomplete paralysis of a third cranial nerve (the blepharoptosis, a mydriasis, doubling in eyes amplifying at a look inside.

At an inflammation of a back surface of a pyramid of a temporal bone also Preddverno-ulitkovy nerves (a hearing disorder, dizziness) can be surprised front (dysfunction of face muscles). Localization of process on a lower surface of a pyramid of a temporal bone leads to paralysis (more often to combined) the glossopalatine, wandering, additional and hypoglossal nerves, droop of the corresponding half of a soft palate, an immovability of a voice fold, a deviation of language in the sick party, difficulty in a raising of a shoulder).

The combination of a purulent acute inflammation of a middle ear to paresis or paralysis of the taking-away nerve, to pains on the course of a trifacial, and also the relative deafness caused by the combined defeat of the sound carrying out and sound perceiving systems, is described as Gradenigo's syndrome (see. Gradenigo syndrome ). In rare instances at a petrositis Bernard's syndrome — Horner (see Bernard — Horner a syndrome), connected with defeat of cervical nodes of a sympathetic trunk or sympathetic texture in the channel of a carotid artery of a pyramid of a temporal bone is observed.

At P. the following complications are possible: purulent meningitis (see), thrombosis of sine of a firm meninx is much more rare (see. Thrombosis ) and abscess brain (see); at distribution of process on a lower surface of a pyramid of a temporal bone — verkhnezadny or side retropharyngeal abscess (see).

Diagnosis The item, and especially definition of localization of intra pyramids-nogo of the inflammatory center, are complicated. At rentgenol, a research can be found various degree of an enlightenment of a bone or disappearance of its certain sites, first of all the upper edge of a pyramid of a temporal bone.

Treatment hl. obr. operational — is carried out an antromastoidotomiya (see. Mastoiditis ) or obshchepolostny operation (see. Otitis ), sometimes resort to special operative measures or expansion of the fistular courses. Nek-rye from operative measures is made with use of an ear microscope and tools for microsurgeries. It is original, but operation of Ramadye at which the way to depth of the upper edge of a pyramid of a temporal bone is laid from the bared medial wall of the channel of a carotid artery is very difficult. For this purpose after expanded obshchepolostny operation with a resection of the lower and front bone walls of outside acoustical pass and a root of a malar shoot remove a medial bone wall eustachian (acoustical, T.) pipes also delay a carotid artery of a kpereda.

If there are data on transition of inflammatory process to an intracranial surface of a pyramid of a temporal bone, make radical or conservative and radical operation, resect an upper bone wall of outside acoustical pass, a roof of an attic and a considerable part of a scaly part of a temporal bone. Then separate a firm cover of a brain from a surface of a pyramid and gradually move ahead in the medial direction to abscess which is opened. At abscess on a lower surface of a pyramid of a temporal bone in a throat of rather intra pharyngeal opening of abscess. At more lateralno the amide abscesses located on dpir carry out an operative measure from a neck.

Apply to P.'s treatment also the antibiotics hyposensibilizing means appoint fortifying therapy.

At timely begun treatment of the Item. forecast for life favorable.

Bibliography: Gordyshevsky T. I. Clinic and therapy of petrosites, Vestn, from-rino-lar., No. 1, page 3, 1948, bibliogr.; Gorokhov A. A., Kostrov N. I. and Hilko V. A. Otoneyrokhirurgiya at diseases of a pyramid of a temporal bone and a mostomozzhechkovy corner, in the same place, No. 6, page 30, 1979, bibliogr.; At N d-r and V. F. O c petrosites, Saturday. works Leningr, nauch. - issled, in-that according to Bol. fish soup, throats, nose and speech, t. 10, page 32, 1952, bibliogr.; Missura'T. Neuere Aspekte in Diagnose und Therapie der Pyramiden-zelleneiterungen, Pract. oto-rhino-laryng. (Basel), Bd 21, S. 49, 1959, Bibliogr.; $ t e f a n i u A. § i a. PetroapexitS. cu meningitS, seroasS, a septici in cursui oto-mastoiditel cronice §i a diabetului zaharat, Oto-rino-laringologie (Buc.), t. 14, p. 269, 1969; T o b e with k A. Pathologie und Klinik der Pyramidenzelleneiterungen, Lpz., 1951, Bibliogr.

T. I. Gordyshevsky.