Not Your Otitis Media 101 The American Journal of Medicine

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Not Your Otitis Media 101 The American Journal of Medicine Matthew Gingo, MD, Michael G. Risbano, MD, MA, Paul D. Russ, MD, Edward D. Chan, MD The American Journal of Medicine Volume 123, Issue 8, Pages e9-e11 (August 2010) DOI: 10.1016/j.amjmed.2009.12.038 Copyright © 2010 Terms and Conditions

Figure 1 Complications of otitis media. A, Axial temporal bone computed tomography scan adjusted for bone detail. B, Axial contrast-enhanced head computed tomography scan adjusted for soft tissue and vascular detail. C, Coronal contrast-enhanced, T1-weighted magnetic resonance imaging through the posterior fossa. D, Axial magnetic resonance angiogram extended into the venous phase. E, Inferior surface of the base of the skull with the mandible removed showing close proximity of the mastoid (short arrow) to the lower motor neuron fibers of the facial nerve as they exit out the cranium through the stylomastoid foramen. Mastoiditis, an extracranial complication of otitis media, may therefore cause a peripheral facial nerve palsy. F, Upper and lower motor neurons of the facial nerve. Note that upper motor neurons from both cerebral cortices synapse to the facial nerve motor nuclei that supply the forehead. By contrast, facial nerve motor nuclei that supply the lower half of the face are innervated only by upper motor neurons originating from the contralateral cerebral cortex. G, With an upper motor neuron lesion (lower case “x”), as in a stroke, the contralateral lower facial muscles are weak, but the muscles in the forehead are generally spared. H, With a lower motor neuron lesion affecting the facial nerve (upper case “X”), the entire ipsilateral face is weak. CT, Computed tomography, MR, magnetic resonance; MRA, magnetic resonance angiography. The American Journal of Medicine 2010 123, e9-e11DOI: (10.1016/j.amjmed.2009.12.038) Copyright © 2010 Terms and Conditions