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Medical condition
A persistent stapedial artery (PSA ) is a rare anomaly in human anatomy where the stapedial branch of posterior auricular artery , or simply stapedial artery, remains within the ear of a fetus after the first ten weeks of pregnancy . Whilst not problematic for the majority of people with the anomaly, it can cause difficulties with hearing .
Signs and symptoms [ edit ]
Most cases of PSA cases remain asymptomatic for a person's life;[1] however, symptoms can include vertigo ,[2] pulsatile tinnitus , conductive hearing loss or sensorineural hearing loss via bone erosion of the otic capsule in rare cases.[3] Hearing loss in children can also cause developmental delays .[4]
During pregnancy , the stapedial artery originates as a branch of the hyoid artery in the dorsal branch of the second aortic arch , which is in turn connected to the internal carotid artery . The stapedial artery after passing through the stapes splits into two vessels, the supraorbital branch and the maxillomandibular branch, the latter of which has a smaller mandibular branch. The former later anastomoses with the ophthalmic artery and becomes the middle meningeal artery , the latter anastomoses with the internal maxillary branch of the external carotid artery , becoming the inferior alveolar artery and infraorbital artery , respectively.[3]
Diagnosis [ edit ]
Since most cases of PSA do not present with symptoms, it is usually discovered incidentally upon middle ear surgery , or during postmortem temporal bone dissections .[5] The absence of the foramen spinosum is sometimes associated with a PSA,[6] although the prevalence of a missing foramen spinosum is much higher than the prevalence of a PSA.[7] On the other hand, a foramen spinosum may be present if the maxillomandibular artery originates from the stapedial artery.[8] A differential diagnosis can help eliminate other possible conditions such as glomus tumour of the tympanicum , facial nerve schwannoma , and aberrant internal carotid artery (ICA) based on results of high-resolution computed tomograms , angiograms , or magnetic resonance angiograms .[9] An aberrant ICA refers to when agenesis of the cervical portion of the ICA occurs, causing the inferior tympanic artery to anastomose with the caroticotympanic artery . This causes the internal carotid artery to enter the middle ear through the same canal as the tympanic nerve , rather than the normal carotid canal.[10] Aberrant internal carotid arteries are often found alongside a PSA,[1] [11] although both anomalies can occur independent of each other.[10]
Treatment [ edit ]
An electrocoagulation machine
Treatment of PSA usually involves some form of coagulation , either laser coagulation or electrocoagulation .[12] Palliative care such as the installation of hearing aids can help resolve hearing loss caused by a PSA;[13] conversely, the PSA may prevent the insertion of cochlear implants meant to alleviate the hearing loss.[14] Ablation of the PSA is also an option, although this treatment carries the risk of potential facial nerve damage and haemorrhage .[13]
The central hospital of the University of Porto reported in 2016 the first successful implementation of a bone-anchored hearing aid in an 8-year-old patient without complications, successfully resolving their hearing loss.[4] Further successful insertions of cochlear implants to resolve hearing loss have also been reported.[15]
Epidemiology [ edit ]
The prevalence of persistent stapedial arteries is thought to be somewhere between 0.02 and 0.48% of the general population;[16] [N 1] a study in the American Journal of Radiology in 2000 stated that only fifty-six cases of PSA had been reported since the first report of PSA was published in 1836 by Austrian anatomist Josef Hyrtl .[1]
References [ edit ]
^ a b Tien HC, Linthicum FH (November 2001). "Persistent Stapedial Artery". Otology & Neurotology . 22 (6 ): 975–976. doi :10.1097/00129492-200111000-00044 . PMID 11698828 .
^ a b Santos M, Esteves SS, Pinto A, et al. (15 December 2016). "Clinical Experience of bone-anchored hearing aid in a patient with Persistent Stapedial Artery". Acta Otorrinolaringológica . 9 (1 ): 140–145. ISSN 2340-3438 .
^ Bonasia S, Smajda S, Ciccio G, et al. (September 2020). "Stapedial Artery: From Embryology to Different Possible Adult Configurations" . American Journal of Neuroradiology . 41 (10 ): 1768–1776. doi :10.3174/ajnr.A6738 . PMC 7661070 . PMID 32883664 .
^ Guinto FC, Garrabrant EC, Radcliffe WB (November 1972). "Radiology of the Persistent Stapedial Artery". Radiology . 105 (2 ): 365–369. doi :10.1148/105.2.365 . PMID 5079662 .
^ Klostranec JM, Krings T (2022). "Cerebral neurovascular embryology, anatomic variations, and congenital brain arteriovenous lesions" . Journal of NeuroInterventional Surgery . 14 (9 ): 910–919. doi :10.1136/neurintsurg-2021-018607 . PMID 35169032 . S2CID 246829491 .
^ Hitier M, Zhang M, Labrousse M, et al. (2013). "Persistent stapedial arteries in human: from phylogeny to surgical consequences". Surgical and Radiologic Anatomy . 35 (10 ): 883–891. doi :10.1007/s00276-013-1127-z . PMID 23640742 . S2CID 21065191 .
^ Yilmaz T, Bilgen C, Savas R, Alper H (June 2003). "Persistent Stapedial Artery: MR Angiographic and CT Findings" . American Journal of Neuroradiology . 24 (6 ): 1133–1135. PMC 8148996 . PMID 12812939 .
^ a b Hatipoglu HG, Cetin MA, Yuksel E, et al. (May 2011). "A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis" . Ear, Nose & Throat Journal . 90 (5 ): 17–20. doi :10.1177/014556131109000513 . PMID 21563075 .
^ Sullivan AM, Curtin HD, Moonis G (February 2019). "Arterial Anomalies of the Middle Ear: A Pictorial Review with Clinical-Embryologic and Imaging Correlation". Neuroimaging Clinics of North America . 29 (1 ): 93–102. doi :10.1016/j.nic.2018.09.010 . PMID 30466646 . S2CID 53716332 .
^ Quarte R, Manipoud P, Schmerber S (June 2019). "Persistent stapedial artery in PHACE syndrome" . European Annals of Otorhinolaryngology, Head and Neck Diseases . 136 (3 ): 215–217. doi :10.1016/j.anorl.2019.02.015 . PMID 30876851 .
^ a b Hill FC, Teh B, Tykocinski M (2018). "Persistent Stapedial Artery with Ankylosis of the Stapes Footplate" . Ear, Nose & Throat Journal . 97 (7 ): 227–228. doi :10.1177/014556131809700702 . PMID 30036438 .
^ Wardrop P, Kerr AI, Moussa SA (September 1995). "Persistent stapedial artery preventing successful cochlear implantation: a case report". The Annals of Otology, Rhinology, and Laryngology . 166 : 443–445. PMID 7668745 .
^ Jones H, Hintze J, Gendre A, et al. (2022). "Persistent Stapedial Artery Encountered during Cochlear Implantation" . Case Reports in Otolaryngology . 2022 : 1–3. doi :10.1155/2022/8179062 . PMC 8888055 . PMID 35242393 .
^ a b Moreano EH, Paparella MM, Zelterman D, et al. (2 March 1993). "Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: A report of 1000 temporal bones". The Laryngoscope . 104 (3 Pt 1): 309–320. doi :10.1288/00005537-199403000-00012 . PMID 8127188 . S2CID 10575546 .
^ Jehl J, Jeunet L, Berraiah M, et al. (2006). "Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula" . Interventional Neuroradiology . 12 (4 ): 327–334. doi :10.1177/159101990601200406 . PMC 3354603 . PMID 20569590 .
R e t r i e v e d f r o m " https://en.wikipedia.org/w/index.php?title=Persistent_stapedial_artery&oldid=1219018364 "
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