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Absent Stapedial Tendon: Imaging Features of an Underrecognized Entity

Clinical Neuroradiology

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Abstract

Purpose

Congenital absence of the stapedial tendon is a rare entity with characteristic imaging findings, which can go unrecognized due the scarcity of the diagnosis and limited previous description in the imaging literature. We aim to characterize the imaging features of this entity.

Methods

A series of 9 cases with surgical confirmation of stapedial tendon absence were retrospectively reviewed and the most common abnormalities on high resolution computed tomography (CT) of the temporal bone described.

Results

Congenital fixation of the stapes footplate was present in nearly all cases of stapedial tendon absence (n = 8, 89%), a clinically important association because the stapes footplate abnormality was not detectable on preoperative CT. Absence or hypoplasia of the pyramidal eminence and aperture was identified in almost all cases (n = 8, 89%), which may be the sole imaging finding to suggest stapedial tendon absence and associated stapes footplate fixation prior to surgery.

Conclusion

The most reliable indicator of stapedial muscle absence on temporal bone CT is the absence or hypoplasia of the pyramidal eminence and aperture. Importantly, most patients had congenital stapes footplate fixation confirmed intraoperatively with a normal stapes footplate on CT, meaning the pyramidal eminence/aperture abnormality was the only preoperative imaging finding that could have suggested the footplate fixation.

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References

  1. Prasad KC, Azeem Mohiyuddin SM, Anjali PK, Harshita TR, Indu Varsha G, Brindha HS. Microsurgical Anatomy of Stapedius Muscle: Anatomy Revisited, Redefined with Potential Impact in Surgeries. Indian J Otolaryngol Head Neck Surg. 2019;71:14–8.

    Article  CAS  PubMed  Google Scholar 

  2. Wojciechowski T, Skadorwa T, Nève de Mévergnies JG, Niemczyk K. Microtomographic morphometry of the stapedius muscle and its tendon. Anat Sci Int. 2020;95:31–7.

    Article  CAS  PubMed  Google Scholar 

  3. Potu BK. Morphometrics of the stapedius muscle: A systematic review of cadaveric studies. Eur J Anat. 2021;25:117–24.

    Google Scholar 

  4. Blevins CE. Innervation patterns of the human stapedius muscle. Arch Otolaryngol. 1967;86:136–42.

    Article  CAS  PubMed  Google Scholar 

  5. Djerić D, Savić D. Les variations anatomiques et les anomalies du tendon du muscle de l’étrier. Etude en microscopie électronique scanning [Anatomical variations and anomalies of the musculus stapedius tendon. Study by scanning electron microscopy]. Ann Otolaryngol Chir Cervicofac. 1987;104:59–63.

    PubMed  Google Scholar 

  6. Kopuz C, Turgut S, Kale A, Aydin ME. Absence of both stapedius tendon and muscle. Neurosciences (Riyadh). 2006;11:112–4.

    PubMed  Google Scholar 

  7. Dey S, Dutta M, Misra S. Congenital absence of stapedius muscle and tendon: case report with review of literature. J Clin Diagn Res. 2022;16:MD1–4.

    Google Scholar 

  8. Nassiri AM, Benson JC, Doerfer KW, Perkins EL, Sweeney AD, Patel NS, Babu SC, Rivas A, Lane JI, Carlson ML. Absent pyramidal eminence and stapedial tendon associated with congenital stapes footplate fixation: Intraoperative and radiographic findings. Am J Otolaryngol. 2021;42:103144.

    Article  PubMed  Google Scholar 

  9. Kanona H, Virk JS, Kumar G, Chawda S, Khalil S. A rare stapes abnormality. Case Rep Otolaryngol. 2015;2015:387642.

    PubMed  PubMed Central  Google Scholar 

  10. Dalmia D, Behera S. Congenital absence of stapedius muscle and tendon: Rare finding in two cases. Indian J Otol. 2017;23:43–5.

    Article  Google Scholar 

  11. Juliano AF, Ginat DT, Moonis G. Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology. 2013;269:17–33.

    Article  PubMed  Google Scholar 

  12. Rodríguez-Vázquez JF, Mérida-Velasco JR, Verdugo-López S. Development of the stapedius muscle and unilateral agenesia of the tendon of the stapedius muscle in a human fetus. Anat Rec (Hoboken). 2010;293:25–31.

    Article  PubMed  Google Scholar 

  13. Bachor E, Just T, Wright CG, Pau HW, Karmody CS. Fixation of the stapes footplate in children: a clinical and temporal bone histopathologic study. Otol Neurotol. 2005;26:866–73.

    Article  PubMed  Google Scholar 

  14. Henriques V, Teles R, Sousa A, Estevão R, Rodrigues J, Gomes A, Silva F, Fernandes Â, Fernandes F. Abnormal Congenital Location of Stapes’ Superstructure: Clinical and Embryological Implications. Case Rep Otolaryngol. 2016;2016:2598962.

    PubMed  PubMed Central  Google Scholar 

  15. Connor SE, Pai I, Jiang D, Spiers AJ, Fitzgerald-O’Connor A. Discontinuity of the incudo-stapedial joint within a fully aerated middle ear and mastoid on computed tomography: A clinico-radiological study of its aetiology and clinical consequence. Clin Radiol. 2012;67:955–9.

    Article  CAS  PubMed  Google Scholar 

  16. Park HY, Han DH, Lee JB, Han NS, Choung YH, Park K. Congenital stapes anomalies with normal eardrum. Clin Exp Otorhinolaryngol. 2009;2:33–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Whyte Orozco JR, Cisneros Gimeno AI, Yus Gotor C, Obón Nogues JÁ, Pérez Sanz R, Gañet Solé JF, Fraile Rodrigo JJ. Ontogenic development of the Incudostapedial joint. Acta Otorrinolaringol. 2008;59:384–9.

    Article  Google Scholar 

  18. Helwany M, Arbor TC, Tadi P. Embryology, ear. Treasure Island: StatPearls; 2022.

    Google Scholar 

  19. Verheij E, Elden L, Crowley TB, Pameijer FA, Zackai EH, McDonald-McGinn DM, Thomeer HGXM. Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review. AJNR Am J Neuroradiol. 2018;39:928–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Mafee MF, Charletta D, Kumar A, Belmont H. Large vestibular aqueduct and congenita l sensorineural hearing loss. AJNR Am J Neuroradiol. 1992;13:805–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Levenson MJ, Parisier SC, Jacobs M, Edelstein DR. The large vestibular aqueduct syndrome in children. A review of 12 cases and the description of a new clinical entity. Arch Otolaryngol Head Neck Surg. 1989;115:54–8.

    Article  CAS  PubMed  Google Scholar 

  22. Subramaniam S, Tan TY, Yuen HW. Bilateral enlarged vestibular aqueduct with associated bilateral Mondini’s dysplasia. Am J Otolaryngol. 2012;33:455–6.

    Article  PubMed  Google Scholar 

  23. Declau F, Jacob W, Montoro S, Marquet J. Dehiscence of the facial canal: developmental aspects. Int J Pediatr Otorhinolaryngol. 1991;21:21–32.

    Article  CAS  PubMed  Google Scholar 

  24. Zhou W, Lane JI, Carlson ML, Bruesewitz MR, Witte RJ, Koeller KK, Eckel LJ, Carter RE, McCollough CH, Leng S. Comparison of a photon-counting-detector CT with an energy-integrating-detector CT for temporal bone imaging: a cadaveric study. AJNR Am J Neuroradiol. 2018;39:1733–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kemp P, Stralen JV, De Graaf P, Berkhout E, Horssen PV, Merkus P. Cone-beam CT compared to multi-slice CT for the diagnostic analysis of conductive hearing loss: a feasibility study. J Int Adv Otol. 2020;16:222–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Benson JC, Rajendran K, Lane JI, Diehn FE, Weber NM, Thorne JE, Larson NB, Fletcher JG, McCollough CH, Leng S. A new frontier in temporal bone imaging: photon-counting detector CT demonstrates superior visualization of critical anatomic structures at reduced radiation dose. Ajnr Am J Neuroradiol. 2022;43:579–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rajendran K, Benson J, Lane J, Diehn F, Weber N, Thorne J, Larson N, Fletcher J, McCollough C, Leng S. Reply. AJNR Am J Neuroradiol. 2022;43:E44.

    CAS  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st St SW, MN 55901, Rochester, MN, USA

    Brian J. Burkett, Michael P. Oien, John C. Benson & John I. Lane

  2. University of Colorado Hospital, Aurora, CO, USA

    Ashley M. Nassiri

  3. Department of Neurologic Surgery, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA

    Matthew L. Carlson

Authors
  1. Brian J. Burkett
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  2. Michael P. Oien
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  3. John C. Benson
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  4. Ashley M. Nassiri
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  5. Matthew L. Carlson
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  6. John I. Lane
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Brian J. Burkett, Michael P. Oien, John C. Benson, Ashley M. Nassir, Matthew L. Carlson, and John I. Lane. The first draft of the manuscript was written by Brian Burkett and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brian J. Burkett.

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Conflict of interest

B.J. Burkett, M.P. Oien, J.C. Benson, A.M. Nassiri, M.L. Carlson and J.I. Lane declare that they have no competing interests.

Ethical standards

This research study was conducted retrospectively from data obtained for clinical purposes. This work was conducted following approval by the Mayo Clinic Institutional Review Board. Informed consent was not obtained for the retrospectively collected images and clinical data in this case series. The retrospective review was conducted with Institutional Review Board approval. No identifying information is presented in this publication. The clinical data and CT images are deidentified.

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Burkett, B.J., Oien, M.P., Benson, J.C. et al. Absent Stapedial Tendon: Imaging Features of an Underrecognized Entity. Clin Neuroradiol 33, 645–651 (2023). https://doi.org/10.1007/s00062-022-01251-1

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  • DOI: https://doi.org/10.1007/s00062-022-01251-1

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