![]() ![]() The vagus nerve yields an auricular branch ( Arnold nerve) via the mastoid canaliculus on the lateral wall of the foramen adjacent to the mastoid segment of the facial nerve. Jugular bulb: a venous expansion sitting in the jugular fossa, between the endocranial sigmoid sinus and the exocranial jugular vein The pars vascularis is the posterolateral portion of the jugular foramen and is larger than the smaller anteromedial portion termed the pars nervosa. The glossopharyngeal nerve yields a tympanic branch ( Jacobson nerve) which reaches and supplies the middle ear along with the inferior tympanic artery via the inferior tympanic canaliculus which is occasionally seen at CT in cross-section at the level of the caroticojugular spine. The inferior petrosal sinus drains the cavernous sinus and courses in the petro-occipital fissure adjacent to the clivus prior to its exit through the pars nervosa and subsequent drainage into the internal jugular vein beneath the foramen. The pars nervosa is the anteromedial portion of the jugular foramen and is smaller than the larger, posterolateral pars vascularis. This nomenclature is misleading because both compartments contain vascular and neural structures. Pars vascularis: posterolateral and larger The jugular foramen is commonly described in two parts, separated by a fibrous septum or a bony septum called the jugular spine (intrajugular processes on the opposing surfaces of the temporal and occipital bones): Gross anatomy Divisions: 2-part classification Ascending occipital and pharyngeal arteries are also located in this foramen 5. Referral to an otolaryngologist also is indicated for an uncooperative child, who may require sedation, or for failed attempts at removal.The jugular foramen is the cranial foramen located posterior to the carotid canal, formed by the petrous temporal bone and occipital bone where the sigmoid sinus and inferior petrosal sinus drain into the internal jugular vein and where cranial nerves IX–XI ( glossopharyngeal, vagus, and accessory) exit 5. Without a microscope, a foreign body lying at or medial to the isthmus (the bony cartilaginous junction of the external auditory canal) is difficult to remove without injuring the delicate canal skin, tympanic membrane, or ossicular chain. Foreign bodies medial to the isthmus should be removed under operating microscope guidance by a specialist. If a smooth, rounded, or spherical foreign body is lateral to the isthmus (bony-cartilaginous junction), it should be removed by reaching behind the object and rolling it out. Patients with such objects should be referred to an otolaryngologist if the object cannot be easily removed with a curette. However, forceps tend to push round, smooth objects (eg, beads, beans) deeper into the canal. In general, foreign bodies that appear easy to grasp and remove (eg, paper, an insect wing) can be removed with alligator forceps by most practitioners. Symptoms include otalgia, often with systemic symptoms (eg, fever. read more and cause an acute otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include painless otorrhea with conductive hearing. ![]() Water entering the middle ear through a tympanic membrane perforation may exacerbate chronic otitis media Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a persistent, chronically draining (> 6 weeks), suppurative perforation of the tympanic membrane. Irrigation is contraindicated in patients with a known tympanic membrane perforation or with a suspected infection. Irrigation may also be combined with cerumenolytic agents, such as liquid docusate sodium. Irrigation is often done in the emergency department or primary care setting and should be done carefully to avoid complications. These methods, particularly when done by an experienced practitioner, can be quicker and safer than irrigation. Cerumen can be removed by rolling it out of the ear canal with a blunt curet or loop or a small, blunt right angle hook, or by removing it with a suction tip (eg, Baron, size 5 French). ![]()
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