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| TEACHING IMAGES |
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| Year : 2019 | Volume
: 7
| Issue : 1 | Page : 134-135 |
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Korner's septum: An uncommon clinical entity
RM Deekshith, KS Gangadhara Somayaji
Department of Otorhinolaryngology, Yenepoya Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 12-Jun-2019 |
Correspondence Address:
Dr. R M Deekshith
Department of Otorhinolaryngology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/amhs.amhs_62_19
A case of mastoid surgery in which Korner's septum was identified is presented. Identification of this structure is important to make sure complete exenteration of the air cells of mastoid and thus reduce the tendency of recurrent mastoid disease.
Keywords: High resolution computed tomography, Körner's septum, petrosquamous suture, temporal bone
How to cite this article:
Deekshith R M, Gangadhara Somayaji K S. Korner's septum: An uncommon clinical entity. Arch Med Health Sci 2019;7:134-5 |
A 28-year-old female patient presented with the complaints of right ear discharge for 8 months which was scanty, purulent, foul-smelling, occasionally bloodstained and associated with intermittent tinnitus. Otomicroscopic examination revealed attic perforation in the right ear and a normal tympanic membrane in the left ear. The audiometric examination demonstrated a moderate conductive hearing loss on the right side with normal hearing in the left ear. The high-resolution computed tomography showed a thin bridge of bone that divided the petrous and squamous portion of the mastoid air cells at the level of the mastoid antrum [Figure 1]. | Figure 1: High resolution computed tomography scan of the right temporal bone showing Korner's septum (axial cut)
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The patient was posted for right mastoid exploration under general anesthesia. On exploring the mastoid, a thick plate of bone was seen bridging the antrum [Figure 2]. After identifying the plate as Korner's septum (KS) further drilling of mastoid was carried out and the cholesteatoma was located posteroinferior to the KS. The cholesteatoma sac was seen deep to the antral air cells extending to the tip and anteriorly up to the epitympanum. | Figure 2: ⋆Intraoperative picture of Korner's septum with cholesteatatoma sac seen deep to Korner's septum. White arrow indicates cholesteatoma
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| Discussion | |  |
Korner's septum (KS) was first described by Cheattle in 1906 and later was named after Korner after the clinical significance of the petrosquamous suture creating a dual antrum.[1],[2],[3] KS is a developmental remnant formed at the junction of mastoid and temporal squama bone, representing the persistence of the petrosquamosal suture. KS identification is associated with retraction pockets or adhesion, retraction of the tympanic membrane than in normal ears.[1],[2],[3] However, various studies in the literature have shown the very minimal incidence of the presence of KS. However, literature also mentions about the variants of KS. With the advent of high-resolution computed tomography (HRCT) scan of temporal bone it is now possible to identify the presence of KS preoperatively and in turn help in avoiding untoward complications of surgery. The clinical significance of the duality of the antrum and the mastoid process in its relationship to disease of the middle ear and mastoid is clarified by an understanding of KS. During mastoid surgery, it could be taken as a false medial wall of the antrum so that the deeper cells might not be explored.
In general, it is very uncommon to find the persistence of KS in the adult temporal bone as compared to the pediatric temporal bone. However, in our case, KS was seen in chronic otitis media squamosal disease type. A good knowledge of the anatomy of pneumatization of mastoid and HRCT scan of the temporal bone is very essential to avoid complications in micro ear surgery.
Declaration of patient
The authors certify that they have obtained all the appropriate patient consent forms. In the form the patient(s) has/have given her/his consent for her/his/their images and other clinical information to be reported in the journal. The patient understands that every effort will be taken to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Shulman A, Rock EH. Korner's (petrosquamous) septum in otology. Report of five cases. Arch Otolaryngol 1972;96:124-9.  |
| 2. | Göksu N, Kemaloǧlu YK, Köybaşioǧlu A, Ileri F, Ozbilen S, Akyildiz N. Clinical importance of the Korner's septum. Am J Otol 1997;18:304-6. |
| 3. | Puricelli MD, Newby MD, Fishman AJ, Rivera AL. The petrosquamous stalactite. Otolaryngol Head Neck Surg 2017;156:549-53. |
[Figure 1], [Figure 2]
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