All patients with fractures classified as both transverse and ocv had snhl. Trauma was applied to the temporal bone samples by using a weight with a radius of 60 mm. Are cochlear implants a viable option following temporal bone. Oblique fractures cross the petrotympanic fissure while longitudinal fractures run within it. Temporal bone dissection guide, by house ear institute. Temporal bone fracture is suggested by battle sign postauricular ecchymosis and bleeding from. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid csf leak, and hearing loss.
Characteristically, longitudinal fractures account for 80% of. Snhl was detected in 14 20% patients and chl in 1723. Original article radiographic classification of temporal. Longitudinal temporal bone fractures radiology reference. These comprise to about 20% of all the temporal bone fractures and are usually caused by anteroposterior frontal or parietal or posteroanterior occipital impact injuries to the skull. Sep 09, 2019 temporal bone injury can be associated with severe trauma to the head, spine, and maxillofacial region. Temporal bone fracture, head injury, petromastoid introduction the incidence of temporal bone fracture has been reported to be as high as 30 to 70% of all cases of skull fractures in patients with head trauma1.
Depending on the direction of trauma, fracture planes rotate around an anteroposterior axis. The temporal bone goes around your ear, in your skull. When the skull is viewed from a posterior aspect, the temporal bones can be seen on the lateral extremities of the skull, with a rounded prominence, the mastoid process, being the most prominent feature visible. Progressive hearing loss after transverse temporal bone. Temporal bone fractures can affect ear canal and hearing. Patients with temporal bone fractures will have suffered a significant head injury in order to impart sufficient force to fracture bone1,2. Classically, fractures of the temporal bone are classified into longitudinal or transverse according to its long axis which. Apr 06, 20 temporal bone fractures the evaluation of the temporal bone in a patient with multiple traumatic injuries can often be incomplete or overlooked, delaying diagnosis and management. They have a prevalence of 3% of all trauma patients in one series 6. Knife that transected the facial nerve classifications fractures may be unilateral or bilateral. Scribd is the worlds largest social reading and publishing site. Danton, a radiologist at ryder trauma center, discusses the most important observations a radiologist should make when looking at the temporal bone fract.
The number of complications of temporal bone fractures were significantly higher in the otic capsule ocviolating group than in the ocsparing group with regard to facial nerve injury p. Temporal bone fracture and latent meningitis lww journals. Temporal bone fractures and their complications springerlink. The most frequent site of injury was the area of the geniculate ganglion. A 21yearold woman at admission to the trauma center after a motor vehicle accident with loss of consciousness. May 22, 2020 temporal bone fractures are traditionally classified in relation to the axis of the petrous portion of the temporal bone. They are the thickest skull base bones and require a great force to fracture. Many such patients will require monitoring in a level 2 or level 3 setting4. The temporal bone is situated on the sides and the base of the cranium and lateral to the temporal lobe of the cerebrum. Role of mastoid pneumatization in temporal bone fractures. Feb 23, 2021 the temporal bone also houses the structures forming the middle and inner ear.
Temporal bone anatomy cadaveric dissection iowa head. Nur aini jusoh introduction the temporal bone is the most complex bone. Normal anatomy the skull base is made up of 7 bones, the paired frontal and temporal bones, and the unpaired ethmoid, sphenoid, and occipital bones. Fractures of the temporal bone maypresent with haemotympanum, bleeding. As otolaryngologists, we must remain cognizant that temporal bone trauma, changes in intracranial pressure, and temporal bone fractures, as reported here, may all precipitate scd. A, an axial noncontrastenhanced computed tomographic scan of the bone window shows a complex fracture of the right occipital bone and temporal bone, and mastoid air cells extending into the right side of the cavity. Temporal bone trauma american academy of otolaryngology. The indications for surgery as well as the proper timing and extent of surgical exploration are the principal questions debated. Temporal bone fractures can lead to high morbidity andor mortality. Pdf facial nerve palsy following temporal bone fracture.
Temporal bone fracture requiring facial nerve decompression or repair. Facial paralysis in longitudinal temporal bone fractures. Temporal bone fractures tbfs occur in up to 20% of patients who sustain a skull fracture, and they may result in a range of complications. Temporal bone fractures can have associated intracranial injuries such as epidural or subdural haematoma, cerebral oedema and elevated intracranial pressure.
Some fractures may have characteristics of both patterns. These fractures are divided into three pattern typeslongitudinal, transverse, and mixed 1,2and each type has specific anatomic descriptions. Fractures typically result from a lateral blow to the temporoparietal region and are commonly associated with fractures of the squamosal portion of the temporal bone fig. Free download temporal bone fractures powerpoint presentation. They are the thickest skull base bones and require a great force to. A quick otoscopy examination is an excellent screening for evidence of a temporal bone injury and can guide additional diagnostic testing dr. Temporal bone dissection guide first version, by john k. Jun 30, 2020 urgent decompression of the fn is required in the case of a progressive deficit in the setting of a temporal bone fracture causing pressure on the fn. Temporal bone fractures have been categorized as longitudinal, transverse, and mixed 1,2. Sensorineural hearing loss and vertigo are secondary to direct injury of the inner ear, and occur in up to 50% of these fractures. The diagnosis of a temporal bone fracture was established by axial hrct in almost every case. Imaging of temporal bone trauma geisel school of medicine. A large case series of temporal bone fractures at a uk major trauma.
Temporal bone fractures are associated with a 31% incidence of a facial nerve injury. Typically, the more frequent longitudinal fractures break through. The initial classification of temporal bone fractures was done by ulrich. Oblique fractures, also called mixed or complex fractures, are the most common types, followed by longitudinal and transverse fractures 4. The temporal bone is very complex and consists of five parts 1,2 squamous part. Less illplaced blows can result in hearing damage or loss as the delicate structures inside the temporal bone are damaged. Many will have significant intracranial injuriesthis 3 requiring neurosurgical intervention and these will take priority. According to nosan, 5 percent of patients with significant head trauma will also sustain temporal bone fractures. The primary purpose of temporal bone drilling is to learn temporal bone anatomy. Original article radiographic classification of temporal bone.
Facial nerve decompression in temporal bone fractures can significantly improve clinical outcomes. The actual incidence of the temporal bone fracture is almost certainly higher because it has been clearly shown that many temporal. They are the thickest skull base bones and require a great force to fracture find, read and cite all the research. Facial nerve decompression led to good results within 3 months after injury. Approximately 1525% of the longitudinal and 50% of the transverse temporal bone fractures result in facial paralysis. Risk of meningitis with csf leak facial nerve injury possible with temporal bone fractures full evaluation of facial nerve function referral for expert consultation otolaryngologistent for possible intervention if evidence of injury temporal bone fracture temporal bone fracture cochlea. In a study of 150 temporal bone fractures, the majority were oblique. Plain axial ct scan image a showing compound fracture with displaced fragment and spiral component. The temporal bones are pyramidal structures set within the thick bone of the skull base. Feb 15, 2021 temporal bone fractures can occur when someone is hit very hard in the head.
Describe normal structures that mimic temporal bone fractures. Axial hrct disclosed 63 longitudinal, transverse, 10 complex and 3 atypical fractures. Pdf temporal bone fracture causing superior semicircular. Effect of transverse temporal bone fracture on the fluid compartment of the inner ear. Rhee et al 10 showed, in a study on the biomechanics of zygomatic bone fractures on cadaver heads, that the severity of the fractures did not depend on the contact surface area or on the thickness of the soft tissue covering the bone. Therefore, it is imperative that the fn is examined on presentation since documentation on presentation determines if there is a need for a temporal bone decompression surgery versus observation. In the eight cases described above none had a visible temporal bone fracture onplain radiographs althoughthree hadevidence ofother skull fractures. Case of bilateral pneumolabyrinth presenting as sudden. Temporal bone fractures were historically divided into three main categories, longitudinal, in which the vertical axis of the fracture paralleled the petrous ridge, horizontal, in which the axis of the fracture was perpendicular to the petrous ridge, and oblique, a mixed type with both longitudinal and horizontal components. Temporal bone fractures are a product of highenergy blunt trauma commonly resulting in fracture, hemorrhage, nerve trauma, vascular damage, with disruption of the middle or inner ear structures, classically classified into longitudinal, transverse, or oblique fractures.
Motor vehicle accidents are the cause of 31% of temporal bone fractures. Mar 01, 2008 fracture of the temporal bone is, by definition, a fracture of the skull base. Anatomy and inflammatory and neoplastic processes1 from a clinicalradiologic standpoint, there are a limited number of structures and disease entities in the temporal bone with which one must be familiar in order to proficiently interpret a computed tomographic or magnetic resonance imaging study of the temporal bone. Temporal bone anatomy cadaveric dissection iowa head and. Longitudinal fractures make up 70 to 90% of temporal bone fractures, and transverse fractures make up 10 to 30%. However, for the precise topographic analysis of the. Pdf patterns and incidence of temporal bone fractures ip. A large volume of force is required to fracture the temporal bone. To identify the anatomic architecture of the temporal bone by using reference points. Temporal bone fracture is thought to occur in 20% range 1422% of all calvarial fractures. An array of fracture planes accounts for most of the fractures observed. Theabsence ofa fracture onthe plain radiographs madethose responsible for the. The temporal bone is one of the most important calvarial and skull base bones. It houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein.
Temporal bone fracture requiring facial nerve decompression or. Temporal lobe injury in temporal bone fractures radiology. Longitudinal fractures reportedly make up 70% to 90% of temporal bone fractures, with the remaining 10% to 30% categorized as transverse. Resident manual of trauma to the face, head, and neck. Longitudinal fractures often result from lateral to medial forces. Temporal bone fractures may be complicated by intracranial haemorrhage, c.
Evaluation of classification of temporal bone fractures. However, temporal bone fractures account for only 4% of non fatal blunt cranial injuries suggesting a correlation of temporal fracture and fatal outcome. Horizontal fractures were thought to be associated with. Jenkins the incidence and clinical features of temporal bone frac tures have been well documented in the medical literature. Temporal bone injury is a major component of head and neck trauma and sometimes has profound clinical implications. Brodie and thompson14 used this new nomen published. Temporal bone fractures free download as powerpoint presentation.
Pdf temporal bone fractures can lead to high morbidity andor mortality. Because temporal bone fractures can occur in individuals who have altered consciousness andor severe bodily injury, physical examination of functional status may be limited. As regards trauma mechanisms and main complications of each type of temporal fracture, they may be summarized as follows. Setting university trauma center and department of otolaryngologyhead and neck surgery. It protects the part of your brain that controls hearing, speech, memory, and behavior. It requires substantial force 1875 lb to fracture the temporal bone. Facial nerve paralysis is one of the complications with temporal bone fractures. Acute management of temporal bone fractures guideline.
Management of cerebrospinal fluid leaks involving the temporal bone. Temporal bone fracture radiology reference article. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientation, description of fractures in terms of longitudinal or transverse or mixed orientation is still. The surgical significance lies in the fact that iatrogenic injury to the petrous segment of the temporal bone including the carotid artery, sigmoid. Axial ct scan image at higher level bone window with edgeenhancement showing better. Pmid 30571012 the temporal bone is the thickest bone in the body, and requires great force to fracture 1875 pounds of lateral force in one study. A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution ct hrct a few hours to 21 months after the initial trauma. Figure 1 shows a nearcomplete cortical mastoidectomy with mastoid tip intact, atticotomy, posterior tympanotomy, and dissection of the retrolabyrinthine and nfralabyrinthine areas. Fractures of the temporal bone are common in patients with major head trauma, with a reported incidence of 18%22% of skull fractures involving the temporal bone. Temporal bone fractures have been classified by orientation with respect to the long axis of the petrous portion of the temporal bone. Pdf patterns and incidence of temporal bone fractures. It is divided into anterior, central, and posterior re.
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