A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol

Abstract

ObjectiveTo review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.MethodsA review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention.ResultsOf 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients.ConclusionTemporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.

Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases

“…Temporal bone fractures (TBFs) represent 14-22% of cranial fractures [1][2][3][4][5][6][7][8]. In the majority of patients, these fractures are unilateral, but approximately 12% of TBFs are bilateral [8,9]. TBFs have been extensively studied because of their severity and emergent nature [1,8,10].…”

“…In the majority of patients, these fractures are unilateral, but approximately 12% of TBFs are bilateral [8,9]. TBFs have been extensively studied because of their severity and emergent nature [1,8,10]. Conventionally, TBFs are divided into transverse, longitudinal, and mixed, depending on the direction of the fracture line compared to the long axis of the petrous pyramid [1,[8][9][10][11].…”

“…TBFs have been extensively studied because of their severity and emergent nature [1,8,10]. Conventionally, TBFs are divided into transverse, longitudinal, and mixed, depending on the direction of the fracture line compared to the long axis of the petrous pyramid [1,[8][9][10][11]. Some authors have criticized this classification because many fractures do not strictly follow this scheme [8][9][10][11][12][13].…”

“…Conventionally, TBFs are divided into transverse, longitudinal, and mixed, depending on the direction of the fracture line compared to the long axis of the petrous pyramid [1,[8][9][10][11]. Some authors have criticized this classification because many fractures do not strictly follow this scheme [8][9][10][11][12][13]. An alternative classification system grouped TBFs as those sparing the otic capsule (OSC) or violating the otic capsule (OVC), because its involvement is a source of severe complications, which negatively affect patient quality of life (QoL) [1,[8][9][10][12][13][14].…”

“…Some authors have criticized this classification because many fractures do not strictly follow this scheme [8][9][10][11][12][13]. An alternative classification system grouped TBFs as those sparing the otic capsule (OSC) or violating the otic capsule (OVC), because its involvement is a source of severe complications, which negatively affect patient quality of life (QoL) [1,[8][9][10][12][13][14]. Approximately 95% of all TBFs are OSC fractures [1,10,12].…”