Fracture of Temporal Bone With Exsanguination: Pathology and Mechanism

Abstract

ABSTRACT:Eight cases of basal skull fracture with transverse fracture of the petrous temporal bone with medial extension to the internal carotid artery and lateral extension of the structures of the middle ear are described. Injuries in all cases were due to major blunt impact to the head usually occurring in a motor vehicle accident. General autopsy revealed major blood loss without any obvious external or internal site of hemorrhage suggesting that exsanguination was a complication of the head injury. The internal carotid arteries at the most medial extension of the fractures were lacerated or transected in all cases. In selected cases, the cervical internal carotid arteries were perfused and perfusate escaped rapidly from the ear(s) with the majority of fluid bypassing the cerebral venous system. Magnetic resonance image reconstruction of sequential sections of the fractured base of the skull confirmed the laceration of the internal carotid arteries and disruption of the middle ear. Based on this evidence, we propose that some displaced fractures of the base of the skull produce carotid-middle ear continuities which act as arterial shunts, resulting in rapid fatal exsanguination through the ear.

A comparison of external and internal injuries within an autopsy series

“…Of the expected stereotypical injury patterns examined, only bleeding from the ears was found to be predictive of internal injury (base of skull fracture). This bleeding may result from a displaced base of skull fracture where a conduit between the cranial cavity and the middle ear is opened to allow egress for intracranial bleeding (Pollanen et al, 1992). Bleeding from both ears was highly predictive (95%) of a basal skull fracture.…”

A revolution in preventing fatal craniovertebral junction injuries: lessons learned from the Head and Neck Support device in professional auto racing

“…1,2,12,23,31 Pollanen et al evaluated a series of 8 fatal basilar skull fractures and found that fractures of the petrous portion of temporal bones will often involve laceration of the internal carotid arteries, leading to massive hemorrhage. 21 These fractures can involve the middle ear as well and create a carotid-middle ear fistula leading to rapid exsanguination. 21,30 The grave prognosis of these high-velocity sports injuries from atlantooccipital dissociation, fatal vascular injuries, and concurrent basilar skull ring fractures necessitated further investigation into prevention and safety.…”

“…21 These fractures can involve the middle ear as well and create a carotid-middle ear fistula leading to rapid exsanguination. 21,30 The grave prognosis of these high-velocity sports injuries from atlantooccipital dissociation, fatal vascular injuries, and concurrent basilar skull ring fractures necessitated further investigation into prevention and safety. Trammell and Hubbard explored medical and technical outcomes of the HANS device in Championship Auto Racing Team (CART) series racing.…”