Management of complication from temporal bone fractures

Abstract

The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squama-mastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.

Patient-Assessed Outcomes following Temporal Bone Fractures

“…However, in a study [ 23 ] comprising 174 patients with immediate FP after TBF, postoperatively, 28 (16%) had final HB I, 123 (71%) had HB II-V, and 11 (6%) HB VI, supporting the fact that surgical intervention did not appear to improve on the natural course of immediate FP; we agree with this, as 75% of our patients with immediate FP consequently had mild FP after conservative treatment and the two surgically treated patients had final HB III and IV. Facial function recovery among patients with delayed FP is almost always to HB I or II, precluding surgical decompression of the facial nerve [ 6 , 7 , 24 ].…”

“…The electrodiagnostic tests, including the ENoG and excitability test, have been widely used to predict facial nerve recovery after traumatic FP [ 3 , 6 , 7 , 24 ]. In post-traumatic FP, neural degeneration of the facial nerve correlates with poor recovery by more than 95%, especially when it occurs within the first 14 days after injury [ 25 ].…”

“…Conventionally, TBFs are divided into longitudinal, transverse, and mixed types, depending on the direction of the fracture line [ 5 ]. The complications of TBF include facial nerve palsy (FN), hearing loss (HL), which may be conductive, sensorineural, or mixed, and have a cerebrospinal fluid (CSF) leak [ 6 , 7 , 8 ]. All these sequelae of TBFs may adversely affect quality of life (QOL) with a psychological, emotional and social impact.…”

The potential protective effects of temporal bone pneumatization: A shock absorber in temporal bone fracture

“…OCV fractures which lead to disruption of the membranous labyrinth were associated with a 100% incidence of SNHL as expected. Even without damage to the otic capsule, SNHL could occur due to avulsion or trauma to the cochlear nerve, interruption of the cochlear blood supply, hemorrhage in the cochlea, perilymphatic fistulas or obstruction of the endolymphatic duct [19]. In the literature, microfractures involving the otic capsule which would not be visible on CT scan were identified by histopathologic analysis [20].…”

Post traumatic deafness: a pictorial review of CT and MRI findings

“…Nevertheless, temporal bone trauma is frequently associated with brain and cervical spine injuries [ 1 ] that sometimes require surgical management. Six months after a temporal bone trauma, persistent CHL occurs in 50 % of patients [ 2 ].…”