Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review

Kennedy, Kenneth; Cash, Elizabeth; Petrey, Jessica; Lin, Jilei

doi:10.1177/0194599820968796

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Over the last decade, published outcomes consist primarily of single-site case series, few systematic reviews, 38,39 and retrospective cohort studies. [40][41][42][43] Three randomized controlled trials [44][45][46] compared clinical and radiographic nonunion, complications, and infections of open reduction and internal fixation to closed reduction and maxillomandibular fixation of mandibular fractures sustained from gunshot injury.…”

Section: Resultsmentioning

confidence: 99%

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

2023

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Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.

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Section: Resultsmentioning

confidence: 99%

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

2023

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“…11 The bullet’s velocity is the main driver of its kinetic energy (KE = ½ mv 2 ) to achieve this force. 12 The vast majority of temporal bone ballistic injuries do not fracture the otic capsule bone, which houses the delicate labyrinthine structures. However, due to acoustic trauma and labyrinthine concussion from a higher primary blast wave associated with GSW, our series demonstrates that sensorineural hearing loss is common even with a spared otic capsule.…”

Section: Discussionmentioning

confidence: 99%

Audiologic Consequences of Gunshot Wounds to the Temporal Bone Show No Relation to Concomitant Neurologic or Vascular Injuries

Maxwell

Kahane

Murphy

2023

Ann Otol Rhinol Laryngol

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Objectives: To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal bone. Study design: Retrospective case series. Setting: University-based level-one trauma center. Methods: Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed. Results: Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without ( P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury. Conclusions: All patterns of hearing loss—conductive, sensorineural, mixed and normal—may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.

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“…Temporal bone injuries due to ballistic projectiles are uncommon, accounting for 3% of all temporal bone fractures. However, the penetrating trauma caused by these injuries is among the most devastating for vestibulocochlear and facial nerve function [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Bulletproof Temporal Bone: A Case of Self-Inflicted Ballistic Injury

Casanova¹,

Correia²,

Lino³

et al. 2023

Cureus

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Temporal bone injuries due to gunshot wounds are uncommon but devastating, with a high risk of damage to critical neurovascular structures. The high resistance of the temporal bone, the densest bone in the human body, can sometimes avoid a fatal outcome. However, the complications are in many cases devastating and include hearing loss, facial paralysis, cerebrospinal fluid leakage, intracranial damage, and vascular injuries. Our goal was to report a case of ballistic injury to the temporal bone and describe the surgical approach taken for treatment. A 74-year-old man was transferred to the emergency room of our tertiary hospital, intubated and sedated, after an attempted suicide with a firearm. The CT scan showed the metal projectile lodged within the temporal bone on the right side, with the destruction of the ossicular chain and bony labyrinth. After stabilization, sedation was reversed, and the otolaryngology team was called. On examination, the entry wound was located in the cavum concha, with no active bleeding but presenting active otorrhea of cerebrospinal fluid. The patient had complete peripheral facial paralysis on the right side and spontaneous horizontal nystagmus toward the left side. Empirical antibiotic therapy was initiated. A subtotal petrosectomy was performed, with the removal of the foreign body, repair of the cerebrospinal fluid fistula, obliteration of the cavity with abdominal fat, and closure of the external auditory canal. He was discharged on the 11th-day post-surgery, maintaining complete facial paralysis and right-side anacusis, but was able to walk with assistance. In conclusion, penetrating trauma of the temporal bone is a potentially life-threatening situation, and patients that survive have a guarded prognosis, as it often leads to permanent sequelae even when managed promptly.

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Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review

Cited by 7 publications

References 17 publications

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

Audiologic Consequences of Gunshot Wounds to the Temporal Bone Show No Relation to Concomitant Neurologic or Vascular Injuries

Bulletproof Temporal Bone: A Case of Self-Inflicted Ballistic Injury

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