Treatment of Temporal Bone Fractures

Abstract

Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.

Evaluation of Clinical Outcome in Traumatic Facial Nerve Paralysis

“…Studies report immediate onset of facial paralysis in 27% of cases while the remaining 73% had delayed onset of facial paralysis among patients with temporal bone fractures. 13,19 The chi-squared test also indicated that there was no statistical difference between the observed frequencies in the present study with the expected frequency reported by the earlier studies. The onset of immediate facial paralysis could be due to nerve stretching/compression by bone spicule(s) or fracture fragment/crushing/division.…”

“…Female drivers are, by and large, less rash and more cautious than the risk-taking behavior by male drivers while driving. 12,13 There are other reports that highlighted that males are three to four times more prone to trauma than females while driving. [14][15][16][17] Different age groups of people have different exposure risk.…”

Reconstruction of Complex Cranial and Orbit Fractures with Associated Hemorrhages: Case Report and Review of the Literature

“…Otic capsule disrupting fractures are highly associated with sensorineural hearing loss, facial nerve paralysis, nerve disruption, CSF leaks and fistulae, and intracranial complications. Otic capsule sparing fractures, although generally associated with conductive or mixed hearing loss, impart a better neurological outcome [15]. Temporal fracture in our case spared the otic capsule, resulting in no hearing loss or facial palsy, demonstrating that the presence of complex temporal trauma may not be the inciting event for neurological sequelae.…”

“…Temporal fractures are typically divided into two categories relative to the petrous ridge: transverse or longitudinal [15]. However, most cases, including the case herein, cannot be clearly delineated in this manner.…”

“…However, most cases, including the case herein, cannot be clearly delineated in this manner. Diaz et al described that separating fractures into these two categories is not prognostic for neurological deficits, and argued for segregation into "otic capsule sparing" and "otic capsule disrupting" cohorts [15]. Otic capsule disrupting fractures are highly associated with sensorineural hearing loss, facial nerve paralysis, nerve disruption, CSF leaks and fistulae, and intracranial complications.…”