Temporal bone fractures
Temporal bone fractures are usually a sequela of blunt head injury, generally from severe trauma. Associated intracranial injuries, such as extra-axial haemorrhage, shear (or diffuse axonal) injury and brain contusion are common. Early identification of temporal bone trauma is essential to managing the injury and avoiding complications.
Temporal bone fractures are thought to occur in ~20% (range 14-22%) of all calvarial fractures. They have a prevalence of 3% of all trauma patients in one series 6.
Temporal bone fractures are suggested by Battle's sign (post-auricular ecchymosis) and bleeding from the ear. As it can sometimes involve structures of the middle or inner ear, symptoms such as hearing loss, vertigo, balance disturbance or facial paralysis may be present.
Classification: otic capsule involvement
Other classifications have been proposed and are more clinically relevant 4-5. Temporal bone fractures can be classified based on:
- otic capsule sparing
- otic capsule violating
Involvement of the otic capsule is a predictor of more serious complications including 5,6:
- facial nerve paralysis (2-5x as likely)
- CSF leak (4-8x as likely)
- sensorineural hearing loss (7-25x as likely)
- epidural haematoma and subarachnoid haemorrhage
Head CT with petrous temporal bone fine slice multiplanar bone window reformats is the imaging modality of choice. Refer to fracture subtypes for further details.
Treatment and prognosis
Treatment is based on managing facial nerve injury, hearing loss, vestibular dysfunction, and CSF leakage. If immediate facial nerve paralysis occurs with loss of electrical response, surgical exploration may be warranted. Delayed-onset or incomplete facial paralysis almost always resolves with conservative management, including the use of corticosteroids, which are gradually tapered.
- facial and other cranial nerve injuries
- vertigo and hearing loss
- cerebrospinal fluid (CSF) leak, CSF fistula, meningitis, and post-traumatic cholesteatoma may also result
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