Temporal bone fractures

Temporal bone fractures are usually a sequela of significant blunt head injury. In addition to potentially damaging hearing and the facial nerve, associated intracranial injuries, such as extra-axial haemorrhage, diffuse axonal injury and cerebral contusions are common. Early identification of temporal bone trauma is essential to managing the injury and avoiding complications.

Although the temporal bone includes the squamous part, forming the inferolateral part of the skull vault, generally the term temporal bone fracture refers to the involvement of the petrous part. 

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 sign (post-auricular ecchymosis) and bleeding from the external auditory canal. As these fractures can sometimes involve the ossiclesinner ear and facial nerve, symptoms such as hearing loss, vertigo, balance disturbance, or facial paralysis may be present.

Fractures of the petrous temporal bone are usually classified according to the main direction of the fracture plane and/or involvement of the otic capsule

Temporal bone fractures are described relative to the long axis of the petrous temporal bone which runs obliquely from the peterous apex posterolaterally through the mastoid air cells. Using this plane, fractures are classically divided into: 

Other classifications have been proposed as being more clinically relevant, specifically focusing on whether or not the otic capsule is involved 4-5.  Involvement of the otic capsule is a predictor of more serious complications including 5,6:

Head CT with petrous temporal bone fine slice (≤1mm) multiplanar bone window reformats is the imaging modality of choice. These are discussed in detail in separate articles:

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 should be considered. Delayed-onset or incomplete facial paralysis almost always resolves with conservative management, including the use of tapered-dose corticosteroids.

Fractures
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Article information

rID: 12970
Tags: trauma, ent
Synonyms or Alternate Spellings:
  • Temporal bone fracture
  • Fractures through the temporal bone
  • Fractures involving the temporal bone
  • Petrous temporal bone fracture
  • Petrous temporal bone fractures
  • T-bone fracture

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Cases and figures

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    Case 1: mixed fracture
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    Axial MIP shows t...
    Case 2: longitudinal temporal bone fracture
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    Case 3: with ossicular disruption
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    Case 4: longitudinal temporal bone fracture
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    Case 5: transverse temporal bone fracture
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    Case 6: mixed
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