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: direction

Temporal bone fractures classically are described concerning the long axis of the petrous bone, being classified as:

Classification: otic capsule involvement

Other classifications have been proposed and are more clinically relevant 4-5Temporal 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:

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 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.

Complications
  • 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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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

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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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