The human temporal bone contains a large number of complex structures within a small space. Imaging of temporal bone trauma operative techniques in. Temporal bone fracture with tympanic membrane perforation and hemorrhage. A temporal bone fracture generally requires very strong forces to the skull that occur either laterally or in an anterior or posterior ear direction. A temporal bone fracture may cause facial paralysis, hearing loss, bruising behind the ear, and bleeding from the ear. Management of facial paralysis in temporal bone fractures. In 20 cases the fracture involved more than one cranial bone, and the implications of this with regard to nonaccidental injury are discussed. Danton, a radiologist at ryder trauma center, discusses the most important observations a radiologist should make when looking at the temporal bone fractures in the acute setting. Case of bilateral pneumolabyrinth presenting as sudden. Temporal bone or basilar skull fractures are extremely common in any head injury. Injuries to the temporal bone may be considered in three. Dental anatomy temporal bone questions and study guide. Associated trauma to other cranial nerves oth er than the facial nerve. Theabsence ofa fracture onthe plain radiographs madethose responsible for the.
Acute management of temporal bone fractures guideline. Temporal bone fractures were previously classified as longitudinal or transverse. One hundred fortyone cases of traumatic facial nerve palsy with an intact nerve were decompressed at our center through transcanal approach from january 1998 to december 2017. Immediate and complete facial palsy suggests transection of the nerve, whereas a delayed and partial palsy suggests neurapraxia from fracture oedema. Fracture of the petrous temporal bone is usually classified according to the main direction of the fracture plane andor involvement of the otic capsule. According to nosan, 5 percent of patients with significant.
We report a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, after a fall. Traffic collisions in bangalore are a major cause of temporal bone fractures with facial nerve palsy. These figures form part of a larger study of 90 temporal bone fractures treated over a sixyear period from 1975 through 1981. Downloadable 3d virtual models of the human temporal bone. Temporal bone fractures were historically divided into three main categories, longitudinal, in which the vertical axis of the fracture paralleled the petrous ridge, horizontal, in which the axis of the fracture was perpendicular to the petrous ridge, and oblique, a mixed type with both longitudinal and horizontal components. Temporal bone fracture msd manual consumer version. The purpose of this study was to investigate the prevalence of temporal bone fractures in patients with mandibular fractures and the relationship between temporal bone fractures and the mandibular fracture location using multidetectorrow computed tomography mdct. Temporal bone fracture radiology reference article. Temporal bone fracture requiring facial nerve decompression. Temporal bone fracture is described relative to the long axis of the petrous temporal bone, which runs obliquely from the petrous apex posterolaterally through the mastoid air cells. Because computerbased 3d virtual models can be valuable tools for teaching and learning this anatomy, we have developed virtual models of the human temporal bone and made them available as downloadable. A large volume of force is required to fracture the temporal bone. After deformation of the temporal bone that occurs from a. The anatomy of the temporal bone is complex, and correct identification of normal structures is necessary to prevent misinterpretation as fractures.
Temporal bone ct can detect deviations in the course and caliber of the intratemporal facial nerve, which can provide key information regarding facial nerve pathology and. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientation, description of fractures in terms of longitudinal or transverse or mixed orientation is still. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. If a temporal bone fracture is suspected, immediate ct of the head with special attention to the temporal bone is recommended. Temporal bone fracture can cause blood coming from the ear, blood behind the tympanic membrane, hearing loss, vestibular dysfunction, andor facial nerve paralysis. After your bones are put back in place, you may have a cast or splint to keep the injured bones from moving. Temporal bone fractures and its classification ijars.
Trauma temporal bone fractures, uw health, university of. In the eight cases described above none had a visible temporal bone fracture onplain radiographs althoughthree hadevidence ofother skull fractures. Pdf facial nerve palsy has been observed in about 1. Dec 21, 2012 one study looked at the causes, the signs and symptoms as well as the management of temporal bone fractures in kids.
Facial nerve palsy is rare temporal bone fractures unless there has been a penetrating injury, in which case the frequency rises. Temporal bone fractures merck manuals professional edition. Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. A broken bone is often caused by a fall, an injury or an accident. Evaluation of classification of temporal bone fractures juniper. This patient had a ct scan of the temporal bone, which found a temporal bone fracture. Do ct with attention to the temporal bone, refer patients for audiometry, and, if facial nerve paralysis is. Apr 06, 20 temporal bone fractures the management of temporal bone fractures is generally aimed at restoring functional deficits, rather than reducing and fixating bone fragments. Early identification of temporal bone trauma is essential to managing the injury and avoiding complications.
Of the 11 fractures, 7 63% were longitudinal and 4 37% were of mixed type. Longitudinal temporal bone fractures radiology reference. Highresolution ct of the temporal bones was performed in patients suspected of having a temporal bone fracture. Temporal bone fracture, the consequences of which are unpredictable, can dramatically change a persons life. Resident manual of trauma to the face, head, and neck aaohns. Temporal bone fractures mitchell jay ramsey, md, lt colonel, mc, usa although temporal bone fractures are relatively uncommon, they present many complex diagnostic and therapeutic challenges. Abnormal enhancement of the facial nerve is apparent in the labyrinthine small arrow, geniculate open arrow, and tympanic double arrow portions of the. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Pneumolabyrinth secondary to temporal bone fracture. Pdf temporal bone fractures can lead to high morbidity andor mortality. The most common cause of a temporal bone fracture was a motor vehicle accident occurring in 4090 44% patients. This complex anatomy is a challenge for students in the basic science and medical disciplines.
Etiology for basilar skull and temporal bone fractures. Multidetector computed tomography aids in the detection and subsequent classification of skull base and temporal bone fractures. Facial nerve decompression after temporal bone fracture. Temporal bones house numerous nerves, therefore, fracture of the.
The main objective of the study is to document the frequency and most prevalent type of temporal bone fracture, coexisting complications. After deformation of the temporal bone that occurs from a blow to the head, possible serious consequences. O 20% of patients with skull fracture have temporal bone fractures o 2. Dec 27, 2015 traditional classification of temporal bone fractures, axial ct show a a longitudinal fracture and b a transverse fracture in two different patients, the longitudinal fracture is parallel to the long axis of the petrous pyramid arrow, a and traverses the mastoid portion of the temporal bone, the transverse fracture is oriented. Fracture classification traditional classification. Doctors use computed tomography ct to diagnose temporal bone fractures. Complications of temporal bone fractures are common11. A highresolution computed tomography of the temporal bone with submillimeter cuts should be obtained in the setting of temporal bone trauma, particularly with acute onset facial nerve paralysis. Introduction to ct interpretation of temporal bone fractures. Accurate early diagnosis is important to enable adequate investigation and prompt treatment of any complications. It protects the part of your brain that controls hearing, speech, memory, and behavior. A 49yearold man presented with sudden, bilateral deafness and whirling vertigo, without any other neurological manifestations.
There were 6 54% left and 5 46% rightsided temporal bone fractures. What 5 bones does the temporal bones articulate with. Temporal bone ct can detect deviations in the course and caliber of the intratemporal facial nerve, which can provide key information regarding facial nerve pathology and prove critical in surgical planning for otologic surgery. Cochlear implantation following temporal bone fracture the. Temporal bone fracture is usually a sequela of significant blunt head injury. They are the thickest skull base bones and require a great force to fracture find, read and cite all the research. A temporal bone fracture can involve none or all of these structures.
Cochlear implantation following temporal bone fracture. Abstractpneumolabyrinth following temporal bone fracture is an extremely rare. Temporal bone article about temporal bone by the free. Specific anatomic defects include semicircular canal dehiscence, perilabyrinthine fistula, enlarged vestibular aqueduct, dehiscence of the scala vestibuli. Third window abnormalities are defects in the integrity of the bony structure of the inner ear, classically producing soundpressureinduced vertigo tullio and hennebert signs andor a lowfrequency air bone gap by audiometry. You have two temporal bones, one on each side of your head. If there is a blow to the side of the head, it can cause a fracture of the skull that extends to the inner ear and often to the geniculate ganglion longitudinal temporal. Temporal bone fractures were found in 48 patients 2% and were classified as longitudinal, transverse, or mixed. Cochlear implantation following temporal bone fracture volume 1 issue 5 andrew e. Temporal bone fractures may be complicated by intracranial haemorrhage, c. Approximately 50% of all temporal bone fractures are a result of road. Sep 09, 2019 temporal bone injury can be associated with severe trauma to the head, spine, and maxillofacial region.
Pdf a study of temporal bone fractures researchgate. Pdf facial nerve palsy following temporal bone fracture. Do ct with attention to the temporal bone, refer patients for audiometry, and, if facial nerve paralysis is suspected, arrange electrical testing of the facial nerve. Resident manual of trauma to the face, head, and neck. Treatment, sometimes including surgery, is needed if the fracture causes problems. After your bone s are put back in place, you may have a cast or splint to keep the injured bone s from moving.
This article is from international medical case reports journal, volume 7. The temporal bone is the bone that goes around your ear, in your skull. More than 75% of these injuries are to the head, and the ear being the most frequently injured sensory organ of the body. The literature regarding management of traumatic facial nerve palsies remains inconclusive and large prospective studies are lacking12. The etiology of the temporal bone fracture was a fall in 5 50% patients, motor vehicle accidents in 4 40%, and crush injury in 1 10%. Bone fractures a fracture is also called a broken bone. You may need an xray to see if you have a broken bone. The criteria for ct scan following head injury in general, and temporal bone fracture in particular are discussed. Temporal bone fractures introduction the temporal bone is the most complex bone in the human body trauma of the intratemporal structures cochlear and vestibular end organs facial nerve carotid artery jugular vein trauma of the extratemporal structures other cranial nerves vi abducens, ix glossopharyngeal, x vagus. Fracture mimics on temporal bone ct a guide for the. Prevalence of temporal bone fractures in patients with. Clinical examination should include the cranial nerves, otoscopy and anterior rhinoscopy. We present eight cases seen in a 12 month period in which a temporal bone fracture was not diagnosed at presentation in spite of a full clinical examination and.
Axial a and coronal b contrastenhanced t1weighted mr imaging of the temporal bone in a patient with acute onset of left facial paralysis and a clinical diagnosis of bells palsy. However, formal audiometric examination is required for all patients with temporal. Traumatic carotid cavernous fistula accompanying basilar skull fracture. Temporal bone fracture merck manuals consumer version. The etiology of the temporal bone fracture was a fall in 5 50% patients, motor vehicle accidents in. Jan 24, 2014 temporal bone fracture after mandibular trauma is thought to be rare, and its prevalence has not been reported in the literature. Ct scans were carried out in 14 cases and 11 of these showed intracranial haematoma. A basilar skull fracture occurs with severe trauma to the head, as with a blow to the head or a motor vehicle accident.
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