Fracture of Temporal bone

TEMPORAL BONE FRACTURE
  • The temporal bone houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein.
  • A temporal bone fracture can involve none or all of these structures.
  • CSF Otorrhea may occur due to fracture of petrous temporal bone.
  • Middle meningeal artery may get torned in temporal bone fracture.
TYPES OF TEMPORAL BONE FRACTURE
Types of Temporal bone fracture include Longitudinal, Transverse. Mixed, Oblique and Unusual.
A.)Longitudinal:
  • The longitudinal fracture is one where fracture line runs parallel to the Petrous ridge, that is longitudinal axis of the bone.
  • It constitutes 80% of all the Temporal Bone fracture.
  • 23% are bilateral.
  • Caused by a lateral force over the mastoid or temporal squama, usually produced by temporal or parietal blows.
  • Fracture begins in Squamous Temporal Bone & continues towards the Petrous apex, cours
  • ing around the dense Otic capsule bone. Hearing loss is common after the injury; it is usually conductive hearing loss.
  • Results in laceration of the roof of the External Auditory Canal and often the tympanic membrane.
  • Blood from the middle ear appears in the of External Auditory Canal, leading to a-dictum, that bloody Otorhea after head injury usually represents a longitudinal temporal bone fracture until proved otherwise.
  • If the Dura is disrupted ,CSF may leak through a disrupted Tegmen Tympani, resulting in CSF Otorrhea.
  • Spontaneous Nystagmus is Rare.
  • Facial N. is usually spared
  • Facial weakness after this fracture is usually incomplete and is most often delayed, secondary. to the edema rather than disruption of the nerve.
B.)Transverse:
  • Transverse fractures comprise 20% of all temporal bone fractures.
  • Runs right angle to the longitudinal axis of the Petrous bone.
  • They are usually caused by a frontal or parietal blow but may result from an occipital blow. 
  • Has a higher mortality than longitudinal fracture and greater force is required to generate them.
  • The “Classical’ Transverse fracture begins in Posterior Cranial Fossa, usually in the region of Foramen Lacerum or Foramen Spinosum.
  • Cochlear and vestibular structures are usually destroyed, producing a profound sensorineural hearing loss and severe ablative vertigo.
  • Vertigo with spontaneous Nystagmus & post traumatic common.
  • Facial n. paresis is also common (50%), it is immediate and greater intensity than longitudinal fracture.
C.)Mixed:
  • Involves a combination of several of the routes, described.
D.)Oblique:
  • A recent study (not confirmed) shows that these types of fractures are actually the most common (75%).
INVESTIGATION IN A CASE OF TEMPORAL BONE FRACTURE.
  • Best investigation for temporal bone fracture is CT scan.
  • It is useful in assessing injuries complicated by CSF leak, facial paralysis, or suspected vascular injury.
MANAGEMENT IN A CASE OF TEMPORAL BONE FRACTURE
  • Patient with delayed facial paralysis is managed conservatively with 10-14 days of systemic corticosteroids unless medically contraindicated.
  • In a patient presenting with immediate facial paralysis-Facial Nerve Decompression is required
Exam Question
  • CSF otorrhoea is caused by Fracture of petrous temporal bone.
  • Transverse fractures of the petrous bone will cause facial nerve palsy.
  • Treatment of choice for mastoid fracture with facial nerve palsy is Nerve decompression.
  • Middle meningeal artery is usually torn in temporal bone fracture.
  • Best investigation for temporal bone fracture is CT scan.
  • The type of temporal bone fracture in a patient who was punched over his face,he was conscious and blood was trickling from right ear which got controlled and Audiometry showing conductive type of hearing loss would be Longitudinal fracture of Temporal bone.

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