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Fracture of temporal bone. Chunfu Dai M.D & Ph.D Otolaryngology Department Fudan University. Classifications . Longitudinal fractures Transverse fractures Mixed fractures. Longitudinal fractures. 80% of Temporal Bone Fractures Lateral Forces along the petrosquamous suture line

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fracture of temporal bone

Fracture of temporal bone

Chunfu Dai M.D & Ph.D

Otolaryngology Department

Fudan University

classifications
Classifications
  • Longitudinal fractures
  • Transverse fractures
  • Mixed fractures
longitudinal fractures
Longitudinal fractures
  • 80% of Temporal Bone Fractures
  • Lateral Forces along the petrosquamous suture line
  • 15-20% Facial Nerve involvement
  • EAC laceration
transverse fractures
Transverse fractures
  • 20% of Temporal Bone Fractures
  • Forces in the Antero-Posterior direction
  • Inner ear injury
  • 50% Facial Nerve Involvement
  • EAC intact
physical examination
Physical Examination
  • Tuning Fork exam
  • Pneumatic Otoscopy
imaging
Imaging
  • HRCT
  • MRI
  • Angiography/ MRA
symptoms
symptoms
  • Hearing Loss & tinnitus
  • Dizziness
  • CSF Otorrhea and Rhinorrhea
  • Facial Nerve Injuries
hearing loss
Hearing loss
  • Formal Audiometry vs. Tuning Fork
  • 71% of patients with Temporal Bone Trauma have hearing loss
  • TM Perforations
    • CHL > 40db suspicion for ossicular discontinuity
hearing loss1
Hearing loss

Longitudinal Fractures

    • Conductive or mixed hearing loss
    • 80% of CHL resolve spontaneously
  • Transverse Fractures
    • Sensorineural hearing loss
    • Less likely to improve
dizziness
Dizziness
  • Otic capsule fracture, labyrinthine concussion, Perilymphatic Fistula
  • Perilymphatic Fistulas
    • Fluctuating dizziness and/or hearing loss
    • Tulio’s Phenomenon
    • Management
      • 40% spontaneously close
      • Surgical management
dizziness1
Dizziness
  • BPPV
    • Acute, latent, and fatigable vertigo
    • Can occur any time following injury
    • Dix Hallpike
    • Epley Maneuver
csf otorrhea and rhinorrhea
CSF Otorrhea and Rhinorrhea
  • Temporal bone Fractures are the most common cause of CSF Otorrhea
  • Beta-2-transferrin
  • HRCT
csf otorrhea and rhinorrhea1
CSF Otorrhea and Rhinorrhea
  • Management
    • Conservative therapy
      • Lie in bed with Head elevated 30-45°
    • Antibiotics
    • Surgery
csf otorrhea and rhinorrhea surgical management
CSF Otorrhea and RhinorrheaSurgical Management
  • Surgical approach
    • Status of hearing
    • Meningocele/encephalocele
    • Fistula location
  • Transmastoid
  • Middle Cranial Fossa
facial nerve injuries
Facial Nerve Injuries
  • Evaluation
    • Previous status
    • Time
    • Onset and progression
    • Complete vs. Incomplete
house brackman grading system
House Brackman grading system

I Normal Normal facial function

II Mild Slight synkinesis/weakness

IIIModerate Complete eye closure, noticeable synkinesis, slight forehead movement

IVModerately Severe Incomplete eye closure, symmetry at rest, no forehead movement

V Severe Assymetry at rest, barely noticeable motion

VITotal No movement

nerve excitability test maximal stimulation test
Nerve Excitability TestMaximal Stimulation Test
  • >3.5mA difference suggests a poor prognosis for return of facial function
electroneuronography
Electroneuronography
  • Most accurate, qualitative measurement
  • Reduction of >90% amplitude correlates with a poor prognosis for spontaneous recovery
electromyography
Electromyography
  • Limited use until 10-14 days
  • Polyphasic potentials= Good
facial nerve injuries1
Facial Nerve Injuries
  • Decision to treat is primarily based on whether there is complete vs. incomplete paralysis
treatment
Treatment
  • Conservative treatment candidates
  • Surgical candidates
conservative treatment candidates
Conservative Treatment Candidates
  • Chang and Cass
    • Normal Facial Function regardless of progression
    • Incomplete paralysis and no progression to complete paralysis
    • Less than 95% degeneration by ENoG
surgical candidates
Surgical Candidates
  • Critical Prognostic factors
    • Immediate vs. Delayed
    • Complete vs. Incomplete paralysis
    • ENoG criteria
surgical approach
Surgical Approach
  • Suspect location of neural injury
  • Presence or absence of hearing
surgical approach1
Surgical Approach
  • Lateral to the geniculate ganglion
    • transmastoid
  • Medial to the Geniculate Ganglion
    • No useful hearing
      • Transmastoid-translabyrinthine
    • Intact hearing
      • Transmastoid-trans-epitympanic
      • Middle Cranial Fossa
surgical findings
Surgical findings
  • Nerve repair
    • Direct anastomosis
    • Nerve graft
  • Decompression
case report
Case Report
  • 32 yr old fisherman was wading
    • Minding his own business
  • Hit in head by a flying fish
  • Immediate profound vertigo, hearing loss
  • CT scan revealed longitudinal Temp bone fracture