Temporal Bone Trauma Management: A Study of 100 Cases
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ORIGINAL ARTICLE
Temporal Bone Trauma Management: A Study of 100 Cases Shruti Venugopalan1 Sejal N. Mistry1
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Manish R. Mehta1 • Paresh J. Khavdu1 • Alpesh D. Fefar1
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Received: 5 May 2020 / Accepted: 12 August 2020 Association of Otolaryngologists of India 2020
Abstract To address the management of complications after temporal bone fractures and the outcomes. A prospective clinical study of 100 patients from the Department of Trauma (Surgery ? E.N.T.), P.D.U. Medical College, Rajkot between the time period of 2017–2019. Among 100 patients, 79 were males and 21 were females. The most affected age group was 16–45 years (72). The longitudinal fracture (90) is the most common type of fracture, in which non-petrous type is the most prevalent (88) as low impact injuries are more common. The most common presentations of temporal bone fracture are ear bleed (59) and decreased hearing (59), mostly over the side of trauma. The most common clinical finding is hearing impairment (59), followed by haemotympanum (20) and facial palsy (15), more common over the side of trauma. Facial palsy had been easily managed conservatively by steroids and physiotherapy in most of the cases. 12 out of 15 patients had good recovery i.e. upto grade I and II by conservative management, 3 had undergone facial nerve decompression, following which 1 had recovered completely, i.e. grade 1; 1 upto grade II while 1 did not show any improvement. Other complications included giddiness (18), trigeminal neuralgia (1) and abducens nerve palsy (1). The temporal bone is more prone to injury and complications following trauma like hearing impairment, cerebrospinal fluid leak and facial palsy resolve either spontaneously or with conservative management. Surgeries must be undertaken only if adequate conservative treatment fails and after proper investigations. & Shruti Venugopalan [email protected] 1
Keywords Temporal bone trauma Facial palsy Hearing impairment Haemotympanum Ear bleed
Introduction In 1926, Ulrich [1] classified temporal bone fractures into longitudinal fractures and transverse fractures [2]. Ghoyareb and Yeakley described that majority of fractures were actually oblique and often mixed [3]. Otic capsule sparing and otic capsule violating fracture was classified then by Kelly and Tami [4] and later adopted by Brodie and Thompson [5, 6]. John Groves (the co-author of Scott and Brown’s textbook of Otorhinolaryngology) said, ‘‘Otology could be a dull way of life without the seventh cranial nerve arrogantly swerving through the temporal bone to the muscles of facial expression.’’ [7] Gabriel Fallopius described the fallopian canal for the intra-temporal portion of facial nerve [8]. Sterling Bunnel performed the first successful intratemporal suture of facial nerve in 1927 and in 1930, the first successful facial nerve graft within the temporal bone [9]. Cerebrospinal Fluid Rhinorrhoea was first described by Galen who postulated the non-traumatic type. During the World War-II, the current classification for Cerebrospinal Flu
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