Temporal Bone Trauma
Temporal bone is the strongest bone of the body and at the same time one of the most complex bone as it contains many important structures, including the vestibulocochlear apparatus, carotid artery, jugular vein, and the facial nerve. Also, it is surround
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Hassanin Abdulkarim, Abdulsalam Al-Qahtani, and Ahmed Elsotouhy
Key Points
In this chapter, we will learn: • Three main conditions involved in temporal bone trauma. • Types of temporal bone fractures and their clinical presentation, investigations, and management plans. • Middle ear trauma and its clinical presentation, investigations, and management plans. • Barotrauma causes, clinical presentation, investigations, and management plans.
15.1 Temporal Bone Fractures 15.1.1 Introduction • Temporal bone is the strongest bone of the body and at the same time one of the most complex bone as it contains many important structures, including the vestibulocochlear
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H. Abdulkarim (*) · A. Al-Qahtani · A. Elsotouhy Hamad Medical Corporation, Doha, Qatar e-mail: [email protected]; aaa2009@qatar-med. cornell.edu; [email protected]
© Springer Nature Switzerland AG 2021 A. Al-Qahtani et al. (eds.), Textbook of Clinical Otolaryngology, https://doi.org/10.1007/978-3-030-54088-3_15
apparatus, carotid artery, jugular vein, and the facial nerve. Also, it is surrounded by the brain and other cranial nerves. Temporal bone as part of skull base has many foramina and openings causing weakness points which are involved by head trauma leading the fracture to follow these weak points. Temporal bone may involve none or all of these structures, and also can involve other structures like cranial nerve (6th, 9th, 10th, and 11th). The head is the most commonly injured part of the body (75% of all motor vehicle accidents). Approximately 30% of head traumas have skull fracture, and the ear is the most frequently sensory organ damaged. Temporal bone injury happens in up to 22% of all skull fractures and is caused mainly by motor vehicle accidents (around 30%). Temporal bone fracture is a common manifestation of head trauma, and 90% of temporal bone fractures are associated with intracranial injuries and 9% with cervical spine injury. Bilateral temporal bone fractures are present in 8–29% of all fractures. These can be due to blunt or penetrating trauma, and stab and gunshot wounds are the most common penetrating wounds. Gunshot wounds medial to the geniculate ganglion are usually fatal because it is associated with big vessels bleeding.
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15.1.2 Types • Ulrich was the first to classify temporal bone fractures into longitudinal and transverse fractures in 1926 [1]. • Ghorayeb and Yeakley studied 150 temporal bone fractures and found the majority is actually oblique or mixed [2]. • Other classification is otic capsule involvement or sparing. • Ishman and Friedland classified them into petrous and non-petrous involvement, where the petrous-involved fractures have greater correlation with sensorineural hearing loss (SNHL) presence [3]. • All these classifications are arbitrary but useful to predict the type of injury expected. Although temporal bone fractures are irregular and non-uniform in their pathway. • Despite the recent classifications, Ulrich’s is the most commonly use
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