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Understanding Temporal Bone Fractures

Temporal bone fractures can be classified as longitudinal, transverse, or mixed based on the direction of the fracture through the petrous pyramid. Longitudinal fractures extend from the squama into the external auditory canal and commonly involve the middle ear, with a high risk of ossicular derangement and conductive hearing loss. Transverse fractures involve the labyrinth and commonly cause sensorineural hearing loss or vertigo. Mixed fractures have irregular breaks through the middle and inner ear structures. All temporal bone fractures carry risks of facial nerve palsy, cerebrospinal fluid leakage, and injury to nearby arteries.

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samson bd mokuntil
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343 views28 pages

Understanding Temporal Bone Fractures

Temporal bone fractures can be classified as longitudinal, transverse, or mixed based on the direction of the fracture through the petrous pyramid. Longitudinal fractures extend from the squama into the external auditory canal and commonly involve the middle ear, with a high risk of ossicular derangement and conductive hearing loss. Transverse fractures involve the labyrinth and commonly cause sensorineural hearing loss or vertigo. Mixed fractures have irregular breaks through the middle and inner ear structures. All temporal bone fractures carry risks of facial nerve palsy, cerebrospinal fluid leakage, and injury to nearby arteries.

Uploaded by

samson bd mokuntil
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

TEMPORAL BONE FRACTURE

Samson Bd Mokuntil
Year 4 Medical Student
MM4508 Combined Specialities Posting.
Anatomy
Anatomy
Tympanic part
• Small parts laterally
• Forms the auditory canal
Mastoid part
• Articulates laterally with the parietal and
occipital bones
• Houses major portion of the mastoid air cells
system
• Which communicates with the nasopharynx
through middle ear and eustachian tube.
Petrous part
• Located medially
• Relates to internal carotid artery, the sigmoid
sinus, and the facial and vestibulocochlear
nerves.
• It contains the labyrinth with its neural
aperture, the internal auditory canal.
Trauma
• Are most common fractures of the skull base
• Classified according to the long axis of the
petrous pyramid.
• Classic distribution of fractures are
longitudinal, transverse and mixed.
T

L
Pathophysiology
• 1,875 lb lateral force for longitudinal fractures
• Fractures take path of least resistance
• 60% considered open
– Bloody otorrhea, brain herniation, CSF leak,
penetrating wound
• 8-29% occur bilaterally
Longitudinal fractures
• Most common (classically >80% but many are mixed)
• Extend from squama into the external auditory canal
• All go through middle ear with high incidence of ossicular
derangement (Incus & incudostapedial joint most common) and
conductive hearing loss
• Inner ear usually spared
• Facial paralysis in about 15% (proximal tympanic segment just distal
to geniculate ganglion)
• CSF leak (usually caused by fracture through tegmen or the mastoid)
– Otorrhea: perforation or tear of tympanic membrane
– Rhinorrhea: tympanic membrane intact
• Injury to carotid artery, jugular vein or sigmoid sinus
Transverse fractures
• Exhibit a hemotympanum with an intact tympanic membrane.
• Commonly involve the labyrinth
–  Cochlear fracture: sensorineural hearing loss, permanent if cochlear
nerve transected
–  Labyrinthine fracture: severe vertigo
• Facial palsy in 50% - permanent if 7th nerve transected (usually the
distal labyrinthine segment just proximal to geniculate ganglion)
• Perilymph fistula (can also result from barotrauma)
– Disruption of stapes footplate, oval window or round window
– Pneumolabyrinth highly suggestive but not always present
– Labyrinthine enhancement sometimes present
• Injury to carotid artery 
Mixed
• This term used to define lesions in which such
predominant lines are not apparent.
• Severe injuries are characterized by multiple,
irregular breaks involving the middle ear and
inner ear structures in unpredictable
combinations.
Reference
• Moore, Keith L.; Dalley, Arthur F; Clinically Oriented Anatomy,
5th Edition, 2006 Lippincott Williams & Wilkins.
• Canalis, Lambert, The Ear Comprehensive Otology; 2000
Lippincott Williams & Wilkins.
• http://www.theodora.com/anatomy/the_temporal_bone.htm
l
• http://en.wikipedia.org/wiki/File:Gray193.png
• http://spinwarp.ucsd.edu/NeuroWeb/Text/ent-
210.htm#anchor163481
• Temporal Bone Fracture, Otolarygology Head and Neck
Surgery, University of California.

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