Fracture of the petrous temporal bone is usually classified according to the main direction of the fracture plane andor involvement of the otic capsule. Axial ct image displayed in bone window demonstrates a thin, lucent line arrows in the medial petrous apex that is oriented almost perpendicular to the long axis of the temporal bone and consistent with a transverse, petrous apex fracture. Fracture mimics on temporal bone ct a guide for the. Dysfunctional temporal bone movement impediments to normal temporal bone motion can occur anywhere along the arc of its normal motion. To compare the traditional and otic capsule classification system of temporal bone fractures for clinical relevance. Department of neuroradiology, nottingham university hospital, derby rd, nottingham ng2 7uh, united kingdom. In the eight cases described above none had a visible temporal bone fracture onplain radiographs althoughthree hadevidence ofother skull fractures. The extent of the injuries based on physical examination and imaging studies, will determine the urgency and type of. Imaging of temporal bone trauma geisel school of medicine.
The most common cause of a temporal bone fracture was a motor vehicle accident occurring in 4090 44% patients. It houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein. The squamous portion lies superior and anterior in relation to the remainder of the temporal bone and comprises much of the lateral wall of the middle cranial fossa. Most cases of temporal bone fracture involve severe body andor head trauma. It protects the part of your brain that controls hearing, speech, memory, and behavior. Middle ear the middle ear is located in the petrous portion of the temporal bone and is bounded laterally by. Temporal bone fracture is described relative to the long axis of the petrous temporal bone, which runs obliquely from the petrous apex posterolaterally through the mastoid air cells. A, ct image shows occipitomastoid suture arrowheads. Temporal bone fractures and their complications springerlink. A comparison of temporal bone fracture classification. The first is the mastoid process, an inferior projection of bone, palpable just behind the ear. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.
The rate and distribution of each major clinical complications within each classification system to establish if either one was more clinically useful. Some fractures may have characteristics of both patterns. In the adult population, approximately 90% of temporal bone fractures are associated with concurrent intracranial injuries and 9% with cervical spine injuries. Hearing loss is of course not a lifethreatening event. Temporal bone fracture can cause blood coming from the ear, blood behind the tympanic membrane, hearing loss, vestibular dysfunction, andor facial nerve paralysis. Temporal bone trauma and the role of multidetector ct in the. Pdf facial nerve palsy has been observed in about 1. Temporal bone fractures may be complicated by intracranial haemorrhage, c. Temporal lobe injury in temporal bone fractures radiology. The temporal bone is the bone that goes around your ear, in your skull. There are a number of openings and canals in the temporal bone through which structures enter and. Early identification of temporal bone trauma is essential to managing the injury and avoiding complications. Categorization of temporal bone fractures should include a descriptor for fracture direction, the presence or absence of labyrinthine involvement, and the segment of temporal bone.
Temporal bone fractures merck manuals professional edition. The mean age at the time of trauma was 25 285 years. Temporal bone fracture injuries and poisoning msd manual. Do ct with attention to the temporal bone, refer patients for audiometry, and, if facial nerve paralysis is suspected, arrange electrical testing of the facial nerve. Sensorineural hearing loss can occur in temporal bone fractures with involvement of the otic capsule cochlea, vestibule, and semicircular canal andor internal auditory canal. Doctors use computed tomography ct to diagnose temporal bone fractures. The temporal bones form parts of the middle and posterior cranial fossae and contribute to the neurocranium or skull base. Resident manual of trauma to the face, head, and neck. Temporal bone fractures mitchell jay ramsey, md, lt colonel, mc, usa although temporal bone fractures are relatively uncommon, they present many complex diagnostic and therapeutic challenges. A comparison of temporal bone fracture classification systems. All patients were seen at beaumont hospital, the national tertiary referral centre for neuro. Ct scans demonstrated multiple intracranial injuries including bilateral temporal bone fractures. Trauma temporal bone fractures, uw health, university of. Temporal bone fracture is usually a sequela of significant blunt head injury.
The criteria for ct scan following head injury in general, and temporal bone fracture in particular are discussed. May 11, 2020 the temporal bones are a pair of bilateral, symmetrical bones that constitute a large portion of the lateral wall and base of the skull. It contains the middle and inner portions of the ear, and is crossed by the majority of the cranial nerves. It is important to note whether fractures involve the otic capsule or brain parenchyma by reference to the long axis of the petrous temporal bone ie in the plane of the ear canal, 80% of temporal bone fractures are longitudinal from lateral blows and 20%. We present eight cases seen in a 12 month period in which a temporal bone fracture. The temporal bones form parts of the middle and posterior cranial fossae and contribute to. Some structures are discussed in more detail with emphasis on related pathology. They are the thickest skull base bones and require a great force to fracture. Abnormal enhancement of the facial nerve is apparent in the labyrinthine small arrow, geniculate open arrow, and tympanic double arrow portions of the. Standard noncontrastenhanced ct imaging showed adjacent temporal lobe contusions in 6 46% of the fractures. The middle ear consists of the tympanic cavity and.
Apr 06, 20 temporal bone fractures the temporal complex is a non weight bearing region, thus displaced fracture does not have any cosmetic sequel, but if facial nerve is involved can lead to devastating cosmetic and functional injuries. Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. We present eight cases seen in a 12 month period in which a temporal bone fracture was not. Ct scans were carried out in 14 cases and 11 of these showed intracranial haematoma. Fracture classification traditional classification. Axial hrct disclosed 63 longitudinal, transverse, 10 complex and 3 atypical fractures. Temporal bone fractures are subdivided into petrous apex and nonpetrous apex fractures. Patients with a onesided temporal bone fracture were selected and subsequent magnetic resonance imaging performed in all cases. In this article, we shall look at the different parts of the temporal bone, their articulations, and any. A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution ct hrct a few hours to 21 months after the initial trauma. They are highly irregular bones with extensive muscular attachments and articulations with surrounding bones. B, from more cranial slice than a, ct image shows anterior part of suture arrowhead.
Horizontal fractures were thought to be associated with. The information provided should not be used during any medical emergency or for the diagnosis or treatment of any. Transverse fracture of the temporal bone sciencedirect. The lower portion of the bone articulates with the mandible, forming the temporomandibular joint of the jaw. Temporal bone injury is frequently associated with severe brain injury which limits the clinical evaluation and detracts from the clinical signs of temporal bone fracture such as sensorineural hearing loss, conductive hearing loss, and facial nerve paralysis. Petrous apex fractures tend to involve the iac and cochlea, explaining the higher prevalence of cn vii and viii dysfunction than with nonpetrous apex fractures fig. Temporal bone pseudofractures can be divided into three categories. Notice the extension into the internal auditory canal dots, placing the patient at risk for cn vii and viii.
Axial a and coronal b contrastenhanced t1weighted mr imaging of the temporal bone in a patient with acute onset of left facial paralysis and a clinical diagnosis of bells palsy. A 21yearold woman at admission to the trauma center after a motor vehicle accident with loss of consciousness. Temporal fractures with the fracture lines extending in any direction across the basal portion of the skull may be seen dolan, 1989. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientation, description of fractures in terms of longitudinal or transverse or mixed orientation is still. Temporal bone fracture following blunt trauma caused by a. On emergence from sedation, the patient reported rightsided hearing loss which was attributed to ossicular chain disruption after the incus was found to be in the external auditory canal. These figures form part of a larger study of 90 temporal bone fractures treated over a sixyear period from 1975 through 1981. B, on ct image of 46yearold man with fracture of occipital bone white arrows, petrooccipital suture black arrows can be differentiated from fracture line by its corticated margins. In addition to potentially damage to hearing and the facial nerve, associated intracranial injuries, such as extraaxial hemorrhage, diffuse axonal injury and cerebral contusions are common. This portion of the temporal bone is located posteriorly. This will diagnose temporal bone fractures and associated intracranial pathology. Consequently pluridirectional tomography has been the method of choice for the. Accurate early diagnosis is important to enable adequate investigation and prompt treatment of any complications.
Temporal bone fractures can lead to high morbidity andor mortality. The consequences of the intracranial injuries dominate in the early period after the trauma. A 24yearold man sustained significant injuries as a result of a motor bicycle accident. The objectives were to evaluate the clinical relevance of traditional temporal bone radiographic descriptors and to investigate the efficacy of an alternative fracture classification scheme. Contrecoup injury in patients with traumatic temporal bone.
Sep 09, 2019 the temporal bone is the most complex bone in the human body. Contrecoup injury incidence, type, severity and outcome were recorded. The sections of the temporal bone show a transverse fracture of the petrous bone, partially healed with fibrous tissue and new bone and obviously occuring some months or years before death. There was a statistically significant relationship between the. Contrecoup injury was significantly associated with petrous temporal bone fracture p temporal bone fractures mitchell jay ramsey, md, lt colonel, mc, usa although temporal bone fractures are relatively uncommon, they present many complex diagnostic and therapeutic challenges.
Temporal bone trauma and the role of multidetector ct in. There is acute suppurative otitis media, labyrinthitis, and meningitis. Temporal bone fracture radiology reference article. The temporal bones are paired structures located on the lateral aspects of the skull inferior to the parietal bones, posterior to the sphenoid bone, and anterior to the occipital bone fig. Temporal bone fractures have been classified by orientation with respect to the long axis of the petrous portion of the temporal bone. This can lead to a number of serious complications, including damage to hearing, vertigo, facial paralysis due to damage to the facial nerve, and bleeding in the ear as well as bone bruising. The anatomy of the temporal bone is complex, and correct identification of normal structures is necessary to prevent misinterpretation as fractures. A temporal bone fracture can manifest itself with acute signs like bleeding from the ear or acute facial paralysis. Pneumolabyrinth after temporal bone fracture is a rare phenomenon, and to date only 14 cases have been reported in the international literature. Radiographic evaluation of the failed total hiptotal knee feat.
Sep 09, 2019 temporal bone fracture is a frequent manifestation of head trauma. Anatomy and inflammatory and neoplastic processes1 from a clinicalradiologic standpoint, there are a limited number of structures and disease entities in the temporal bone with which one must be familiar in order to proficiently interpret a computed tomographic or magnetic resonance imaging study of the temporal bone. Fractures of the temporal bone are associated with head injuries. A large volume of force is required to fracture the temporal bone. Longitudinal temporal bone fractures radiology reference. Temporal bone fractures were significantly associated with intracranial injuries p temporal bone fracture was. Plain radiography displays only 17%30% of temporal bone fractures 4, 5. Longitudinal fractures make up 70 to 90% of temporal bone fractures, and transverse fractures make up 10 to 30%.
Pdf facial nerve palsy following temporal bone fracture. Disruption of the ossicles was noted in 2 fractures. In 20 cases the fracture involved more than one cranial bone, and the implications of this with regard to nonaccidental injury are discussed. Jul 26, 2006 of 338 patients, 31 9% were identified as having a temporal bone fracture on high. Multidetector temporal bone computed tomography examinations should be performed in patients with a clinical or radiographic suspicion of temporal bone fracture. The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. There are many reports in the literature describing ct of temporal bone trauma, 1. The temporal bone contributes to the lower lateral walls of the skull. Do ct with attention to the temporal bone, refer patients for audiometry, and, if facial nerve paralysis is. These impediments could stop motion completely at a certain point, disallowing left temporal bone axis of rotation right temporal bone figure 1 normal temporal bone motion left and right temporal bones move in sync. A, an axial noncontrastenhanced computed tomographic scan of the bone window shows a complex fracture of the right occipital bone and temporal bone, and mastoid air cells extending into the right side of the cavity. A temporal bone fracture may cause facial paralysis, hearing loss, bruising behind the ear, and bleeding from the ear. Sensorineural hearing loss can also occur with intralabyrinthine bleeding without evidence of temporal bone fracture. In this locationspecific classification system, a stronger correlation be tween petroustype fractures and the presence of snhl, facial nerve injury, and cerebrospinal fluid csf leak was identified.
Threedimensional multidetector ct reconstruction images of the skull, obtained from a superior view, show longitudinal a, transverse b, and mixed c temporal bone fractures dashed lines. You have two temporal bones, one on each side of your head. Temporal bone fractures were historically divided into three main categories, longitudinal, in which the vertical axis of the fracture paralleled the petrous ridge, horizontal, in which the axis of the fracture was perpendicular to the petrous ridge, and oblique, a mixed type with both longitudinal and horizontal components. Patients with blunt trauma to the middle ear and temporal bone are often not evaluated as such initially in the emergency room because. On a lateral view of the temporal bone, such as figure 1. Radiologists are often the first to note the presence of temporal bone fractures and should be familiar with common types of injuries. Theabsence ofa fracture onthe plain radiographs madethose responsible for the. The diagnosis of a temporal bone fracture was established by axial hrct in almost every case. Longitudinal and transverse in the past, temporal bone fractures were classified based on the orientation of the fracture plane with respect to the long axis of the petrous portion of the temporal bone figs.
A guide for the radiologist yune kwong1 david yu jagrit shah kwong y, yu d, shah j 1all authors. While the temporal bone is relatively thick, blunt trauma can cause a fracture of this bone. Each temporal bone is divided into five components. Pneumolabyrinth secondary to temporal bone fracture. Treatment, sometimes including surgery, is needed if the fracture causes problems. Highresolution ct scans of the temporal bone in 12 patients showed longitudinal fracture of the temporal bone in all cases. This information compares the incidence of intracranial injury in patients with temporal bone fracture and those without the fracture.
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