Fracture of temporal bone Chunfu dai m,d ph. d Otolaryngology yy Department Fudan University
Fracture of temporal bone Chunfu Dai M.D & Ph.D Otolaryngology Department Fudan University
Classifications 1. Longitudinal fractures 2.Transverse fractures 3 Mixed fractures
Classifications 1. Longitudinal fractures 2. Transverse fractures 3. Mixed fractures
Longitudinal fractures 80%0 of Temporal Bone fractures Lateral Forces along suti the petrosquamous /oniterosayorich Groove ot greater petrosalre Geniculum of facial nery cochlea suture line Plane of anterior (supe Cochlear nery semicircular canal 15-20% Facial Nerve involvement Vestibulocochlear nerve vIID Lateral horizontal EAC laceration estibular nerve xternal wpstihul Plane ot postenor or endolymphatic out semicircularcanal
Longitudinal fractures ◼ 80% of Temporal Bone Fractures ◼ Lateral Forces along the petrosquamous suture line ◼ 15-20% Facial Nerve involvement ◼ EAC laceration
Transverse fractures 20%of Temporal Bone fractures Forces in the Antero- Posterion【w水 r Groove of greater petrosal rer direction on floor of skull Geniculum of farial nerv Inner ear injury ane of anterior(suo Cochlear nerve 50% Facial nerve taal nerve ( vI Opening of intemal Involvement Vestibulocochlear nerve (vIll) Lateral (horizontal) EAC intact semicircular canal Petrous part semicrcular canal
Transverse fractures ◼ 20% of Temporal Bone Fractures ◼ Forces in the Antero-Posterior direction ◼ Inner ear injury ◼ 50% Facial Nerve Involvement ◼ EAC intact
Physical Examination Tuning Fork exam Pneumatic Otoscopy
Physical Examination ◼ Tuning Fork exam ◼ Pneumatic Otoscopy
Imaging HRCT MRI Angiography/ MRA SYSacT 1582370 I:3 2004 DFUV 20 Oon F:1.9
Imaging ◼ HRCT ◼ MRI ◼ Angiography/ MRA
symptoms Hearing Loss tinnitus Dizziness CSF Otorrhea and Rhinorrhea Facial Nerve Injuries
symptoms ◼ Hearing Loss & tinnitus ◼ Dizziness ◼ CSF Otorrhea and Rhinorrhea ◼ Facial Nerve Injuries
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 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 loss perior projection of right osseous labyrinth Groove ot greater petrosal on floor of skull Geniculum ot facial nerve Longitudinal Fractures Plane of anterior (suno Cochlear ne Conductive or mixed facal nerve vIl Opening of internal hearing loss Vestibulocochlear nerve IVI lateral horizontal 80% of CHL resolve vestibular nerve spontaneously y of temporal bone Transverse fractures S oi posterior Sensorineural hearing loss s likely to improve
Hearing loss Longitudinal Fractures ◼ Conductive or mixed hearing loss ◼ 80% of CHL resolve spontaneously ◼ Transverse Fractures ◼ Sensorineural hearing loss ◼ Less likely to improve
Dizziness Otic capsule fracture, labyrinthine concussion, Perilymphatic Fistula Perilymphatic Fistulas Fluctuating dizziness and or hearing loss Tulio° s Phenomenon 口 Management 40%o spontaneously close Surgical management
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