Temporal bone fracture

Temporal bone fracture
- Often with fractures of calvaria and brain injury
- Thin-slice CT
- Complications
  - CSF leak
    - Air in intracranial cavity
    - CSF otorrhoea
    - CSF rhinorrhoea
    - Meningitis
    - Brain abscess
    - Surgery only if it persists
  - Cochleovestibular symptoms
    - Conductive (fluid in middle ear)
    - Sensorineural (fracture of labyrinth)
      - Vertigo
      - Nausea
  - Facial nerve symptoms
- Types
  - Longitudinal fractures
    - Fracture runs along the external auditory canal and the anterior border of the petrous pyramid
    - Most common
    - Lateral trauma
    - Clinical features
      - Ear discharge with blood and/or CSF
      - Hearing loss
      - Delayed facial paralysis
      - Tearing of meatal skin and TM
    - Complications
      - Fracture of auditory ossicles
      - Meningitis
      - Otitis media
    - Treatment
      - Conservative
      - Surgery if complications
  - Transverse fractures
    - Fracture runs across the petrous pyramid along the internal auditory canal and/or through the labyrinth
    - Vestibule, cochlea destroyed
    - Frontal trauma
    - Much less common
    - Clinical features
      - Vestibular symptoms
      - Hearing loss
      - Immediate facial paralysis
      - No otorrhoea
      - Haemotympanum
    - Complications
      - Higher risk of meningitis
      - Hearing and vestibular function never recovers
    - Treatment
      - Conservative
      - Surgery if CSF leak‎