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
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• 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.