Its meaning, though, differs from that used in engineering. Our objective was to design a finite element model of the petrous bone structure to modelize temporal bone fracture propagation in a scenario of lateral impact. Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. Most cases of temporal bone fracture involve severe body andor head trauma. Results we collected 24 patients with facial palsy among the 347 patients presented for temporal bone fracture during the 3 years of study, only 14 of them were operated. However, the actual proof of the fracture and its location is often missing, as in many instances xray examination cannot reveal the fracture. It does not cover the injury to the tympanic membrane.
The petrous portion is among the most basal elements of the skull and forms part of. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. It houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein. Bilateral facial paralysis caused by bilateral temporal. Longitudinal petrous bone fractures had the highest frequency, 27 61. The fracture extends from the jugular foramen through the petrous pyramid to the foramen spinosum and foramen lacerum. Petrous apex fractures tend to involve the iac and cochlea, explaining the higher prevalence of cn vii and viii dysfunction than with non petrous apex fractures fig. Materials and methods a finite element model of the petrous bone structure was designed based on computed tomography data. To assign each fracture to a segment, the center of the fracture must be determined. The strap muscles sternohyoid, sternothyroid, and omohyoid contract during exercise and pull the larynx. Transverse fractures comprises about 20% of all temporal bone.
Comminuted fracture this is a fracture involving three or more bone fragments. In groves 2 series of 211 skull fractures, 16 were. Longitudinal fractures make up 70 to 90% of temporal bone fractures, and transverse fractures make up 10 to 30%. The management of temporal bone fractures is generally aimed at restoring functional. Contrecoup injury in patients with traumatic temporal bone.
It is the midpoint of an oblique or spiral fracture, and in a transverse fracture it is obvious. Sep 19, 2014 the petrous temporal bone is directly related to important vascular and neurological tissues in the middle cranial fossa, so infection at this site can have severe and damaging consequences. Temporal bone fractures represent highenergy trauma. For a simple fracture, where there are only two bone fragments, this is apparent. Temporal bone trauma, with or without associated fracture, is not uncommon in the context of severe trauma and frequently occurs in the context of closed head injury. Introduction skull fractures occur in up to 30% of patients with head injuries.
Temporal bone fracture is gradually being classified into the petrous and nonpetrous types. A 7ms lateral impact was simulated to reproduce a typical lateral. Petrous fracture can be further subdivided into the longitudinal, transverse and oblique types following the orientation of the fracture plane to the longitudinal axis of the. In the eight cases described above none had a visible temporal bone fracture onplain radiographs althoughthree hadevidence ofother skull fractures. Nov 26, 2011 temporal bone fractures are traditionally classified as transverse, longitudinal or mixed. Evaluation of classification of temporal bone fractures juniper. When head trauma is sufficient to fracture the skull, 14 to. Right temporal bone transverse fracture with severe spontaneous nystagmus third degree manifesting immediately after trauma.
Isolated chorda tympani injury following petrous temporal. Temporal bone trauma and the role of multidetector ct in the. Oct 31, 2014 1 longitudinal parallel to petrous portion of temporal bone 2 transverse perpendicular to petrous portion of temporal bone 3 sella turcica fractures d posterior bsf 1 clivus i transverse, oblique, longitudinal 2 occipital i ring fracture encircles foramen magnum at skull base ii occipital condyle type i iv. Fractures of the clivus have historically been associated with a high mortality rate and poor outcomes. In the center of the image is highlighted the aspect of bone depression black arrows that keeps the ball contour impaction at the junction with the mastoid and temporal scales. The fracture on the right side is less conspicuous but there is a fine lucency extending across the apex of the internal auditory canal. A temporal bone fracture can involve none or all of these structures. A large case series of temporal bone fractures at a uk. Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. Evaluation and management in the modern era temporal bone fractures occur from highenergy mechanisms. The petrous part of the temporal bone is pyramidshaped and is wedged in at the base of the skull between the sphenoid and occipital bones. We have formulated a new classification based on the involvement of four parts of the temporal bone. Apr 19, 2018 temporal bone fractures have traditionally been divided into longitudinal, transverse or mixed fractures, based on the relation of the fracture line with the axis of the petrous bone as first described by ulrich.
Immediate detection of temporal bone fracture and its complications helps in providing early and effective treatment, which if left untreated can. Comminuted fracture of the mastoid with extension in the petrous bone and important depression. Air within the temporomandibular joint b, arrows is often seen if the temporal. Although the petrous apex is made out of bone it contains air pockets, called air cells, lined with mucous membrane. On physical examination, housebrackmann hb facial paralysis of grade 6 was observed on the. The two most important prognostic factors in recovery of facial paralysis were severity and delay of onset. All patients with clinical or radiologic evidence of a temporal bone fracture. Longitudinal temporal bone fractures radiology reference. The fracture line runs at a right angle to the long axis of the petrous pyramid and starts in the middle cranial fossa close to the foramen lacerum and spinosum. Fiftysix patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, malignant tumors of the parotid gland or of the infratemporal spaces with infiltration. Several intrinsic channels, intrinsic fissures, and extrinsic sutures are often apparent on ct images and can mimic. Methods seventyseven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid. Central cranial bases fractures, especially those involving the clivus, are difficult to identify using plain xray imaging because of the dense petrous temporal bones. Epidemiology when head trauma is sufficient to fracture the skull, 14 to 22% of injured patient sustain a temporal bone fracture.
Resident manual of trauma to the face, head, and neck. Each temporal bone is composed of five osseous parts. Age distribution among the intracranial haemorrhages, intracerebral 33. To study the prevalence and patterns of contrecoup injury in traumatic temporal bone fracture cases. If you have hearing loss, there is a good chance that it. Injury to the facial nerve can be both intratympanic as well as in the petrous temporal bone and the management of the two is very different. Petrous fracture is defined as a fracture extending to the petrous apex or the otic capsule, or both. Antimicrobial prophylaxis for prevention of meningitis in traumatic skull fractures associated with csf leak. Axial temporal bone ct images of 4 patients ad show indirect signs of temporal bone fractures. The longitudinal fractures have been encountered far more frequently than the transverse. Evaluation of 77 patients and a management algorithm. Blunt cerebrovascular injury practice management guidelines.
A large volume of force is required to fracture the temporal bone. In all vertebrates, movements of the head are detected by a system of three fluidfilled semicircular canals housed in the petrous part of the temporal bone. The clinical diagnosis of fractures of the petrous bone is usually clear and unambiguous. The fracture extends from the squamous portion of the temporal bone to the carotid and jugular foramina. The longitudinal fractures are most common 7080%, followed by transverse 1020% and mixed 10% fractures. Approximately 50% of all temporal bone fractures are a result of road. Traditionally, fractures of the temporal bone have been classified as longitudinal or transverse depending on their orientation relative to the long axis of the petrous bone, but in reality, most temporal bone fractures are oblique or have overlapping features.
Y cervical spine fracture particularly those with i fracture of c1 to c3 and ii fracture through the foramen transversarium. Management of complications from 820 temporal bone. A total of 820 fractured temporal bones resulted in 58 facial nerve injuries, 122 csf fistulae, and 15 cases of meningitis. Temporal bone fractures are subdivided into petrous apex and non petrous apex fractures. Fleagle, in primate adaptation and evolution third edition, 20. In these spaces there are numerous potential diseases that can occur and cause symptoms. In our case, the ct image is consistent with a transverse fracture of the left petrous bone. Role of mastoid pneumatization in temporal bone fractures. Since these categories have shown little association with clinical symptoms, new classifications have been introduced, including those related to the involvement of the petrous bone and otic capsule. Management of facial palsy secondary to temporal bone fracture. Principles in fractures management linkedin slideshare. The temporal bones comprise the lateral skull base, forming portions of the middle and posterior fossae.
Fracture of the petrous temporal bone is usually classified according to the main direction of the fracture plane andor involvement of the otic capsule. Middle ear the middle ear is located in the petrous portion of the temporal bone and is bounded laterally by. Ct images showing petrous fracture types are shown in figs 2 4. The ptb contains essential anatomical structures including the facial nerve, internal. Fractures of the clivus neurosurgery oxford academic.
Y cervical spine fracture with subluxation or rotational component. 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. The petrous temporal bone ptb is one of the hardest bones in the body and therefore a significant amount of force must be applied to result in a fracture. Sep 09, 2019 the temporal bone is the most complex bone in the human body. Theabsence ofa fracture onthe plain radiographs madethose responsible for the. Original article computed tomography evaluation of.
The larynx is suspended from the petrous part of the temporal bone by a chain of paired hyoid bones, the stylohyoid, ceratohyoid, single basihyoid bone, and thyrohyoid, which articulates with the rostral aspect of the thyroid cartilage. In the adult population, approximately 90% of temporal bone fractures are associated with concurrent intracranial injuries and 9% with cervical spine injuries. The sensitivity and other functional aspects of these canals are determined by their position in the skull and their relative dimensions and. Longitudinal fractures b result most often from a blow to the side of the head. Original article computed tomography evaluation of petrous.
The surgeon uses the word stability to express the degree of displacement at the fracture site induced by load. It is the retrospective clinical study and the study took place at tertiary referral center. Across petrous bone, from foramen magnum towards foramen spinosum bleeding from ear common absent,tm intact. Right axial ct shows a medial subtype of horizontal temporal bone fracture. Temporal bone fracture radiology reference article. Pdf temporal bone fractures can lead to high morbidity andor. Temporal bone fractures have traditionally been divided into longitudinal, transverse or mixed fractures, based on the relation of the fracture line with the axis of the petrous bone as first described by ulrich. There was strong suspicion that this involved the basal turn of the cochlea in view of. Temporal bone fractures merck manuals professional edition. Head trauma is associated with nearly 75% of traffic accidents. There is a fracture of the posterior petrous surface white arrow extending anteriorly through the fundus of the internal auditory canal. A quick otoscopy examination is an excellent screening for evidence of a temporal bone injury and can guide additional diagnostic testing dr. Acute ent intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. In this paper, we describe a 40yearold male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident.
Head injury with fracture of the petrous bone is frequent and directly related to the development of human activity. 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. Intracranial air a, arrows can be seen if the temporal bone fracture communicates with the intracranial cavity. This is well shown in the comprehensive clinical study by grove. The fast component beats away from the fracture site in all directions of the gaze. Imaging of temporal bone trauma geisel school of medicine. The temporal bone forms part of the lateral skull base and is made up of the squamous, styloid, tympanic, mastoid and petrous segments. 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. Comparison of the clinical relevance of traditional and new. Sep 09, 2019 temporal bone fracture is a frequent manifestation of head trauma. Temporal bone trauma and the role of multidetector ct in.
Temporal bone fractures have been classified by orientation with respect to the long axis of the petrous portion of the temporal bone. Temporal bone fractures and its classification ijars. To study the relationship pattern of intracranial hemorrhage in cases of traumatic petrous temporal bone fracture. Evaluation of classification of temporal bone fractures. Fractures of the petrous pyramid are commonly classified as 1 longitudinal and 2 transverse. Apr 06, 20 temporal bone fractures the evaluation of the temporal bone in a patient with multiple traumatic injuries can often be incomplete or overlooked, delaying diagnosis and management. Directed medially, forward, and a little upward, it presents a base, an apex, three surfaces, and three angles, and houses in its interior, the components of the inner ear. Skull base fractures and their complications kristen l. Note the sclerotic fused sphenooccipital synchondrosisfissure thin black arrow. Management of complications from 820 temporal bone fractures. Management of complication from temporal bone fractures. Of particular relevance is the close proximity of the gasserian ganglion of the vth cranial nerve, the abducens nerve vith cranial nerve, the carotid.
Pediatric trauma patients should be evaluated using the. Management of facial palsy secondary to temporal bone. Patterns of intracranial hemorrhage in petrous temporal. A prospective, cohort study was undertaken of all patients with traumatic head injury admitted to a tertiary referral hospital in malaysia within an 18month period. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Usually caused by frontal or parietal blow, rarely by occipital blow. 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. Some fractures may have characteristics of both patterns. Some fractures need surgery to heal and some do not. Bo portion of the clivus is a portion of the occipital bone, within the posterior cranial fossa. It is estimated that approximately 5% of patients with closed head injury and 40% of patients with basilar skull fracture demonstrate a fracture of the temporal bone which is.
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