Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries? (original) (raw)
Related papers
European Archives of Oto-Rhino-Laryngology, 2012
Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed. 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. We have formulated a new classification based on the involvement of four parts of the temporal bone (squama, tympanic, mastoid, and petrous) and assessed which of these classification systems is the most rational using a retrospective chart review in hospital settings (KyungHee Medical Center, Seoul, Korea and Samsung Changwon Hospital, Changwon, Korea). The association between each classification and clinical symptoms was examined by analyzing temporal bone computed tomography scans of 129 patients diagnosed as temporal bone fractures over the past 7 years. Using the traditional classification, there was a significant correlation between transverse fractures and the incidence of sensorineural hearing loss. Patients with petrous bone fractures had significantly higher incidence rates of sensorineural hearing loss, vertigo, and eardrum perforation than patients without petrous bone involvement. Involvement of the otic capsule was significantly associated with sensorineural hearing loss and the severity of hearing loss. The associations of the traditional classification and the classification according to the involvement of the otic capsule, four parts of temporal bone with clinical symptoms were not high. Petrous bone fractures were significantly associated with sensorineural hearing loss, vertigo, and eardrum perforation, suggesting that this classification may be optimally associated with clinical symptoms including hearing and the results of otological examination.
Patterns and incidence of temporal bone fractures
IP innovative publication pvt. ltd, 2019
Introduction: Temporal bone has a complex anatomy, divided into five bony divisions, which include squamous part, petrous bone, tympanic part, mastoid process, and styloid process. This contains cranial nerves V, VI, VII, and VIII and vascular structures such as the internal carotid and middle meningeal arteries, the sigmoid sinus, and the jugular bulb. It also harbors the sensorineural and membranous structures of the inner ear. The most common cause of temporal bone fractures is high energy blunt head trauma. For the assessment of temporal fractures, cranial CT is a fundamental and initial diagnostic modality. Complications of temporal bone fractures include facial nerve palsy, cerebrospinal fluid leakage, conductive hearing loss, sensorineural hearing loss, and vertigo. These fractures are divided into longitudinal and transverse based on whether the fracture line is passing parallel to or perpendicular to petrous bone respectively. Materials and Methods: This was a cross-sectional study done at Dr. PSIMS & RF, Gannavaram, Andhra Pradesh. The study period was between January 2015 to December 2018, done on Siemens 16 Slice CT machine with the patients' age ranging from 18 to 70 years who underwent CT brain in view of Road traffic accidents.
Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases
Journal of Clinical Medicine
Temporal bone fractures are a common lesion of the base of the skull. The diagnosis and management of temporal bone fractures require a multidisciplinary approach. Variable clinical presentations may arise from such fractures, ranging from an asymptomatic course to very serious consequences. The aim of this study was to report our experience with a series of patients with temporal bone fractures and to propose a diagnostic/therapeutic algorithm. This study enrolled 141 patients, 96 (68.1%) males and 45 (31.9%) females, ranging in age from 20 to 60 (average age: 39 ± 4.1 years), with temporal bone fractures who were referred to Cardarelli Hospital between 2006 and 2018. The present paper presents a classification of temporal bone fractures and typical clinical sequelae and provides an illustration of their prognosis and treatment.
Head injuries and the risk of concurrent cervical spine fractures
Acta Neurochirurgica
Background: Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesized that TBI patients with positive head CT scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. Methods: This widely generalizable retrospective sample was derived from 3023 consecutive patients who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010-July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within one week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) (n=1091). Results: Of the whole cranio-cervically CT-imaged sample (n=1091), 24.7% (n=269) had an acute CT-positive TBI. Car accidents 22.4% (n=244) and falls 47.8% (n=521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% (n=72) and dislocation and/or subluxation in 2.8% (n=31) of the patients. The patients with acute traumatic intracranial lesions had significantly (p=0.04; OR=1.689) more cervical spine fractures (9.3%, n=25) compared to head CT-negative patients (5.7%, n=47). On an individual cervical column level, head CT positivity was especially related to C6 fractures (p=0.031, OR=2.769). Patients with cervical spine fractures (n=72) had altogether 101 fractured vertebrae which were most often C2 (22.8, n=23), C7 (19.8%, n=20) and C6 (16.8%, n=17). Conclusion: Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
Management of complication from temporal bone fractures
European Archives of Oto-Rhino-Laryngology, 2011
The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squamamastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.
Frequency of cervical spine injuries in patients with midface fractures
International Journal of Oral and Maxillofacial Surgery, 2020
The aim of this retrospective cohort study was to determine the frequency and risk factors for cervical spine injury (CSI) in patients with midface fractures. Patients !18 years of age entered in the Massachusetts General Hospital Trauma Registry from 2007 to 2017 were identified. Those with a midface fracture, computed tomography and/or magnetic resonance imaging of the cervical spine, and complete medical records were included. There were 23,394 patients in the registry; 3950 (16.9%) had craniomaxillofacial fractures and 1822 (7.8%) had a CSI. Craniomaxillofacial fractures included fractures of the midface (n = 2803, 71.0%), mandible (n = 873, 22.1%), and midface plus mandible (n = 274, 6.9%). The overall frequency of CSI in patients with midface fractures was 11.4% (350/ 3077). Patients with midface fractures had a higher risk for CSI compared to patients without a midface fracture (odds ratio 2.4, 95% confidence interval 2.1-2.4, P < 0.001). In a multivariate model, nasal and orbital fractures, chest injuries, age, injury severity score, and motor vehicle crash or fall as the etiology were independent risk factors for CSI. Mortality was two times higher in subjects with CSI. Early and accurate diagnosis of CSI is a critical factor when planning the treatment of patients with these fractures.
Predicting complications of pediatric temporal bone fractures
International Journal of Pediatric Otorhinolaryngology, 2020
Our aim is to characterize complications of pediatric temporal bone fractures and identify predictive risk factors associated with fracture complications. Methods: A retrospective review was conducted of all temporal bone fractures diagnosed in children (age less than or equal to 18 years) from a single academic institution between 2003 and 2017. Demographics, mechanism of injury, fracture characteristics, computed tomography evaluation and follow-up duration were recorded on each patient. Outcomes measured include facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL). Results: One-hundred-seventeen patients with 129 temporal bone fractures were included in the study. Most fractures were otic capsule sparing (OCS) (96%, n = 124) and longitudinal (71%, n = 91). Otic capsule violating (OCV) fractures were associated with higher CSF leak rates (20% versus 2%, p = 0.14) and FNI rates (60% versus 5%, p = 0.002) compared to OCS fractures. Audiograms were available in 37 patients (34%). Patients with Glasgow coma scale (GCS) consistent with a mild traumatic brain injury (TBI) (GCS > 13) had significantly fewer complications (FNI and CSF leaks) compared to the group with moderate and severe TBI (GCS < 13), 5% versus 23% (p = 0.03). Conclusions: Higher complication rates are seen with OCV fractures and transverse fractures. Moderate and severe TBI as measured by GCS is predictive of FNI and CSF complications in pediatric temporal bone fractures.
A study of temporal bone fractures
Indian Journal of Otolaryngology and Head & Neck Surgery, 2008
Many young adults are now killed and injured in accidents than from another causes. More than 75% of these injuries are to the head, and the ear being the most frequently injured sensory organ of the body. Temporal bone or basilar skull fractures are extremely common in any head injury. Injuries to the temporal bone may be considered in three groups: Those affecting the external auditory meatus (extralabyranthine fractures), those largely affecting middle ear cleft (tympanolabyranthine) and those affecting the internal ear (labyrinthine fractures). Many injuries, however, involve all these structures .The sudden onset of facial paralysis, vertigo and hearing impairment after a head injury is a matter of great concern for the patients and clinicians. Presence of cerebrospinal fl uid leak (CSF Otorrhoea) can be a challenge for both the neurosurgeons and otologists. We hereby present 86 patients of temporal bone fractures who presented in the departments of emergency, Neurosurgery or ENT of Himalayan Institute of Medical Sciences, Dehradun during last 10 years (1996-2006).
Temporal bone fractures: evaluation of 77 patients and a management algorithm
Turkish Journal of Trauma and Emergency Surgery, 2012
Temporal kemik kırığı olan hastalarda etyoloji, otolaringolojik semptom ve bulguların radyolojik değerlendirmeleri, tedavi yaklaşımları ve sonuçlar değerlendirildi. GEREÇ VE YÖNTEM Yetmiş yedi temporal kemik kırığı olgusu, yaş, cinsiyet, kırığın yeri, kırığın etyolojisi ve kanlı otore, timpanik membran perforasyonu, serebrospinal otore, işitme kaybı, hemotimpanum, fasiyal ve diğer kraniyal sinir paralizilerinin varlığı ve bilgisayarlı tomografi sonuçları yönünden geriye dönük olarak değerlendirildi. BULGULAR Olgularda kırıkların %55'i trafik kazası sonucu meydana gelmişti ve çoğunluğu erkekti (%76,6). Otolaringolojik bulgular sıklık sırası ile erken dönem iletim tipi işitme kaybı (%65,8), kanlı otore (%61,2), hemotimpanum (%58,5), timpanik membran perforasyonu (%25,6), fasiyal sinir paralizisi (%12,3), serebrospinal otore (%8,5) ve sensörinöral işitme kaybı (%5,4) idi. Kırıkların çoğu petroz (%65,8) ve uzunlamasına tip (%51,2) idi. SONUÇ Bu araştırmada 77 temporal kemik kırığı hastasında sıklık sırası ile otolaringolojik bulguları ve tedavi yaklaşımımızı literatür bulguları ile karşılaştırıp tartıştık. Temporal kırıklarda sistematik bir değerlendirme ve tedavi için bir algoritma oluşturduk. Anahtar Sözcükler: Kafa travması; maksillofasiyal yaralanma; temporal kemik. BACKGROUND We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures. METHODS Seventy-seven 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 otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports. RESULTS Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%). CONCLUSION In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.