Temporal Bone Fracture

Aetiology

  • Can be classified as either longitudinal or transverse (many are mixed), depending on their relation to the axis of the ear canal
  • Can also be categorised into fractures which involve the optic capsule and those which do not

Longitudinal fractures (80%)

  • Typically occurring from a lateral blow to the head
  • Fracture line parallel the long axis of the petrous pyramid

Transverse fractures (20%)

  • Occur from fronto-occipital head trauma
  • Fracture at right angles to the long axis of the petrous pyramid

Clinical presentation

Important questions to ask

  • Injury mechanism
  • Hearing loss
  • Facial palsy - immediate or delayed
  • CSF leak
  • Associated injuries

Signs

  • Bruising - Battle sign
    • Bruising over mastoid, indicates base of skull fracture
  • Condition of TM and ear canal
  • Cranial nerve examination, especially CN VII
  • Hearing test
notion image

Investigations

  • CT

Management

  • Most managed conservatively

Complications

Longitudinal fracture

  • Bleeding from external canal due to laceration of skin and ear drum
  • Hemotympanum - conductive deafness
  • Ossicular chain disruption - conductive deafness
  • Facial palsy (20%)
  • CSF otorrhoea

Transverse fracture

  • Can cross the internal acoustic meatus causing damage to auditory and facial nerves
  • Sensorineural hearing loss due to damage to CN VIII
  • Facial palsy (50%) and vertigo