eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Temporal Bone Fractures: Multimedia

Author: Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Coauthor(s): Sarah Connell, MD, Fellow, Department of Otolaryngology, Head and Neck Surgery, University of Miami, Jackson Memorial Hospital; Peter C Belafsky, MD, MPH, PhD, Assistant Professor, Department of Otolaryngology, University of California at Davis; Mark L Belafsky, MD, FACS, Clinical Instructor, Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University
Contributor Information and Disclosures

Updated: Mar 20, 2008

Multimedia

Internal aspect of the skull base: arcuate eminen...
(Enlarge Image)
Media file 1: Internal aspect of the skull base: arcuate eminence (AE), cochlea (C), foramen magnum (FM), internal auditory canal (IAC), foramen lacerum (L), foramen ovale (O), foramen rotundum (R), foramen spinosum (SP), sigmoid sinus (SS), transverse sinus (TS), vestibular system (V).
[ CLOSE WINDOW ]
Internal aspect of the skull base: arcuate eminen...

Internal aspect of the skull base: arcuate eminence (AE), cochlea (C), foramen magnum (FM), internal auditory canal (IAC), foramen lacerum (L), foramen ovale (O), foramen rotundum (R), foramen spinosum (SP), sigmoid sinus (SS), transverse sinus (TS), vestibular system (V).

External aspect of the skull base: carotid canal ...
(Enlarge Image)
Media file 2: External aspect of the skull base: carotid canal (C), condyle (CO), foramen magnum (FM), jugular foramen (J), foramen lacerum (L), foramen ovale (O), pterygoid plates (P), styloid foramen (S), foramen spinosum (SP).
[ CLOSE WINDOW ]
External aspect of the skull base: carotid canal ...

External aspect of the skull base: carotid canal (C), condyle (CO), foramen magnum (FM), jugular foramen (J), foramen lacerum (L), foramen ovale (O), pterygoid plates (P), styloid foramen (S), foramen spinosum (SP).

Internal aspect of the skull base that represents...
(Enlarge Image)
Media file 3: Internal aspect of the skull base that represents, in black and blue colors, the pathway of the longitudinal temporal bone fracture lines.
[ CLOSE WINDOW ]
Internal aspect of the skull base that represents...

Internal aspect of the skull base that represents, in black and blue colors, the pathway of the longitudinal temporal bone fracture lines.

Internal aspect of the skull base that represents...
(Enlarge Image)
Media file 4: Internal aspect of the skull base that represents, in black and red colors, the pathways of the transverse temporal bone fracture lines.
[ CLOSE WINDOW ]
Internal aspect of the skull base that represents...

Internal aspect of the skull base that represents, in black and red colors, the pathways of the transverse temporal bone fracture lines.

Axial high-resolution CT of the right temporal bo...
(Enlarge Image)
Media file 5: Axial high-resolution CT of the right temporal bone that represents a longitudinal fracture line that extends from the roof of the external auditory canal to the middle ear cavity.
[ CLOSE WINDOW ]
Axial high-resolution CT of the right temporal bo...

Axial high-resolution CT of the right temporal bone that represents a longitudinal fracture line that extends from the roof of the external auditory canal to the middle ear cavity.

Right temporal bone transverse fracture with seve...
(Enlarge Image)
Media file 6: Right temporal bone transverse fracture with severe spontaneous nystagmus (third degree) manifesting immediately after trauma. The fast component beats away from the fracture site in all directions of the gaze; the intensity of the spontaneous nystagmus is represented by the different lengths of black arrows. This type of nystagmus is usually seen by the naked eye. According to Alexander's law, the nystagmus increases when the eyes are turned in the direction of the quick component and decreases when the eyes are turned in the direction of the slow component.
[ CLOSE WINDOW ]
Right temporal bone transverse fracture with seve...

Right temporal bone transverse fracture with severe spontaneous nystagmus (third degree) manifesting immediately after trauma. The fast component beats away from the fracture site in all directions of the gaze; the intensity of the spontaneous nystagmus is represented by the different lengths of black arrows. This type of nystagmus is usually seen by the naked eye. According to Alexander's law, the nystagmus increases when the eyes are turned in the direction of the quick component and decreases when the eyes are turned in the direction of the slow component.

More on Temporal Bone Fractures

Overview: Temporal Bone Fractures
Workup: Temporal Bone Fractures
Treatment: Temporal Bone Fractures
Multimedia: Temporal Bone Fractures
References
[ CLOSE WINDOW ]

References

  1. Lee D, Honrado C, Har-El G, Goldsmith A. Pediatric temporal bone fractures. Laryngoscope. Jun 1998;108(6):816-21. [Medline].

  2. Ulrich K. Verletzungen des Gehorlorgans bel Schadelbasisfrakturen(Ein Histologisch und Klinissche Studie). Acta Otolaryngol Suppl. 1926;6:1-150.

  3. Ghorayeb BY, Yeakley JW. Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures. Laryngoscope. Feb 1992;102(2):129-34. [Medline].

  4. Kerr AG, Smyth GDL. Ear Trauma. In: Maran AGD, Stell PM. Clinical Otolaryngology. Blackwell Scientific Publications; 1979:113-114.

  5. Olsson JE, Shagets FW, MC, USAF. Blunt Trauma of the Temporal Bone. American Academy of Otolaryngology-Head and Neck Surgery Fo.; Second Edition 1986. A Self-Instructional Package from the Committee on Continuing Education in Otolaryngology.

  6. Diaz R, Brodie HA. Middle Ear and Temporal Bone Trauma. In: Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Otolaryngology-Head and Neck Surgery. 4. Fourth edition. Elsevier Mosby; 2005:2057-2079/139.

  7. Ghorayeb BY, Yeakley JW, Hall JW 3d, Jones BE. Unusual complications of temporal bone fractures. Arch Otolaryngol Head Neck Surg. Jul 1987;113(7):749-53. [Medline].

  8. Woodcock R. Temporal Bone, Fractures. eMedicine [serial online]. Available at http://www.emedicine.com/radio/topic678.htm.

  9. Fisch U. Facial paralysis in fractures of the petrous bone. Laryngoscope. Dec 1974;84(12):2141-54. [Medline].

  10. Hough JV, Stuart WD. Middle ear injuries in skull trauma. Laryngoscope. Jun 1968;78(6):899-937. [Medline].

  11. Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol. Mar 1997;18(2):188-97. [Medline].

  12. MacGee EE, Cauthen JC, Brackett CE. Meningitis following acute traumatic cerebrospinal fluid fistula. J Neurosurg. Sep 1970;33(3):312-6. [Medline].

  13. Rathmore MH. Do prophylactic antibiotics prevent meningitis after basilar skull fracture?. Ped Inf Dis J. Feb 1991;10(2):87-88. [Medline].

  14. Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23(6):377-80. [Medline].

  15. Villalobos T, Arango C, Kubilis P, Rathore M. Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. ALYSIS. Aug 1998;27(2):364-9. [Medline].

  16. Leech PJ, Paterson A. Conservative and operative management for cerebrospinal-fluid leakage after closed head injury. Lancet. May 12 1973;1(7811):1013-6. [Medline].

  17. Turner JWA. Facial paralysis in closed head injuries. Lancet. 1944;246:756-57.

  18. Maiman DJ, Cusick JF, Anderson AJ, Larson SJ. Nonoperative management of traumatic facial nerve palsy. J Trauma. Jul 1985;25(7):644-8. [Medline].

  19. Arriaga Moises A. Traumatic Facial Paralysis. In: Gates George A. Current Therapy in Otolaryngology-Head and Neck Surgery. Sixth Edition. Mosby; 1998:121-125.

  20. Barber HO. Head injury audiological and vestibular findings. Ann Otol Rhinol Laryngol. Apr 1969;78(2):239-52. [Medline].

  21. Bobad MS. Eagle syndrome caused by traumatic fracture of a mineralized stylohyoid ligament: literature review and case report. Journ Craniomand Pract. 1995;13(3):189-92.

  22. Brodie HA. Management of Temporal Bone Trauma. In: Bailey Byron J. & Johnson Jonas T. Head & Neck Surgery-Otolaryngology. Vol. 2. 4th edition. Lippincott Williams & Wilkins; 2006:125/2848-2866.

  23. Cannon CR, Jahrsdoerfer RA. Temporal bone fractures. Review of 90 cases. Arch Otolaryngol. May 1983;109(5):285-8. [Medline].

  24. Chang CY, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol. Jan 1999;20(1):96-114. [Medline].

  25. Clark JM, Shockley WW. Management and Reanimation of the Paralyzed Face. In: Papel Ira D. Facial Plastic and Reconstructive Surgery. Second Edition. Thieme; 2002:660-685/53.

  26. Darrouzet V, Duclos JY, Liguoro D, Truilhe Y, De Bonfils C, Bebear JP. Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases. Otolaryngol Head Neck Surg. Jul 2001;125(1):77-84. [Medline].

  27. DiBiase P, Arriaga MA. Post-traumatic hydrops. Otolaryngol Clin North Am. Dec 1997;30(6):1117-22. [Medline].

  28. Eagle WW. Elongated styloid process: report of two cases. Arch Otolaryn Head Neck Surg. 1937;25:584-87.

  29. Felix H, Eby TL, Fisch U. New aspects of facial nerve pathology in temporal bone fractures. Acta Otolaryngol. 1991;111(2):332-6. [Medline].

  30. Fisch U. Current surgical treatment of intratemporal facial palsy. Clin Plast Surg. Jul 1979;6(3):377-88. [Medline].

  31. Gianoli GJ, Amedee RG. Temporal bone fractures. J La State Med Soc. Oct 1989;141(10):11-3. [Medline].

  32. Girdjian ES, Lissnerl IR. Deformation of the skull in head injury studied by the "Stesscoat" technique, quantitative determinations. Surg Gynecol Obstret. 1946;83:219-233.

  33. Goodwin WJ Jr. Temporal bone fractures. Otolaryngol Clin North Am. Aug 1983;16(3):651-9. [Medline].

  34. Grahne B. Traumatic cranionasal fistulas persistent cerebrospinal fluid rhinorrhoea and their repair with frontal sinus osteoplasty. Acta Otolaryngol. Nov-Dec 1970;70(5):392-400. [Medline].

  35. Griffin JE, Altenau MM, Schaefer SD. Bilateral longitudinal temporal bone fractures: a retrospective review of seventeen cases. Laryngoscope. Sep 1979;89(9 Pt 1):1432-5. [Medline].

  36. Hagan WE, Tabb HG, Cox RH, Travis LW. Gunshot injury to the temporal bone: an analysis of thirty-five cases. Laryngoscope. Aug 1979;89(8):1258-72. [Medline].

  37. Kahn JB, Stewart MG, Diaz-Marchan PJ. Acute temporal bone trauma: utility of high-resolution computed tomography. Am J Otol. Sep 2000;21(5):743-52. [Medline].

  38. Lambert PR, Brackmann DE. Facial paralysis in longitudinal temporal bone fractures: a review of 26 cases. Laryngoscope. Aug 1984;94(8):1022-6. [Medline].

  39. Lyos AT, Marsh MA, Jenkins HA, Coker NJ. Progressive hearing loss after transverse temporal bone fracture. Arch Otolaryngol Head Neck Surg. Jul 1995;121(7):795-9. [Medline].

  40. McKennan KX, Chole RA. Facial paralysis in temporal bone trauma. Am J Otol. Mar 1992;13(2):167-72. [Medline].

  41. McKennan KX, Chole RA. Post-traumatic cholesteatoma. Laryngoscope. Aug 1989;99(8 Pt 1):779-82. [Medline].

  42. Meriot P, Veillon F, Garcia JF, Nonent M, Jezequel J, Bourjat P, et al. CT appearances of ossicular injuries. Radiographics. Nov-Dec 1997;17(6):1445-54. [Medline].

  43. Morgan WE, Coker NJ, Jenkins HA. Histopathology of temporal bone fractures: implications for cochlear implantation. Laryngoscope. Apr 1994;104(4):426-32. [Medline].

  44. Nelson EL, Melton LJ 3rd, Annegers JF, Laws ER, Offord KP. Incidence of skull fractures in Olmsted County, Minnesota. Neurosurgery. Sep 1984;15(3):318-24. [Medline].

  45. Nosan DK, Benecke JE Jr, Murr AH. Current perspective on temporal bone trauma. Otolaryngol Head Neck Surg. Jul 1997;117(1):67-71. [Medline].

  46. Ort S, Beus K. Pediatric temporal bone fractures in a rural population. Otolaryngology Head Neck Surgery. 2004;131:433-437.

  47. Quaranta A, Campobasso G, Piazza F, Quaranta N, Salonna I. Facial nerve paralysis in temporal bone fractures: outcomes after late decompression surgery. Acta Otolaryngol. Jul 2001;121(5):652-5. [Medline].

  48. Resnick DK, Subach BR, Marion DW. The significance of carotid canal involvement in basilar cranial fracture. Neurosurgery. Jun 1997;40(6):1177-81. [Medline].

  49. Ryall RG, Peacock MK, Simpson DA. Usefulness of beta 2-transferrin assay in the detection of cerebrospinal fluid leaks following head injury. J Neurosurg. Nov 1992;77(5):737-9. [Medline].

  50. Schindler JS, Niparko JK. Imaging quiz case 1. Transverse temporal bone fractures (left) with subsequent progressive SNHL, consistent with sympathetic cochleolabyrinthitis. Arch Otolaryngol Head Neck Surg. Jul 1998;124(7):814-818. [Medline].

  51. Schuknecht HF. A clinical study of auditory damage following blows to the head. Ann Otol Rhinol Laryngol. Jun 1950;59(2):331-58. [Medline].

  52. Shindo ML, Fetterman BL, Shih L, Maceri DR, Rice DH. Gunshot wounds of the temporal bone: a rational approach to evaluation and management. Otolaryngol Head Neck Surg. Apr 1995;112(4):533-9. [Medline].

  53. Spetzler RF, Wilson CB. Management of recurrent CSF rhinorrhea of the middle and posterior fossa. J Neurosurg. 1998;49:393-97. [Medline].

  54. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. Am J Neuroradiol. Apr 1999;20(4):706-12. [Medline].

  55. Travis LW, Stalnaker RL, Melvin JW. Impact trauma of the human temporal bone. J Trauma. Oct 1977;17(10):761-6. [Medline].

  56. Tuohimaa P. Vestibular disturbances after acute mild head injury. Acta Ololaryngol (Suppl). 1978;359:1-67. [Medline].

  57. Weissman JL, Curtin HD. Pneumolabyrinth: a computed tomographic sign of temporal bone fracture. Am J Otolaryngol. Mar-Apr 1992;13(2):113-4. [Medline].

  58. Wennmo C, Spandow O. Fractures of the temporal bone--chain incongruencies. Am J Otolaryngol. Jan-Feb 1993;14(1):38-42. [Medline].

  59. Wennmo C, Svensson C. Temporal bone fractures. Vestibular and other related ear sequele. Acta Otolaryngol Suppl. 1989;468:379-83. [Medline].

  60. Yanagihara N, Murakami S, Nishihara S. Temporal bone fractures inducing facial nerve paralysis: a new classification and its clinical significance. Ear Nose Throat J. Feb 1997;76(2):79-80, 83-6. [Medline].

  61. Yeakley JW. Temporal bone fractures. Curr Probl Diagn Radiol. May-Jun 1999;28(3):65-98. [Medline].

  62. Ylikoski J, Palva T, Sanna M. Dizziness after head trauma: clinical and morphologic findings. Am J Otol. Apr 1982;3(4):343-52. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

temporal bone injuries, temporal bone trauma, basilar skull fractures, longitudinal fractures, transverse fractures, oblique fractures, mixed fractures, otic capsule sparing fractures, otic capsule disrupting fractures, head trauma, motor vehicle accidents, MVAs, motor vehicle collisions, MVCs, stab wounds, gunshot wounds, penetrating wounds, tympanic membrane laceration, tympanic membrane perforation, ossicular chain disruption, ossicular chain disruption, ossicular chain fracture, conductive hearing loss, sensorineural hearing loss, mixed hearing loss, facial nerve paralysis, vertigo, posttraumatic vertigo, positional vertigo, postural vertigo, benign paroxysmal postural vertigo

BPPV, nystagmus, spontaneous nystagmus, positional nystagmus, postural nystagmus, third degree nystagmus, second degree nystagmus, first degree nystagmus, hemotympanum, CSF otorrhea, CSF leak, SF fistula, otorrhagia, incudostapedial joint separation, incudomalleolar joint separation, incus dislocation, malleus dislocation, stapes crura fracture, stapes avulsion-stapediovestibular joint separation, labyrinthitis ossificans, cochlear implants, traumatic endolymphatic hydrops, perilymphatic fistula, meningitis, Maximun Stimulation Test, MST, Nerve Excitability test, Minimal Nerve Excitability test, NET, electroneuronography, ENOG, electromyelography, EMG, abducens paralysis, sigmoid sinus thrombosis, posttraumatic cholesteatoma, Eagle syndrome, sympathetic cochleolabyrintitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Antonio Riera March, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, and Society for Ear, Nose and Throat Advances in Children
Disclosure: Nothing to disclose.

Coauthor(s)

Sarah Connell, MD, Fellow, Department of Otolaryngology, Head and Neck Surgery, University of Miami, Jackson Memorial Hospital
Sarah Connell, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and Triological Society
Disclosure: Nothing to disclose.

Peter C Belafsky, MD, MPH, PhD, Assistant Professor, Department of Otolaryngology, University of California at Davis
Peter C Belafsky, MD, MPH, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Mark L Belafsky, MD, FACS, Clinical Instructor, Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University
Mark L Belafsky, MD, FACS is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development
Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Alcon labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Consulting

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.