Gunshot injuries of the temporal bone

Haberkamp, Thomas J.; McFadden, Edith A.; Khafagy, Yasser; Harvey, Steven

doi:10.1288/00005537-199510000-00008

Cited by 19 publications

(22 citation statements)

References 7 publications

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“…CT scans are very effective in evaluating the extent of bony damage (Figure 1). Often the extent of inner ear injury can be determined by CT alone (Haberkamp, 1995).…”

Section: Discussionmentioning

confidence: 99%

Low velocity gunshot injuries to the temporal bone

1998

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ObjectiveTo review the presentation, symptoms and management associated with low velocity gunshot injuries to the temporal bone.MethodsA retrospective analysis of 26 patients treated for low velocity gunshot injuries to the temporal bone.ResultsInitial presentation included otorrhoea (69 per cent), facial nerve injury (27 per cent), hearing loss (65 per cent), intracranial injuries (50 per cent), and cranial neuropathies (58 per cent). Nine patients (35 per cent) underwent angiography, which showed vascular injury in five of them. Four patients died.ConclusionLow velocity gunshot injuries can be devastating and may result in functional sequelae. Low velocity missiles crush and lacerate surrounding structures, while high velocity missiles cause extensive wound cavity formation. Early aggressive management for intracranial, vascular and facial nerve injury can improve outcome.

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“…CT scans are very effective in evaluating the extent of bony damage (Figure 1). Often the extent of inner ear injury can be determined by CT alone (Haberkamp, 1995).…”

Section: Discussionmentioning

confidence: 99%

Low velocity gunshot injuries to the temporal bone

1998

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“…In most studies, facial nerve injury was the most common indication for intervention, though patients often had multiple indications for surgery. 10 The use of corneal reflex or grimace as an extension of the physical examination can elicit facial nerve function in patients who are unable to follow commands. This allows the timely diagnosis and assessment of the severity of facial nerve injury.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, most authors considered a comminuted fracture of the facial nerve canal on computed tomography as a consistent indication for exploration and repair. 10 Two-thirds of the studies reported the location of the facial nerve injury and the corresponding method of surgical intervention, including facial reanimation. The vertical portion of the facial nerve was the most common site of injury and was seen in 48% of patients with confirmed facial nerve injury.…”

Section: Resultsmentioning

confidence: 99%

“…Haberkamp et al described 5 major indications for surgical intervention: facial paralysis, vascular injury, CSF leak, external auditory canal destruction or cholesteatoma prevention, and intracranial injury. 10 Treatment algorithms are difficult to create, as each patient and pattern of injury are unique. Figure 2 and 3 demonstrate the significant comminution seen with these types of injuries.…”

Section: Resultsmentioning

confidence: 99%

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Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review

Kennedy

Cash

Petrey

et al. 2020

Otolaryngol.--head neck surg.

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Objective Ballistic injuries to the temporal bone are uncommon but devastating injuries that damage critical neurovascular structures. This review describes outcomes after ballistic injuries to the temporal bone and offers initiatives for standardized high-quality future research. Data Sources A systematic search of PubMed, Embase, and Cochrane. Review Methods Studies in the review included adults who experienced temporal bone fractures due to gunshot wounds and survived longer than 48 hours. Individual case reports were excluded. The various searches returned 139 results, of which 6 met inclusion criteria. Results Most of the included studies are case series with low-level evidence that report a wide range of outcomes and follow-up. Outcomes include demographic patient information, audiologic outcomes, vascular injuries, intracranial complications, facial nerve function, and surgical indications. Conclusion This review is the first to characterize the nature and progression of patients who experienced gunshot wounds to the temporal bone. Although all patients share an etiology of injury, they often have vastly different hospital courses and outcomes. This review provides a basis for future studies to guide care for these injuries, as most of the existing literature includes small dated case series.

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“…3,4 These injuries most commonly are not self-inflicted. Gunshots can be either of low velocity (90 -210 m/s) or high velocity (Ͼ610 m/s), which is typical of military weapons.…”

Section: Discussionmentioning

confidence: 99%

Penetrating Temporal Bone Trauma

Kilty

Murphy²

2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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T emporal bone injury overall is an infrequent presentation. In patients presenting with head trauma, only 5% have a temporal bone fracture. 1 Mechanisms of temporal bone trauma are divided into blunt and penetrating. Penetrating injuries of the temporal bone are less common than blunt injuries, but are likely to be more damaging. 2 Penetrating injuries are of two types: stab injuries and gunshot injuries. 3 Either injury may be limited to the temporal bone or involve other cranial structures. These injuries often require a team approach to management. CaseA 38-year-old man was transferred from a peripheral hospital to our trauma center after sustaining a gunshot wound to the head. The patient was awake, alert, and oriented with a Glasgow coma score (GCS) of 15, but a noncooperative historian. The patient was examined and was found to have an entrance wound posterior to the left auricle over the mastoid with scorching of the posterior pinna ( Fig. 1). A focused neurologic examination revealed a House-Brackmann grade 2 left facial weakness, with minimal weakness of the frontal branch of the left facial nerve. There was right beating nystagmus present only on rightward gaze (first-degree nystagmus). The left external auditory canal (EAC) was draining a mixture of blood and cerebrospinal fluid (CSF).A high-resolution computed tomography (HRCT) scan of the temporal bone revealed a mixed fracture of the left temporal bone with an adjacent subdural hematoma (SDH), temporal lobe contusion, and pneumocephalus (Fig. 2). A fracture line extended through the basal turn of the cochlea and the vestibule. The bullet had fractured into two main fragments; one was situated in the superficial lobe of the left parotid gland, the other was in the left mastoid adjacent to the sigmoid sinus extending anteriorly to the middle ear space and the posterior wall of the external auditory canal (Figs. 3 and 4).The patient was taken to the operating room where a left simple mastoidectomy was performed for removal of the mastoid bullet fragment (Fig. 5). This involved an exenteration of the central mastoid air cells with preservation of the posterior EAC wall and without modification to the EAC. A dural tear was situated in the region of the tegmen. Through this tear, the SDH was evacuated with subsequent suture closure of the dural tear, which was then reinforced with a temporalis muscle flap. Postoperatively, the patient developed CSF drainage from the bullet entry site that was resistant to treatment with a lumbar drain. This CSF leak was then subsequently closed using a middle cranial fossa approach to place a fascia lata graft. The patient was discharged from hospital shortly after this procedure without any evidence of a subsequent leak. An audiogram performed in follow-up revealed a profound hearing loss in the left ear. DISCUSSIONTemporal bone injury occurs in 20% to 50% of gunshot wounds to the head. 3,4 These injuries most commonly are not self-inflicted. Gunshots can be either of low velocity (90 -210 m/s) or high velocity (Ͼ610 m...

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Gunshot injuries of the temporal bone

Cited by 19 publications

References 7 publications

Low velocity gunshot injuries to the temporal bone

Low velocity gunshot injuries to the temporal bone

Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review

Penetrating Temporal Bone Trauma

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