Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases

Abstract

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.

Patient-Assessed Outcomes following Temporal Bone Fractures

“…The time of onset of FP after injury is critical for further management. Immediate FP, which is associated with an interruption of nervous conduction in a nerve transection or nerve compression by bone spicula may warrant surgical intervention [ 4 , 6 , 23 ]. However, in a study [ 23 ] comprising 174 patients with immediate FP after TBF, postoperatively, 28 (16%) had final HB I, 123 (71%) had HB II-V, and 11 (6%) HB VI, supporting the fact that surgical intervention did not appear to improve on the natural course of immediate FP; we agree with this, as 75% of our patients with immediate FP consequently had mild FP after conservative treatment and the two surgically treated patients had final HB III and IV.…”

“…However, in a study [ 23 ] comprising 174 patients with immediate FP after TBF, postoperatively, 28 (16%) had final HB I, 123 (71%) had HB II-V, and 11 (6%) HB VI, supporting the fact that surgical intervention did not appear to improve on the natural course of immediate FP; we agree with this, as 75% of our patients with immediate FP consequently had mild FP after conservative treatment and the two surgically treated patients had final HB III and IV. Facial function recovery among patients with delayed FP is almost always to HB I or II, precluding surgical decompression of the facial nerve [ 6 , 7 , 24 ].…”

“…The electrodiagnostic tests, including the ENoG and excitability test, have been widely used to predict facial nerve recovery after traumatic FP [ 3 , 6 , 7 , 24 ]. In post-traumatic FP, neural degeneration of the facial nerve correlates with poor recovery by more than 95%, especially when it occurs within the first 14 days after injury [ 25 ].…”

“…Initially, three of our patients presented with post-traumatic otolithic detachment (BPPV), which was cured after liberatory maneuvers. In a study [ 6 ] which enrolled 141 cases with TBF, vertigo occurred in 86 (67.18%) patients, of which 64 patients had BPPV in the form of canalolithiasis and 22 had an acute vestibular deficit, treated with pharmacotherapy and vestibular rehabilitation. Usually, vestibular symptoms such as dizziness and unsteadiness are self-limiting and resolve within 3–12 months [ 6 , 7 ] due to the central vestibular compensation effect, which occurs following brainstem injury (because of vestibular nuclei damage).…”

“…Conventionally, TBFs are divided into longitudinal, transverse, and mixed types, depending on the direction of the fracture line [ 5 ]. The complications of TBF include facial nerve palsy (FN), hearing loss (HL), which may be conductive, sensorineural, or mixed, and have a cerebrospinal fluid (CSF) leak [ 6 , 7 , 8 ]. All these sequelae of TBFs may adversely affect quality of life (QOL) with a psychological, emotional and social impact.…”