Revisiting the indirect signs of a temporal bone fracture: air, air, everywhere

Ulano, Adam; Vedantham, Srinivasan; Takhtani, Deepak

doi:10.1007/s10140-017-1498-2

Cited by 11 publications

(8 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 14 – 16 Traumatic fractures can often be presumed in the setting of air cell opacification on head CT without the need to visualize the fracture with a high-resolution image. 17 Moreover, surgical intervention is typically not required in the absence of complete facial nerve paralysis. 15 , 18 Therefore, temporal bone CT should not be a routine study in the workup of these patients, especially in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine

Benyo

Benn

Saadi

et al. 2022

WestJEM

View full text Add to dashboard Cite

Objective: Temporal bone computed tomography (CT) requires a relatively high radiation dose to produce high-resolution images required to define surgical anatomy. In the acute setting, the need for this detailed evaluation of temporal bone pathology may not be required for nonsurgical management and clinical decision-making. We performed a retrospective review of the clinical characteristics and subsequent management of children who underwent CT of the temporal bone with the goal of optimizing clinical decision-making and mitigating the risks of radiation exposure in children. Methods: We included pediatric patients (<18 years of age) with International Classification of Diseases (9th or 10th revision) diagnoses consistent with otitis externa, otitis media, mastoiditis, head trauma, temporal bone fracture, and otalgia who were treated in the emergency department and underwent temporal bone CT from January 1, 2012–December 31, 2016. We collected data regarding the patients’ presenting symptoms, physical exam findings, indications for imaging, radiographic findings, disposition, and operative intervention within 30 days of imaging. Features of the suspected mastoiditis group were compared between operative and non-operative patients. Results: Over the four-year study period there were 96 temporal bone CTs. Most studies (70%) were associated with a subsequent inpatient admission. Common indications for imaging included evaluation of acute mastoiditis (55%) or trauma (41%). Of the 53 patients with concern for mastoiditis, 27 (51%) required otologic surgery. Two patients in the trauma group required surgical intervention, both for facial nerve decompression. In patients with suspected mastoiditis, mental status changes (P = 0.02), auricular proptosis (P = 0.05), and fluctuance (P = 0.02) were significantly more prevalent in the operative group; however, no other findings were significantly associated with operative intervention. Conclusion: Temporal bone CT is beneficial in guiding diagnosis and management of acute mastoiditis. We found that a majority of patients with suspected mastoiditis who underwent temporal bone CT ultimately required surgery or hospital admission. However, the potential for reduction in the use of CT still exists in this population. Fractures of the temporal bone typically do not require urgent operative intervention in the absence of complete facial nerve paralysis; thus, the utility of temporal bone CT in trauma evaluation may be limited.

show abstract

Section: Discussionmentioning

confidence: 99%

Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine

Benyo

Benn

Saadi

et al. 2022

WestJEM

View full text Add to dashboard Cite

show abstract

“…Evaluation of other facial structures on the CT scan is also vital since fractures of the facial skeleton may cause cervical emphysema. 13 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, temporal bone fractures most probably will present with indirect findings like the presence of emphysema in the surrounding area. Evaluation of other facial structures on the CT scan is also vital since fractures of the facial skeleton may cause cervical emphysema 13 …”

Section: Discussionmentioning

confidence: 99%

Deep subcutaneous cervical emphysema related to mastoid fracture in an adolescent patient ‐ case report

Paouris

Barkociová

Pavlík³

et al. 2022

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…1,3 Findings such as external auditory canal opacification, mastoid opacification, air within the temporomandibular joint, intracranial air adjacent to the temporal bone, and pneumolabyrinth on these CT sequences should raise suspicion for an associated temporal bone fracture. [4][5][6][7] Classically, temporal bone fractures were described as transverse, longitudinal, or oblique (in relation to the long axis of the temporal bone). Because fractures form along paths of least resistance, these fracture lines span the natural foramina in the temporal bone.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 4% to 30% of cranial traumas result in skull fractures, with 18% to 40% of these being temporal bone fractures 1,3 . Findings such as external auditory canal opacification, mastoid opacification, air within the temporomandibular joint, intracranial air adjacent to the temporal bone, and pneumolabyrinth on these CT sequences should raise suspicion for an associated temporal bone fracture 4–7 . Classically, temporal bone fractures were described as transverse, longitudinal, or oblique (in relation to the long axis of the temporal bone).…”

Section: Introductionmentioning

confidence: 99%

Utilization of Computed Tomography in Temporal Bone Fractures at a Large Level I Trauma Center

et al. 2020

View full text Add to dashboard Cite

Objectives/Hypothesis To identify which patients with temporal bone fractures who have already undergone trauma pan‐scan computed tomography (CT) do not require an additional dedicated temporal bone CT. To determine the added cost of dedicated temporal bone CT in a lower‐risk group of patients. Study Design Retrospective chart review. Methods A chart review was conducted of adult patients at a large level I trauma center with temporal bone fractures who underwent both trauma pan‐scan CT and dedicated temporal bone CT. Patients were risk stratified into lower‐ and higher‐risk groups based on imaging and physical exam findings. Imaging findings regarding five critical anatomic structures were compared between the two types of CT scans. Results There were 180 patients who met inclusion criteria, with 120 patients stratified to the lower‐risk group. The negative predictive values of trauma pan‐scan CT within the lower‐risk group for fracture involvement with the five critical anatomic structures were as follows: otic capsule (1.000), carotid canal (0.960), facial nerve canal (1.000), ossicular chain (0.992), and tegmen (0.856). The annual out‐of‐pocket cost to patients for dedicated temporal bone CT imaging in the lower‐risk group was estimated to be approximately $34,000, for a total of $190,000 during the complete study period. Conclusions Trauma pan‐scan CT may be sufficient in lower‐risk patients to identify temporal bone fracture involvement with critical anatomic structures of the temporal bone. Reductions in dedicated temporal bone imaging will decrease both radiation exposure to trauma patients and strain on radiology departments. Level of Evidence 4 Laryngoscope, 131:E278–E282, 2021

show abstract

Revisiting the indirect signs of a temporal bone fracture: air, air, everywhere

Cited by 11 publications

References 12 publications

Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine

Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine

Deep subcutaneous cervical emphysema related to mastoid fracture in an adolescent patient ‐ case report

Utilization of Computed Tomography in Temporal Bone Fractures at a Large Level I Trauma Center

Contact Info

Product

Resources

About