The potential protective effects of temporal bone pneumatization: A shock absorber in temporal bone fracture

Abstract

Objectives We hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF). Methods Charts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction. Results Patients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025). Conclusions The degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.

Temporal bone pneumatization: A scoping review on the growth and size of mastoid air cell system with age

“…The pneumatization of temporal bone serves as a prognostic factor in middle ear surgery and could be considered once related surgeries are planned [ 7 – 9 ]. Temporal bone pneumatization has also been reported to give a protective function, acting as a shock absorber in patients with lateral skull-based fracture and traumatic brain injury [ 10 , 11 ], which have had a devastating impact on many individuals, approximately 69 million individuals worldwide and affect a significant number of people in South Africa [ 12 , 13 ]. However, minimal pneumatization of the temporal bone is a characteristic of otitis media [ 14 , 15 ], which is one of the global burdens of disease [ 16 – 20 ], and significantly high in South Africa among younger children and older children with prevalence of 31.4% and 16.7% respectively [ 21 , 22 ].…”

Comparison of mastoid air cell volume in patients with or without a pneumatized articular tubercle

“…Pneumatization in the temporal bone protects the surrounding vital organs such as the cochlea, vestibule, facial nerves, and carotid artery in temporal bone fractures. Kang et al 23 investigated the relationship between the degree of pneumatization and clinical findings after temporal bone fracture. The clinical sequelae evaluated included hearing loss, facial nerve paresis or paralysis, and vestibular disorders.…”

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

“…Our data also demonstrate that TL-TBFs are predominantly observed with mastoid hypopneumatization ( Table 1 ). According to the literature, the authors endorse a potential protective effect of pneumatization in TBFs; in fact, pneumatic cells can absorb most of the impact force during a traumatic event [ 21 , 22 ]. CHL is frequently observed in TBF cases; it is often secondary to otorrhagia, hemotympanum, TM perforation, or ossicular chain disruption [ 1 , 2 , 9 , 10 , 23 ].…”