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ENT
Temporal Bone Trauma
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
6 sections · 80 slides
Overview and Epidemiology
- Spectrum of temporal bone injury
- Demographics of temporal bone fracture
- Associated injuries
- Paediatric temporal bone trauma
Mechanisms of Injury
- Energy transfer and injury severity
- Classification of trauma mechanism
- Cavitation in high-energy penetrating trauma
- Traumatic facial paralysis on coronal CT
Clinical Evaluation
- Initial trauma triage
- History in temporal bone trauma
- External head and neck examination
- Ocular assessment after head trauma
- Otoscopic examination
- Blunt temporal bone injury with bone exposure
- Late appearance of an avulsed auricle
- Tuning fork testing after trauma
- Bedside vestibular assessment
- Grading traumatic facial weakness
- Recognising CSF otorrhoea and rhinorrhoea
Diagnostic Workup
- High-resolution CT of the temporal bone
- Trauma CT versus dedicated temporal bone CT
- Longitudinal fractures
- Transverse fractures
- Trajectory-based fracture classification
- Limits of the trajectory classification
- Otic capsule sparing versus violating
- Vascular imaging after skull base fracture
- Selective use of angiography
- MRI in temporal bone trauma
- Audiometry after temporal bone fracture
- Natural history of post-traumatic conductive loss
- Laboratory confirmation of CSF fistula
- Electrodiagnostic testing of the facial nerve
- Timing of electroneuronography
Management
- Expectant management
- Soft tissue injury over the temporal bone
- Extensive destruction after penetrating trauma
- Canal laceration and late sequelae
- Canal cholesteatoma years after auricular avulsion
- Ossicular chain injuries
- Traumatic ossicular dislocation on CT
- Timing of ossicular reconstruction
- Stapes subluxation into the vestibule
- Depressed stapes footplate with pneumolabyrinth
- Sensorineural hearing loss management
- Cochlear implantation after head trauma
- Post-traumatic vestibular symptoms
- Persistent post-traumatic vertigo
- Traumatic facial paralysis: the open questions
- Mechanism and facial nerve outcome
- Blunt trauma facial paralysis: Nash systematic review
- Steroids and decompression in traumatic palsy
- Traumatic CSF fistula and antibiotic prophylaxis
- Conservative management of CSF leak
- Surgical approach to a tegmen defect
- Combined approach and obliteration
- Vascular injury after temporal bone fracture
- Middle meningeal and venous injury
Emerging Considerations
- Evidence gaps in temporal bone trauma
- Standardising data reporting
- Key points
- References
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- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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