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Temporal Bone Fracture

Fractured Temporal Bone


Presentation

  • Clinical presentations mostly reported were blood rhinorrhea (36%) and blood otorrhea (32.7%).[ncbi.nlm.nih.gov]
Fishing
  • We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.[ncbi.nlm.nih.gov]
Pneumonia
  • Brodie and Thompson found a 20% incidence of meningitis with concurrent infection and 3% incidence in the absence of concurrent infection. [32] Streptococcus pneumoniae and Haemophilus influenzae are the most common infecting organisms.[emedicine.medscape.com]
Drooling
  • On the 4th day after trauma, he was noted to have incomplete closure of both eyes and was feeling difficulty with chewing and drooling of saliva.[ncbi.nlm.nih.gov]
Trismus
  • The phenomenon of trismus following TBF with normal TMJ is rare and not yet reported.[ncbi.nlm.nih.gov]
Referred Otalgia
  • Referred otalgia is common. Traumatic fracture of an ossified styloid and stylohyoid ligament can cause pressure on the external or internal carotid artery and pain may be referred to the cheek or eye, producing atypical pain.[emedicine.medscape.com]
Chemosis
  • It is suspected by a pulsatile or nonpulsatile exophthalmus, chemosis, and a bruit detected in the affected area. [30, 42] Sigmoid sinus thrombosis This condition occurs but is rare. Sigmoid sinus thrombosis is usually aseptic and nonsymptomatic.[emedicine.medscape.com]
Foreign Body Sensation
  • It consists of pain in the throat with foreign body sensation associated with difficult and painful swallowing. Referred otalgia is common.[emedicine.medscape.com]
Withdrawn
  • The pilot electrode was withdrawn and the CI was inserted uneventfully. The right ear was implanted that also demonstrated bony callus and fibrosis along the cochlear basal turn requiring an extended cochleostomy.[omicsgroup.org]
Neck Swelling
  • The patient returned within 6 hours with sudden unilateral neck swelling and stridor after blowing his nose. Flexible nasendoscopy and computed tomography showed extrinsic compression of the pharynx, with partial upper airway obstruction.[ncbi.nlm.nih.gov]
Vertigo
  • In both benign paroxysmal positional vertigo and central postural vertigo, the spontaneous nystagmus and vertigo usually resolve over 3-6 months and the remaining symptoms by 10-12 months; however, these symptoms may persist in elderly patients.[emedicine.medscape.com]
  • We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.[ncbi.nlm.nih.gov]
  • Sensorineural hearing loss /- vertigo after a temporal bone fracture implies traumatic audio/vestibular failure. The vertigo generally improves as the brain adapts, but hearing loss is likely to be persistent.[entsho.com]
Dizziness
  • All patients complained of hearing loss and dizziness. Hearing in most patients (83.3%) did not improve, whereas dizziness improved in 91.7% of patients.[ncbi.nlm.nih.gov]
  • He complained of non-whirling type dizziness and right sided hearing impairment. Computed dynamic postulography showed a vestibular pattern; however, nystagmus was absent.[austinpublishinggroup.com]
  • Complications evaluated included facial nerve paresis or paralysis, SNHL, CHL, dizziness or balance dysfunction, and CSF leakage. The diagnosis of dizziness or balance dysfunction was made on patient self-reporting.[jamanetwork.com]
Neurologic Manifestation
  • A 49-year-old man presented with sudden, bilateral deafness and whirling vertigo, without any other neurological manifestations. Temporal bone computed tomography clearly demonstrated the presence of air in the vestibule and cochlea on both sides.[ncbi.nlm.nih.gov]

Workup

  • This article reviews the current state of temporal bone fracture evaluation and management with special attention to mechanisms of injury, clinical presentations and emergency evaluation, and diagnostic workup, including the evolution of radiographic[ncbi.nlm.nih.gov]
Streptococcus Pneumoniae
  • Brodie and Thompson found a 20% incidence of meningitis with concurrent infection and 3% incidence in the absence of concurrent infection. [32] Streptococcus pneumoniae and Haemophilus influenzae are the most common infecting organisms.[emedicine.medscape.com]

Treatment

  • OBJECTIVE: To explore the characteristics and treatment of temporal bone fractures and injuries in the medial-inner ear.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis : good. Pathogenesis Etiology Trauma. Pathophysiology Initially may cause little problem. Often go undiagnosed in absence of other trauma in area. With time, osseous callus forms causing progressive dimminution of jaw movement.[vetstream.com]
  • These are discussed in detail in separate articles: longitudinal fractures transverse fractures mixed fractures Treatment and prognosis Treatment is based on managing facial nerve injury, hearing loss, vestibular dysfunction, and CSF leakage.[radiopaedia.org]

Etiology

  • We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth.[ncbi.nlm.nih.gov]
  • Characteristics of reported cases of sympathetic hearing loss Author Age Baseline/preop Etiology threshold * Harris et al, (1) 30 15 Exc VS (TL) 1985 55 8 Exc VS (TL) 36 0 Exc VS (MF) 34 2 Exc VS (TL) 64 48 Exc VS (TL) Schindler and 44 NR Trauma Niparko[medical-dictionary.thefreedictionary.com]
  • Pathogenesis Etiology Trauma. Pathophysiology Initially may cause little problem. Often go undiagnosed in absence of other trauma in area. With time, osseous callus forms causing progressive dimminution of jaw movement.[vetstream.com]

Epidemiology

  • LEVEL OF EVIDENCE: Epidemiologic study, Level III. Copyright 2016 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Epidemiology Longitudinal fractures represent the majority (70-90%) of all petrous temporal bone fractures . Periauricular swelling and retroauricular ecchymosis ( Battle sign ) are common, and almost all have otorrhagia .[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Variables included type and severity of hearing loss, as well as pathophysiology of hearing loss. RESULTS: There were 13 studies with 773 patients that met study criteria.[ncbi.nlm.nih.gov]
  • Abstract Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation[thieme-connect.com]
  • Pathophysiology Initially may cause little problem. Often go undiagnosed in absence of other trauma in area. With time, osseous callus forms causing progressive dimminution of jaw movement.[vetstream.com]
  • A combination of both central and peripheral causes are highly possible in the pathophysiology of vertigo after head and temporal bone trauma. Vestibular rehabilitation or canal repositioning may be of value, in particular in BPPV.[emedicine.medscape.com]

Prevention

  • CONCLUSIONS: To minimize or prevent the sequelae of TBF, accurate radiologic evaluation is necessary as soon as possible after injury.[ncbi.nlm.nih.gov]
  • Página 310 - A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. ‎[books.google.es]
  • With high resolution CT of temporal bones there is a detailing of fracture line and its extensions, preventing and treating precocious complications and information of surgical planning.[arquivosdeorl.org.br]
  • How Do I Prevent a Head Injury? Falls are the number one cause of head injuries. Some, like toddlers falling when learning to walk, is unavoidable. Others may be preventable, especially in the elderly.[emedicinehealth.com]

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