Temporal bone fractures

[Lizzy Liz]

Temporal bone fractures can occur after severe blunt trauma to the head and sometimes involve structures of the ear, causing hearing loss, vertigo, balance disturbance, or facial paralysis.
Temporal bone fractures are suggested by

Battle sign (postauricular ecchymosis)
Bleeding from the ear

Bleeding may come from the middle ear (hemotympanum) through a ruptured tympanic membrane or from a fracture line in the ear canal. A hemotympanum makes the tympanic membrane appear blue-black. Cerebrospinal fluid otorrhea indicates a communication between the middle ear and the subarachnoid space.
Temporal bone fractures have been classified by orientation with respect to the long axis of the petrous portion of the temporal bone. Longitudinal fractures make up 70 to 90% of temporal bone fractures, and transverse fractures make up 10 to 30%. Some fractures may have characteristics of both patterns.
Longitudinal fractures can extend through the middle ear and rupture the tympanic membrane; they cause facial paralysis in 20% of cases and may cause hearing loss (usually conductive).
Transverse fractures cross the fallopian canal and otic capsule, causing facial paralysis in about 40% of patients and sometimes hearing loss (usually sensorineural) and vestibular dysfunction (eg, vertigo, balance disturbance).
Rarely, fluctuating sensorineural hearing loss and vestibular dysfunction occur with temporal bone fracture and may be due to a perilymph fistula. Immediate complete facial paralysis may indicate a severed or crushed facial nerve, whereas delayed-onset complete facial paralysis usually indicates edema within an intact nerve.