Faculty Collaboration Database

Temporal bone fractures: traditional classification and clinical relevance. Laryngoscope 2004 Oct;114(10):1734-41

Date

09/30/2004

Pubmed ID

15454763

DOI

10.1097/00005537-200410000-00011

Scopus ID

2-s2.0-4944247819 (requires institutional sign-in at Scopus site)   152 Citations

Abstract

OBJECTIVES/HYPOTHESIS: The objectives were to evaluate the clinical relevance of traditional temporal bone radiographic descriptors and to investigate the efficacy of an alternative fracture classification scheme.

STUDY DESIGN: Retrospective consecutive case series.

METHODS: Charts and computed tomography scans representing 155 temporal bone fractures at a level I trauma center were reviewed. Fracture types were correlated with clinical presentation and outcomes.

RESULTS: The traditional classification system (i.e., longitudinal, transverse, or mixed) correlated poorly with clinical findings such as facial nerve weakness and cerebrospinal fluid leakage. It also had limited utility in predicting conductive hearing loss and sensorineural hearing. An alternative schema distinguishing petrous from nonpetrous involvement demonstrated better correlation with these measures. Cerebrospinal fluid leak was 1.1 times more common in transverse than in longitudinal fractures but was 9.8 times more common in petrous than in nonpetrous fractures. Similarly, facial nerve injury more strongly correlated with fractures through the petrous temporal bone than did the other fracture types. Sensorineural hearing loss did not correlate with the transverse fracture classification but was significantly more prevalent in petrous fractures. Likewise, conductive hearing loss did not correlate with longitudinal fractures but was four times more common in the "middle ear" subcategory of nonpetrous fractures.

CONCLUSION: Traditional temporal bone fracture descriptions correlate poorly with clinical findings. However, simply distinguishing petrous from nonpetrous involvement demonstrates significant correlation with the occurrence of serious sequelae of temporal bone fractures. Subcategories of mastoid and middle ear involvement further refine this classification schema to correlate with minor complications. This simple, radiographically based scheme better focuses clinical resources and attention toward more likely sequelae.

Author List

Ishman SL, Friedland DR

Author

David R. Friedland MD Associate Director, Director, Chief, Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Cerebrospinal Fluid
Facial Nerve Injuries
Female
Hearing Loss
Humans
Male
Middle Aged
Petrous Bone
Retrospective Studies
Skull Fractures
Temporal Bone
Tomography, X-Ray Computed