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A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol

Published online by Cambridge University Press:  03 March 2020

H Kanona ,
C Anderson ,
A Lambert ,
R Al-Abdulwahed ,
L O'Byrne ,
N Vakharia ,
D Motter ,
C Offiah ,
A Adams  and
K Seymour
...Show all authors
H Kanona*
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
C Anderson
Affiliation:
University College London Ear Institute, UK
A Lambert
Affiliation:
Department of ENT, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, UK
R Al-Abdulwahed
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
L O'Byrne
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
N Vakharia
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
D Motter
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
C Offiah
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
A Adams
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
K Seymour
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
M J Wareing
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
*
Author for correspondence: Ms Hala Kanona, Department of ENT, Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Rd, LondonWC1X 8DA, UK E-mail: [email protected]
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Abstract

Objective

To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.

Methods

A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention.

Results

Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients.

Conclusion

Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.

Keywords

Temporal BoneSkull FracturesPatient Care ManagementFacial PalsyCerebrospinal Fluid RhinorrheaHearing Loss
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 3 , March 2020 , pp. 205 - 212
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Ms H Kanona takes responsibility for the integrity of the content of the paper

References

Hasso, AN, Ledington, JA. Traumatic injuries of the temporal bone. Otolaryngol Clin North Am 1988;21:295–316Google ScholarPubMed
Wiet, RJ, Valvassori, GE, Kotsanis, CA, Parahy, C. Temporal bone fractures. State of the art review. Am J Otol 1985;6:207–15Google ScholarPubMed
Dahiya, R, Keller, JD, Litofsky, NS, Bankey, PE, Bonassar, LJ, Megerian, CA. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Trauma 1999;47:1079–83CrossRefGoogle ScholarPubMed
Brodie, HA, Thompson, TC. Management of complications from 820 temporal bone fractures. Am J Otol 1997;18:188–97Google ScholarPubMed
Ishman, SL, Friedland, DR. Temporal bone fractures: traditional classification and clinical relevance. Laryngoscope 2004;114:1734–41CrossRefGoogle ScholarPubMed
Zayas, JO, Feliciano, YZ, Hadley, CR, Gomez, AA, Vidal, JA. Temporal bone trauma and the role of multidetector CT in the emergency department. Radiographics 2011;31:1741–55CrossRefGoogle ScholarPubMed
Cannon, CR, Jahrsdoerfer, RA. Temporal bone fractures. Review of 90 cases. Arch Otolaryngol 1983;109:285–8CrossRefGoogle ScholarPubMed
Little, SC, Kesser, BW. Radiographic classification of temporal bone fractures: clinical predictability using a new system. Arch Otolaryngol Head Neck Surg 2006;132:1300–4CrossRefGoogle ScholarPubMed
Temporal Bone Fractures. In: https://emedicine.medscape.com/article/857365-overview [23 January 2018]Google Scholar
Waissbluth, S, Ywakim, R, Al Qassabi, B, Torabi, B, Carpineta, L, Nguyen, LH. Pediatric temporal bone fractures: a case series. Int J Pediatr Otorhinolaryngol 2016;84:106–9CrossRefGoogle ScholarPubMed
McGuirt, WF, Stool, SE. Temporal bone fractures in children: a review with emphasis on long-term sequelae. Clin Pediatr 1992;31:12–18CrossRefGoogle ScholarPubMed
Lee, D, Honrado, C, Har-El, G, Goldsmith, A. Pediatric temporal bone fractures. Laryngoscope 1998;108:816–21CrossRefGoogle ScholarPubMed
Nishiike, S, Miyao, Y, Gouda, S, Shimada, N, Nagai, M, Nakagawa, A et al. Brain herniation into the middle ear following temporal bone fracture. Acta Otolaryngol 2005;125:902–5CrossRefGoogle ScholarPubMed
Brodie, HA. Management of temporal bone trauma. In: Flint, PW, Haughey, BH, Lund, VJ, Niparko, JK, Richardson, MA, Robbins, KT, eds. Cummings Otolaryngology – Head and Neck Surgery, 5th edn. Philadelphia: Mosby-Elsevier, 2010;2036–47CrossRefGoogle Scholar
Hough, JV. Otologic trauma. In: Paparella, MM, Shumrick, DA, eds. Otorhinolaryngology, Vol 2, The Ear. Philadelphia: Saunders, 1980;1656–79Google Scholar
Magliulo, G, Appiani, MC, Iannella, G, Artico, M. Petrous bone fractures violating otic capsule. Otol Neurotol 2012;33:1558–61CrossRefGoogle ScholarPubMed
Adkins, WY, Osguthorpe, JD. Mini-craniotomy for management of CSF otorrhea from tegmen defects. Laryngoscope 1983;93:1038–40CrossRefGoogle ScholarPubMed
Patel, A, Groppo, E. Management of temporal bone trauma. Craniomaxillofac Trauma Reconstr 2010;3:105–13CrossRefGoogle ScholarPubMed
Ratilal, BO, Costa, J, Sampaio, C, Pappamikail, L. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 2011;(10):CD004884Google ScholarPubMed
Kveton, JF. Obliteration of mastoid and middle ear for severe trauma to the temporal bone. Laryngoscope 1987;97:1385–7CrossRefGoogle ScholarPubMed
Coker, NJ, Jenkins, HA, Fisch, U. Obliteration of the middle ear and mastoid cleft in subtotal petrosectomy: indications, technique, and results. Ann Otol Rhinol Laryngol 1986;95:5–11CrossRefGoogle ScholarPubMed
Diaz, RC, Cervenka, B, Brodie, HA. Treatment of temporal bone fractures. J Neurol Surg B Skull Base 2016;77:419–29Google ScholarPubMed
Glasscock, ME, Dickins, JR, Jackson, CG, Wiet, RJ, Feenstra, L. Surgical management of brain tissue herniation into the middle ear and mastoid. Laryngoscope 1979;89:1743–54CrossRefGoogle ScholarPubMed
Edwards, P, Arango, M, Balica, L, Cottingham, R, El-Sayed, H, Farrell, B et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months. Lancet 2005;365:1957–9Google ScholarPubMed
Alderson, P, Roberts, I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev 2005;(25):CD000196Google ScholarPubMed
Turner, JWA. Facial palsy in closed head injuries: prognosis. Lancet 1944;1:756–7CrossRefGoogle Scholar
May, M. Trauma to the facial nerve. Otolaryngol Clin North Am 1983;16:661–70Google ScholarPubMed
Fisch, U. Facial paralysis in fractures of the petrous bone. Laryngoscope 1974;84:2141–54CrossRefGoogle ScholarPubMed
Lambert, PR, Brackmann, DE. Facial paralysis in longitudinal temporal bone fractures: a review of 26 cases. Laryngoscope 1984;94:1022–6CrossRefGoogle ScholarPubMed
Coker, NJ, Kendall, KA, Jenkins, HA, Alford, BR. Traumatic intratemporal facial nerve injury: management rationale for preservation of function. Otolaryngol Head Neck Surg 1987;97:262–9CrossRefGoogle ScholarPubMed
Darrouzet, V, Duclos, JY, Liguoro, D, Truilhe, Y, De Bonfils, C, Bebear, JP. Management of facial paralysis resulting from temporal bone fractures: our experience in 115 cases. Otolaryngol Head Neck Surg 2001;125:77–84CrossRefGoogle ScholarPubMed
Beck, DL, Benecket, JE. Electroneurography: electrical evaluation of the facial nerve. J Am Acad Audiol 1993;4:109–15Google ScholarPubMed
Fisch, U. Current surgical treatment of intratemporal facial palsy. Clin Plast Surg 1979;6:377–88Google ScholarPubMed
Shelton, C. Facial paralysis caused by temporal bone fractures. In: Shelton, C, ed. Update on Facial Nerve Disorders. Alexandria, VA: American Academy of Otolaryngology Head and Neck Foundation, 2001Google Scholar
Johnson, F, Semaan, MT, Megerian, CA. Temporal bone fracture: evaluation and management in the modern era. Otolaryngol Clin North Am 2008;41:597–618CrossRefGoogle ScholarPubMed
Gordin, E, Lee, T, Ducic, Y, Arnaoutakis, D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofacial Trauma Reconstr 2014;8:1–13CrossRefGoogle Scholar
Mannarelli, G, Griffin, GR, Kileny, P, Edwards, B. Electrophysiological measures in facial paresis and paralysis. Oper Tech Otolayngol Head Neck Surg 2012;23:236–47CrossRefGoogle Scholar
Gantz, BJ, Rubinstein, JT, Gidley, P, Woodworth, GG. Surgical management of Bell's palsy. Laryngoscope 1999;109:1177–88CrossRefGoogle ScholarPubMed
Fisch, U. Prognostic value of electrical tests in acute facial palsy. Am J Otol 1984;5:494–8Google Scholar
House, JW, Brackmann, DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–7CrossRefGoogle ScholarPubMed
Manimaran, R, Sivakumar, K, Prabu, SS. Role of high-resolution computed tomography in the evaluation of temporal bone fracture. Int J Sci Study 2017;5:17–21Google Scholar