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Shapira U, Klein L, Oron Y, Handzel O, Abu-Eta R, Muhanna N, Shilo S, Brenner A, Ungar OJ. The Role of Temporal Bone Pneumatization on Fracture Line and Involved Cranial Structures. Otolaryngol Head Neck Surg 2024. [PMID: 38922718 DOI: 10.1002/ohn.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Temporal bone pneumatization (TBP) is speculated to serve as a shock absorber in temporal bone fractures (TBF), directing the fracture line away from vital structures. This study correlates TBP extent with TBF patterns and preservations of vital TB structures. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral medical center. METHODS All TBF patients referred to a single tertiary center 2017 to 2023 were evaluated. A pneumatization index score for each of their TBs was derived by counting automated-voxel density in a 0 to 100 scale. Results were correlated to the TBF type and the violated structure(s). The ossification index was compared to previously detailed qualitative classification systems of TBP. RESULTS One hundred and forty-five patients were enrolled (mean age 43 ± 17 years). Kinematics were motor vehicle accidents (46%), scooter (15%), bicycle (14%), falls (13%), and assaults (8%). The mastoid ossification index we used showed a strong correlation to all qualitative classification systems (sigmoid = 0.829; labyrinthine = 0.849; carotis = 0.863, infralabyrinthine = 0.869, all P < .001). The pneumatization index strongly correlated with capsule-violating TBFs, with a mean of 44 ± 23 for otic capsule-sparing TBF and 61 ± 20 for otic capsule-violating (OCV) TBF (P < .001). The facial nerve was violated in 30 patients. Facial canal (FC) involvement was not correlated to the ossification index: it was 49 ± 23 for FC-sparing and 44 ± 23 for FC-violating (P = .620). CONCLUSION TBP serves as a protective mechanism against OCV TBF. The more pneumatized the TB, the less likely the otic capsule will be violated in the event of a TBF with the exception of the carotid and FCs. TBP index is in strong agreement with qualitative TBP classification systems.
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Affiliation(s)
- Udi Shapira
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Linor Klein
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Rani Abu-Eta
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Shahaf Shilo
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Brenner
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
- Affiliated to the School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Omer J Ungar
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
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Suzuki Y, Noda K, Ota N, Kondo T, Haraguchi K, Miyoshi N, Kiko K, Yoshikawa K, Ono S, Mizuno H, Okada Y, Takano T, Yasuda S, Oda J, Kamiyama H, Tokuda S, Tanikawa R. A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach. Surg Neurol Int 2023; 14:47. [PMID: 36895239 PMCID: PMC9990793 DOI: 10.25259/sni_995_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
Background Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial. Case Description A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle. Conclusion Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.
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Affiliation(s)
- Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kenichi Haraguchi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norio Miyoshi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kohei Yoshikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shun Ono
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyuki Mizuno
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takuma Takano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Soichiro Yasuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Jumpei Oda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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Dreizin D, Sakai O, Champ K, Gandhi D, Aarabi B, Nam AJ, Morales RE, Eisenman DJ. CT of Skull Base Fractures: Classification Systems, Complications, and Management. Radiographics 2021; 41:762-782. [PMID: 33797996 DOI: 10.1148/rg.2021200189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As advances in prehospital and early hospital care improve survival of the head-injured patient, radiologists are increasingly charged with understanding the myriad skull base fracture management implications conferred by CT. Successfully parlaying knowledge of skull base anatomy and fracture patterns into precise actionable clinical recommendations is a challenging task. The authors aim to provide a pragmatic overview of CT for skull base fractures within the broader context of diagnostic and treatment planning algorithms. Laterobasal, frontobasal, and posterior basal fracture patterns are emphasized. CT often plays a complementary, supportive, or confirmatory role in management of skull base fractures in conjunction with results of physical examination, laboratory testing, and neurosensory evaluation. CT provides prognostic information about short- and long-term risk of cerebrospinal fluid (CSF) leak, encephalocele, meningitis, facial nerve paralysis, hearing and vision loss, cholesteatoma, vascular injuries, and various cranial nerve palsies and syndromes. The radiologist should leverage understanding of specific strengths and limitations of CT to anticipate next steps in the skull base fracture management plan. Additional imaging is warranted to clarify ambiguity (particularly for potential sources of CSF leak); in other cases, clinical and CT criteria alone are sufficient to determine the need for intervention and the choice of surgical approach. The radiologist should be able to envision stepping into a multidisciplinary planning discussion and engaging neurotologists, neuro-ophthalmologists, neurosurgeons, neurointerventionalists, and facial reconstructive surgeons to help synthesize an optimal management plan after reviewing the skull base CT findings at hand. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Osamu Sakai
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Kathryn Champ
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Dheeraj Gandhi
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Bizhan Aarabi
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Arthur J Nam
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Robert E Morales
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - David J Eisenman
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
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Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases. J Clin Med 2021; 10:jcm10020201. [PMID: 33429854 PMCID: PMC7827086 DOI: 10.3390/jcm10020201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/13/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022] Open
Abstract
Temporal bone fractures are a common lesion of the base of the skull. The diagnosis and management of temporal bone fractures require a multidisciplinary approach. Variable clinical presentations may arise from such fractures, ranging from an asymptomatic course to very serious consequences. The aim of this study was to report our experience with a series of patients with temporal bone fractures and to propose a diagnostic/therapeutic algorithm. This study enrolled 141 patients, 96 (68.1%) males and 45 (31.9%) females, ranging in age from 20 to 60 (average age: 39 ± 4.1 years), with temporal bone fractures who were referred to Cardarelli Hospital between 2006 and 2018. The present paper presents a classification of temporal bone fractures and typical clinical sequelae and provides an illustration of their prognosis and treatment.
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Kang TK, Ha R, Oh JH, Sunwoo W. The potential protective effects of temporal bone pneumatization: A shock absorber in temporal bone fracture. PLoS One 2019; 14:e0217682. [PMID: 31150482 PMCID: PMC6544272 DOI: 10.1371/journal.pone.0217682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/17/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives We hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF). Methods Charts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction. Results Patients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025). Conclusions The degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.
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Affiliation(s)
- Tae Kyu Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Ryun Ha
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Hwan Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
- * E-mail:
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Maxillofacial Traumas in Farmers Caused by Farm Animals, Agricultural Vehicles, and Materials. J Craniofac Surg 2016; 27:e401-6. [PMID: 27228372 DOI: 10.1097/scs.0000000000002674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE It has been aimed at evaluating the relationship of maxillofacial fractures in farmers, which are caused due to traumas while working in farms, with trauma etiologies, maxillofacial fracture areas, age, sex, and seasonal variables. METHODS Among the farmers who have come to our emergency service unit as a result of maxillofacial trauma between 2010 and 2012, 146 patients have been analyzed retrospectively. The patients' demographic findings, trauma etiologies, seasonal variables of trauma, and maxillofacial fracture area distribution have been analyzed. RESULTS Patients' age varies between 12 and 80 and 87 of them are female (59.59%), while 59 are male (40.41%). The subjects' etiological distribution is as follows: 47.5% is traumas caused by cattle among the farm animals; 15.75% is traumas caused by the blows of agricultural tools; 12.33% is traumas caused by tractor accidents; 9.59% is traumas caused by falling from haystacks; 7.53% is traumas caused by falling from agricultural vehicles, and 6.85% is traumas caused by horse kicks. When trauma etiology, age, sex, seasonal distribution, and the maxillofacial fractures were analyzed, statistically significant results have been determined. CONCLUSIONS Although the number of maxillofacial traumas is considerably high in farmers due to farm animals, agricultural devices, and agricultural tools, while these traumas can cause functional and aesthetically minor fractures on the face, they can cause important and serious fractures as well. While knowing the mechanism of etiological fractures and accidents in different study groups can be guiding in the speedy diagnosis and treatment of possible fractures, it can also be helpful in taking precautions against traumas in these groups as well.
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Montava M, Masson C, Lavieille JP, Mancini J, Soussan J, Chaumoitre K, Arnoux PJ. Temporal bone fracture under lateral impact: biomechanical and macroscopic evaluation. Med Biol Eng Comput 2015; 54:351-60. [PMID: 26036776 DOI: 10.1007/s11517-015-1317-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/21/2015] [Indexed: 12/01/2022]
Abstract
This work was conducted to study biomechanical properties and macroscopic analysis of petrous fracture by lateral impact. Seven embalmed intact human cadaver heads were tested to failure using an electrohydraulic testing device. Dynamic loading was done at 2 m/s on temporal region with maximal deflection to 12 mm. Anthropometric and pathological data were determined by pretest and posttest computed tomography images, macroscopic evaluation, and anatomical dissection. Biomechanical data were obtained. Results indicated the head to have nonlinear structural response. The overall mean values of failure forces, deflections, stiffness, occipital, and frontal peak acceleration were 7.1 kN (±1.1), 9.1 mm (±1.8), 1.3 kN/mm (±0.4), 90.5 g (±22.5), and 65.4 g (±16), respectively. The seven lateral impacts caused fractures, temporal fractures in six cases. We observed very strong homogeneity for the biomechanical and pathological results between different trials in our study and between data from various experiments and our study. No statistical correlation was found between anthropometric, biomechanical, and pathological data. These data will assist in the development and validation of finite element models of head injury.
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Affiliation(s)
- Marion Montava
- IFSSTAR, LBA, UMR-T 24, Aix Marseille Université, 13344, Marseille, France.
- Hôpital Nord, Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, APHM, 13915, Marseille, France.
| | - Catherine Masson
- IFSSTAR, LBA, UMR-T 24, Aix Marseille Université, 13344, Marseille, France
| | - Jean-Pierre Lavieille
- IFSSTAR, LBA, UMR-T 24, Aix Marseille Université, 13344, Marseille, France
- Hôpital Nord, Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, APHM, 13915, Marseille, France
| | - Julien Mancini
- Inserm, IRD, UMR_S 912 SESSTIM, Aix Marseille Université, 13385, Marseille, France
- Hôpital La Timone, BioSTIC, APHM, 13385, Marseille, France
| | - Jerome Soussan
- Department of Radiology, North Hospital, Aix-Marseille University, Chemin des Bourrelly, 13015, Marseille, France
| | - Kathia Chaumoitre
- Department of Radiology, North Hospital, Aix-Marseille University, Chemin des Bourrelly, 13015, Marseille, France
- UMR 7268 ADES, Aix Marseille Université, 13344, Marseille, France
| | - Pierre-Jean Arnoux
- IFSSTAR, LBA, UMR-T 24, Aix Marseille Université, 13344, Marseille, France
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Temporal bone fractures: sequelae and their impact on quality of life. Am J Otolaryngol 2015; 36:364-70. [PMID: 25618370 DOI: 10.1016/j.amjoto.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/15/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a prospective temporal bone fracture database, and study facial and cochleovestibular sequelae and their impact on quality of life. MATERIALS AND METHODS Prospective study of consecutive cases of 39 patients with 45 temporal bone fractures over 11-month period in a university tertiary referral center. Based on epidemiological data, clinical and imaging findings, treatment modalities and outcome of patients with follow-up of one year, the present study focused on facial and cochleovestibular sequelae and their impact on quality of life after one-year period. RESULTS After 12 months, 44% of patients present with balance problems, 56% with hypoacusis, 56% with tinnitus, and 15% with facial paralysis. In 75%-80% of patients, the cochleovestibular sequelae are described as disabling. Post-trauma quality of life was significantly impaired compared with pre-trauma quality of life, even after 12 months. Long-term cochleovestibular sequelae were significantly associated with poor long-term quality of life. CONCLUSIONS The study demonstrates the need to focus on prevention of temporal bone fractures, notably by promoting the use of helmets and improvements in helmet design. The rapid diagnosis of temporal bone fracture is crucial as it enables effective initial management aimed at avoiding sequelae. The frequency of cochleovestibular sequelae after temporal bone fracture and their impact on quality of life demonstrate the importance of, and need for, ongoing follow-up by a local medical team who can diagnose and manage these long-term sequelae.
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Abstract
OBJECTIVES Determine the prevalence of carotid artery injury (CAI) in patients with basilar skull fractures and describe significant demographic and radiographic risk factors for CAI. STUDY DESIGN From January 2004 to December 2008, medical records of 1,279 consecutive adult patients treated for basilar skull fractures at a tertiary care academic hospital were retrospectively reviewed. Diagnostic angiography was performed in 112 patients because of concern for CAI. Computed tomographic studies of the head and cranial base were reviewed for evidence of pneumocephalus, petrous carotid canal fractures, and sphenoid bone fractures. RESULTS Mean age of patients undergoing angiography was 38.7 years, and 85 patients (75.9%) were male subjects. Thirty-five (50%) of 70 discrete cerebrovascular injuries on angiography involved the carotid canal. The prevalence of CAI in patients with basilar skull trauma was 2.0%. CAI was associated with female sex (p = 0.001), whereas lower Glasgow Coma Scale score approached statistical significance (p = 0.07). Sensitivity and specificity of the 3 computed tomographic findings individually were 44% to 68% and 41% to 67%, respectively. With all 3 findings concurrently, 85% specificity and 80% negative predictive value for CAI were obtained, although sensitivity declined. CONCLUSION The frequency of CAI in patients with basilar skull fractures was higher than that in those without basilar skull involvement. Female sex was strongly associated with CAI. The intimate anatomic relationship between the carotid artery and the cranial base posit substantial diagnostic and therapeutic challenges for the contemporary cranial base surgeon, and thus, understanding the epidemiology and risk factors for CAI is of paramount importance.
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Asha'ari ZA, Ahmad R, Rahman J, Yusof RA, Kamarudin N. Patterns of intracranial hemorrhage in petrous temporal bone fracture. Auris Nasus Larynx 2011; 39:151-5. [PMID: 21592698 DOI: 10.1016/j.anl.2011.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/14/2011] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the relationship pattern of intracranial hemorrhage in cases of traumatic petrous temporal bone fracture. METHODS All head injury cases admitted to the Emergency Department, Hospital Tengku Ampuan Afzan, Pahang, Malaysia in 2008 were assessed. Computerized tomography (CT) scan of the skull base was performed in indicated cases. Patients with a petrous temporal bone fracture were included in the study. Subsequent magnetic resonance imaging (MRI) was performed. Intracranial hemorrhages incidence, management and outcome were recorded. RESULTS From 1421 cases of head injury, 49(3.4%) patients were diagnosed to have a petrous bone fracture from the CT scan. Only 46 cases underwent MRI scan and were included in this study. Of these, 36(78.3%) cases had associated intracranial hemorrhages (p<0.01). Intracranial hemorrhage was associated with the longitudinal types of petrous fracture (p<0.05). Subdural hematoma was the most prevalent type of bleed (55.6%). There was no association between the types of intracranial bleeding (extradural, subdural, subarachnoid or intracerebral hemorrhage) and the types of petrous bone fracture (longitudinal, oblique or transverse). The mortality rate was 17.4%. The mortality cases were associated with the presence of other skull bone fractures (p<0.05). CONCLUSIONS Petrous fracture is significantly associated with intracranial hemorrhage. There was no association between the types of petrous fracture and the types of intracranial hemorrhages in our material.
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Affiliation(s)
- Zamzil Amin Asha'ari
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, International Islamic University Malaysia, Jalan Hospital, Kuantan, Pahang, Malaysia.
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Sun GH, Shoman NM, Samy RN, Cornelius RS, Koch BL, Pensak ML. Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries? Laryngoscope 2011; 121:929-32. [PMID: 21520104 DOI: 10.1002/lary.21718] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gordon H Sun
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Dempewolf R, Gubbels S, Hansen MR. Acute radiographic workup of blunt temporal bone trauma: Maxillofacial versus temporal bone CT. Laryngoscope 2009; 119:442-8. [DOI: 10.1002/lary.20129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Temporal Bone Fracture: Evaluation and Management in the Modern Era. Otolaryngol Clin North Am 2008; 41:597-618, x. [PMID: 18436001 DOI: 10.1016/j.otc.2008.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rafferty MA, Mc Conn Walsh R, Walsh MA. A comparison of temporal bone fracture classification systems. Clin Otolaryngol 2006; 31:287-91. [PMID: 16911644 DOI: 10.1111/j.1749-4486.2006.01267.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the traditional and otic capsule classification system of temporal bone fractures for clinical relevance. DESIGN A retrospective review of all patients with a radiological diagnosis of a skull-base fracture over a 5-year period. SETTING All patients were seen at Beaumont Hospital, the national tertiary referral centre for Neuro-otology. PARTICIPANTS Patients with a clinical diagnosis of skull fracture were identified from the hospitals in patient enquiry (HIPE) database. Of 338 patients, 31 (9%) were identified as having a temporal bone fracture on high-resolution CT scanning. MAIN OUTCOME AND MEASURES The rate and distribution of each major clinical complications within each classification system to establish if either one was more clinically useful. RESULTS Fractures were classified as mixed in 14 (45%), longitudinal in 9 (29%) and horizontal in 8 (26%). Alternatively, 2 (7%) were otic capsule violating and 29 (93%) were otic capsule sparing. Seventeen patients (54.8%) sustained a hearing loss. Seven patients (23%) sustained a facial nerve injury. Four (13%) developed a cerebrospinal fluid (CSF) leak. Of all clinical findings only sensorineural hearing loss occurred significantly more often in the horizontal as opposed to the longitudinal group (P = 0.029) and in the otic violating as opposed to the otic sparing group (P = 0.013). CONCLUSIONS We acknowledge that the relatively small size of our cohort diminishes the statistical power of our conclusions. However, we found that the otic capsule-based classification system was not significantly better than the traditional system in predicting the likelihood of sustaining specific injuries from fractures of the temporal bone.
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Affiliation(s)
- M A Rafferty
- Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
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Ramírez Sabio JB, de Paula Vernetta C, García Sanchís JM, Callejo García FJ, Cortés Andrés O, Quilis Quesada V, Dualde Beltrán D, Marco Algarra J. Fracturas de peñasco. Nuestra experiencia: 1999-2004. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:450-4. [PMID: 17228644 DOI: 10.1016/s0001-6519(06)78747-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. MATERIAL AND METHODS We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. CONCLUSIONS Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.
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Abstract
Head injury is a leading cause of trauma deaths. Prompt recognition of treatable injuries is critical to reduce mortality. Computed tomography (CT) of the head is readily obtainable in most medical centers, and is the cornerstone of rapid diagnosis. This article explains the important prognostic features of various forms of head trauma and their manifestations on noncontrast head CT. Intra-axial lesions are considered first, with explanation of diffuse axonal injury, contusions, and parenchymal hematomas. Extra-axial hemorrhages are also detailed, including subdural hematomas, epidural hematomas, and subarachnoid hemorrhage. Finally, extracranial manifestations of head trauma are explained, with descriptions of craniofacial fractures and orbital injuries. This article should help to place the imaging features of head trauma in clinical perspective for those involved in caring for trauma victims from a diagnostic or therapeutic standpoint.
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Affiliation(s)
- G J Udstuen
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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