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Socolovsky L, Bentan MA, Bauschard M, Reichl K, Coelho DH. Gun shot injuries to the temporal bone: Anatomic predictors of mortality. Am J Otolaryngol 2024; 45:104134. [PMID: 38103487 DOI: 10.1016/j.amjoto.2023.104134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To explore anatomic predictors of mortality from gunshot wounds involving the temporal bone. METHODS A retrospective search of radiology reports was performed for all patients with CT reports suggestive of gunshot wounds (GSW) to the TB (2000-2020). All cases were reviewed by the senior author to confirm injury to the temporal bone. Detailed demographic and radiographic data were collected. MAIN FINDINGS A total of 120 patients met inclusion criteria. The majority of patients were male (n = 101) and the average age was 32.9. The squamosa was the most commonly involved subsite (n = 90), followed by the mastoid (n = 43). Squamosal entry site had the highest associated mortality (89.7 %). For those with known disposition, 65.8 % (79 of 120) expired on the same hospital admission. Inpatient otolaryngology consultation was noted in 18.3 % (n = 22) of patients, with poor outpatient follow-up. CONCLUSIONS This series represents the largest survey of GSW to the temporal bone to date. Although associated mortality is high and outpatient follow-up poor, otolaryngologists should be aware of associated morbidities to facilitate both inpatient and subsequent outpatient management.
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Affiliation(s)
- Leandro Socolovsky
- Department of Otolaryngology - Head & Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW FL 1, Washington, DC 20007, USA; Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University. 401 N 11th St, Richmond, VA 23298, USA
| | - Mihai A Bentan
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University. 401 N 11th St, Richmond, VA 23298, USA
| | - Michael Bauschard
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University. 401 N 11th St, Richmond, VA 23298, USA
| | - Kaitlyn Reichl
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University. 401 N 11th St, Richmond, VA 23298, USA; Department of Otolaryngology - Head & Neck Surgery, University of Missouri, One Hospital Dr. MA314, Columbia, MO 65212, USA
| | - Daniel H Coelho
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University. 401 N 11th St, Richmond, VA 23298, USA.
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Maxwell AK, Kahane JB, Murphy TP. Audiologic Consequences of Gunshot Wounds to the Temporal Bone Show No Relation to Concomitant Neurologic or Vascular Injuries. Ann Otol Rhinol Laryngol 2024; 133:97-104. [PMID: 37497835 DOI: 10.1177/00034894231188574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal bone. STUDY DESIGN Retrospective case series. SETTING University-based level-one trauma center. METHODS Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed. RESULTS Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without (P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury. CONCLUSIONS All patterns of hearing loss-conductive, sensorineural, mixed and normal-may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.
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Affiliation(s)
- Anne K Maxwell
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jacob B Kahane
- Department of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Terrence P Murphy
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, USA
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Johns JD, Pittman C, Briggs SE. Temporal Bone Trauma. Otolaryngol Clin North Am 2023; 56:1055-1067. [PMID: 37385862 DOI: 10.1016/j.otc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Temporal bone trauma represents a potentially underrecognized condition during head injuries and remains an important consideration during the evaluation of these patients. The temporal bone contains many critical neurovascular structures in addition to the primary organs of the auditory and vestibular systems that may be violated during these injuries. Despite the lack of consensus guidelines on the management of these injuries, this review highlights the current literature regarding the diagnosis and management of temporal bone trauma and its potential complications.
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Affiliation(s)
- James Dixon Johns
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Corinne Pittman
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA.
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Menezes JM, Batra K, Zhitny VP. A Nationwide Analysis of Gunshot Wounds of the Head and Neck: Morbidity, Mortality, and Cost. J Craniofac Surg 2023; 34:1655-1660. [PMID: 36927798 PMCID: PMC10445625 DOI: 10.1097/scs.0000000000009268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/28/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Gun violence in the United States rose continuously from 2010 to 2022, spiking during the pandemic, and peaking in 2021 at 48,830 deaths (14.8 per 100,000). Previous reports investigated health and financial burden associated with gunshot wounds (GSWs) during 2004 to 2013; however estimates related specifically to head and neck (H&N) injuries have been lacking. This population-based study aims to examine incidence, morbidity, mortality, and health resource utilization of H&N injuries utilizing the Nationwide Inpatient Sample database. METHODS A population-based study was undertaken using the National (Nationwide) Inpatient Sample (NIS) database (2015Q4-2017Q4). The International Classification of Diseases, Tenth Revision (ICD-10) codes were used to create a composite variable (inclusive of brain, eye, facial nerve, and facial fractures) resulting from GSW to the H&N. Incidence per 100,000 hospitalizations and case fatality rates were calculated to determine the health burden of H&N injuries. Length of hospital stay, and inflation- adjusted hospital charges were compared among H&N and non-H&N injuries. Χ 2 (classical and bootstrapped) and Mann-Whitney tests were used to compare groups. RESULTS Of 101,300 injuries caused by firearms, 16,140 injuries (15.9%) involved H&N region. The average incidence of H&N injuries was 20.1 cases per 100,000 hospitalizations, with intentional injuries having the highest case fatality rates of 32.4%. Patients with H&N injuries had extreme loss of function (33.4% versus 18.3%, P <0.001) and extreme likelihood of mortality (27.0% versus 11.3%, P <0.001) than non-H&N injuries. Statistically significant differences in the median length of stay (4.8 d versus 3.7 d; P <0.001) and median inflation-adjusted hospital charges ($80,743 versus $58,946, P <0.001) were found among H&N and non-H&N injuries. CONCLUSIONS Injuries due to GSW remain an inordinate health care and financial burden, with trauma to the H&N carrying an especially high cost in dollars, morbidity, and mortality.
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Affiliation(s)
- John M. Menezes
- Section Head – Craniofacial Surgery, Department of Plastic Surgery, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas
| | - Kavita Batra
- Medical Research Biostatistician, Department of Medical Education, Kerkorian School of Medicine at the University of Nevada, Las Vegas
| | - Vladislav Pavlovich Zhitny
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University, New York City, NY, USA
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Casanova MJ, Correia JT, Lino J, Magalhães A, Meireles L. Bulletproof Temporal Bone: A Case of Self-Inflicted Ballistic Injury. Cureus 2023; 15:e38500. [PMID: 37273304 PMCID: PMC10238310 DOI: 10.7759/cureus.38500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Temporal bone injuries due to gunshot wounds are uncommon but devastating, with a high risk of damage to critical neurovascular structures. The high resistance of the temporal bone, the densest bone in the human body, can sometimes avoid a fatal outcome. However, the complications are in many cases devastating and include hearing loss, facial paralysis, cerebrospinal fluid leakage, intracranial damage, and vascular injuries. Our goal was to report a case of ballistic injury to the temporal bone and describe the surgical approach taken for treatment. A 74-year-old man was transferred to the emergency room of our tertiary hospital, intubated and sedated, after an attempted suicide with a firearm. The CT scan showed the metal projectile lodged within the temporal bone on the right side, with the destruction of the ossicular chain and bony labyrinth. After stabilization, sedation was reversed, and the otolaryngology team was called. On examination, the entry wound was located in the cavum concha, with no active bleeding but presenting active otorrhea of cerebrospinal fluid. The patient had complete peripheral facial paralysis on the right side and spontaneous horizontal nystagmus toward the left side. Empirical antibiotic therapy was initiated. A subtotal petrosectomy was performed, with the removal of the foreign body, repair of the cerebrospinal fluid fistula, obliteration of the cavity with abdominal fat, and closure of the external auditory canal. He was discharged on the 11th-day post-surgery, maintaining complete facial paralysis and right-side anacusis, but was able to walk with assistance. In conclusion, penetrating trauma of the temporal bone is a potentially life-threatening situation, and patients that survive have a guarded prognosis, as it often leads to permanent sequelae even when managed promptly.
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Affiliation(s)
- Maria J Casanova
- Otolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João T Correia
- Otolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Lino
- Otolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - António Magalhães
- Otolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Luis Meireles
- Otolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Maxwell AK, Lemoine JC, Kahane JB, Gary CC. Management of the facial nerve following temporal bone ballistic injury. Laryngoscope Investig Otolaryngol 2022; 7:1541-1548. [PMID: 36258862 PMCID: PMC9575052 DOI: 10.1002/lio2.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the patterns of temporal bone fracture and facial nerve injury from ballistic trauma. Study Design Retrospective case series. Methods Retrospective review of 42 patients evaluated following temporal bone ballistic injury at a single institution, university‐based level‐one trauma center between 2012 and 2021. Demographics, facial nerve status, CT images, interventions, complications, and outcomes were reviewed. Results Mean age 30.3 years (range 5–58 years); 79% male. Racial demographics reflected the surrounding community. Seven mortalities occurred. Nineteen patients (54%) demonstrated facial nerve injury. Of those, 13/19 displayed immediate paralysis, 1 delayed, 5 unknown (due to altered mental status). On consultation, House‐Brackmann grade 6 paralysis was common (13/19). Fracture was otic capsule‐sparing in 17/19 (90%), universally comminuted, with significant disruption along the mastoid tip (16/19), external auditory canal (EAC) (15/19), and periauricular soft tissues (13/19). Nine patients underwent surgical intervention: Transmastoid facial nerve decompression to remove compressive bony spicules (n = 5); eye protection surgery (n = 3); and peripheral facial nerve exploration (n = 1), noting transection at the pes. One required middle cranial fossa and transmastoid repair of cerebrospinal fistulae in setting of severe meningitis. House‐Brackmann scores improved in 80% following transmastoid nerve decompression despite CT evidence of likely additional injury in its extratemporal course. Conclusions Common patterns of temporal bone fracture seen in blunt trauma (longitudinal/transverse, otic capsule‐sparing/disrupting) were not found in patients with ballistic facial nerve injury. Rather, injury was commonly apparent in the EAC, mastoid tip, and periauricular soft tissues. Clinicians should have high suspicion for extratemporal facial nerve injury following ballistic trauma.
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Affiliation(s)
- Anne K. Maxwell
- Department of Otolaryngology‐Head and Neck Surgery LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - John C. Lemoine
- Department of Otolaryngology‐Head and Neck Surgery LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Jacob B. Kahane
- Department of Otolaryngology‐Head and Neck Surgery LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Celeste C. Gary
- Department of Otolaryngology‐Head and Neck Surgery LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
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Kennedy KL, Cash E, Petrey J, Lin JW. Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review. Otolaryngol Head Neck Surg 2020; 164:1160-1165. [PMID: 33138688 DOI: 10.1177/0194599820968796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ballistic injuries to the temporal bone are uncommon but devastating injuries that damage critical neurovascular structures. This review describes outcomes after ballistic injuries to the temporal bone and offers initiatives for standardized high-quality future research. DATA SOURCES A systematic search of PubMed, Embase, and Cochrane. REVIEW METHODS Studies in the review included adults who experienced temporal bone fractures due to gunshot wounds and survived longer than 48 hours. Individual case reports were excluded. The various searches returned 139 results, of which 6 met inclusion criteria. RESULTS Most of the included studies are case series with low-level evidence that report a wide range of outcomes and follow-up. Outcomes include demographic patient information, audiologic outcomes, vascular injuries, intracranial complications, facial nerve function, and surgical indications. CONCLUSION This review is the first to characterize the nature and progression of patients who experienced gunshot wounds to the temporal bone. Although all patients share an etiology of injury, they often have vastly different hospital courses and outcomes. This review provides a basis for future studies to guide care for these injuries, as most of the existing literature includes small dated case series.
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Affiliation(s)
- Kenneth L Kennedy
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Jessica Petrey
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Jerry W Lin
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
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A Gunshot Injury to Temporal Bone: Saved by the Bone. Otol Neurotol 2018; 39:e1171-e1173. [PMID: 30289848 DOI: 10.1097/mao.0000000000002030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yetiser S, Hidir Y, Gonul E. Facial Nerve Problems and Hearing Loss in Patients With Temporal Bone Fractures: Demographic Data. ACTA ACUST UNITED AC 2008; 65:1314-20. [DOI: 10.1097/ta.0b013e3180eead57] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE This paper presents our experience with gunshot wounds to the temporal bone and discusses facial nerve lesions, surgical indication, surgical timing, and other findings. STUDY DESIGN We performed a retrospective review of patients treated for facial nerve lesion after gunshot injury to the temporal bone. SETTING The study was performed in the Otolaryngology Department of the University of Sao Paulo Medical School, Sao Paulo, Brazil. PATIENTS Ninety-eight patients treated between 1988 and 1999 were analyzed. INTERVENTION Facial nerve lesions, bullet locations, and surgical techniques were analyzed. Patients were monitored for 2 years. RESULTS Gunshot trauma to the temporal bone presented considerable tissue loss resulting from the abrasion effect and severity of the impact. The third segment of the facial nerve was most affected, and the bullet was typically found lodged in the mastoid tip. Postoperative infection was common. Such cases required revision surgery, resulting in worse cosmetic outcomes than in cases of closed trauma. CONCLUSIONS Surgical exploration of the facial nerve should be performed as soon as possible, since long delays increase the chance of traumatic neuroma and more pronounced scarring around the facial nerve. Open mastoidectomy with meatoplasty is the surgical technique recommended for repairing the mastoid and the facial nerve. In the majority of cases, a cable graft is necessary. Since nerve lesion in proximity to the stylomastoid foramen and extratemporal facial nerve is common, these areas must be explored carefully.
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Affiliation(s)
- Ricardo F Bento
- Department of Otolaryngology, University of São Paulo Medical School, São Paulo, Brazil.
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Katzen JT, Jarrahy R, Eby JB, Mathiasen RA, Margulies DR, Shahinian HK. Craniofacial and skull base trauma. THE JOURNAL OF TRAUMA 2003; 54:1026-34. [PMID: 12777923 DOI: 10.1097/01.ta.0000066180.14666.8b] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic craniofacial and skull base injuries require a multidisciplinary team approach. Trauma physicians must evaluate carefully, triage properly, and maintain a high index of suspicion to improve survival and enhance functional recovery. Frequently, craniofacial and skull base injuries are overlooked while treating more life-threatening injuries. Unnoticed complex craniofacial and skull base fractures, cerebrospinal fluid fistulae, and cranial nerve injuries can result in blindness, diplopia, deafness, facial paralysis, or meningitis. Early recognition of specific craniofacial and skull base injury patterns can lead to identification of associated injuries and allow for more rapid and appropriate management. CONCLUSION Early detection and treatment of craniofacial and skull base traumatic injuries should lead to decreased morbidity and mortality. This review discusses the most common of these injuries, their possible complications, and treatment.
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Affiliation(s)
- J Timothy Katzen
- Department of Surgery, Division of Trauma Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Qiu WW, Yin SS, Pate WE, Hardjasudarma M, Stucker FJ. Neurotologic Evaluation of Facial Nerve Paralysis Caused by Gunshot Wounds. EAR, NOSE & THROAT JOURNAL 1999. [DOI: 10.1177/014556139907800412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis—including direct injury, compression, fracture, and concussion of the temporal bone—were demonstrated by audiologic, radiologic, and surgical findings. Hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.
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Affiliation(s)
- William W. Qiu
- Department of Radiology, Louisiana State University Medical Center, Shreveport, Louisiana
| | - Shengguang S. Yin
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical Center, Shreveport, Louisiana
| | - William E. Pate
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical Center, Shreveport, Louisiana
| | - M. Hardjasudarma
- Department of Radiology, Louisiana State University Medical Center, Shreveport, Louisiana
| | - Fred J. Stucker
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical Center, Shreveport, Louisiana
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Abstract
Temporal bone trauma can be disastrous for the individual and his or her family. With the increase in violent crime throughout our society, the number of intracranial complications associated with temporal bone injury has increased significantly. Although multiple reports concerning the diagnosis and management of temporal bone trauma have been published, few studies on its intracranial complications have been addressed. In this study, we assessed the cases of 43 patients treated for temporal bone fractures between January 1992 and December 1994. The number of temporal bone fractures increased from 6 in 1992 to 21 in 1994. Twenty-one patients (49%) presented with decreased mental status. Significant alcohol and drug use was documented in 28% and 58% of patients, respectively. The most common radiologic finding was skull and intracranial injury. Thirty-six patients (84%) had at least one abnormal intracranial finding; of these patients, 14 (39%) had more than one abnormal finding on computed tomography. Cerebral midline shift, subarachnoid hemorrhage, subdural hemorrhage, and cerebral edema were the most common radiologic findings. Nineteen patients (44%) required an open neurosurgical procedure, and almost all patients with more than one abnormal radiologic finding underwent neurosurgery (86%). Seven patients required further institutional care after discharge. Four patients died (9% mortality); all the deaths were neurologically related. Mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994.
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Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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Abstract
OBJECTIVE To review the presentation, symptoms and management associated with low velocity gunshot injuries to the temporal bone. METHODS A retrospective analysis of 26 patients treated for low velocity gunshot injuries to the temporal bone. RESULTS Initial presentation included otorrhoea (69 per cent), facial nerve injury (27 per cent), hearing loss (65 per cent), intracranial injuries (50 per cent), and cranial neuropathies (58 per cent). Nine patients (35 per cent) underwent angiography, which showed vascular injury in five of them. Four patients died. CONCLUSIONS Low velocity gunshot injuries can be devastating and may result in functional sequelae. Low velocity missiles crush and lacerate surrounding structures, while high velocity missiles cause extensive wound cavity formation. Early aggressive management for intracranial, vascular and facial nerve injury can improve outcome.
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Affiliation(s)
- S L Sabin
- State University of New York-Health Science Center at Brooklyn, USA
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