Temporal Bone Fracture 112907 Final no pt pics.pptVIP

Temporal Bone Fracture Rohit Garg MD MBA November 29, 2007 Agenda Case Report Differential Diagnosis FN paralysis Anatomy Epidemiology Pathophysiology Classification Complications FN injury CSF Fistula Hearing Loss Case Report HPI: 27 yo male s/p MVC, restrained driver, BIBA to UCI ER. + LOC, + airbag. Pt was agitated on arrival. Case Report PMH: None PSH: None All: NKDA Meds: None SH: Occ tobacco, Occ ETOH, + marijuana Exam Gen: Intubated and sedated, UTA CN7 H: No bony stepoffs E: PERRL, EOMI E: right ear laceration, R TM clear/intact, blood in EAC, L TM clear/intact, no EAC lacerations/fractures, no drainage N: no lesion/masses/bleeding/hematoma/drainage T: clear, no lesions, fair dentition Neck: No crepitus, masses HB Facial Nerve Grading Pertinent Exam ABCs Ear exam – auricle, EAC, TM Hematoma, CSF leak, perforation, laceration Nystagmus Hearing evaluation Tuning fork exam Audiogram when stable Other facial fractures Avoid irrigation of EAC Common Exam Findings Hemotympanum “Raccoon” sign for ant skull base Periorbital ecchymosis Battle Sign Postauricular ecchymosis Indications for HRCT Facial paralysis CSF/perilymph leak Suspected vascular injury Disruption of superior EAC or scutum Transient or persistent neurological deficits Differential Diagnosis Vascular Infection Trauma Autoimmune Metabolic Idiopathic/Iatrogenic Neoplasm Drugs Differential Diagnosis Differential Diagnosis Anatomy Anatomy Anatomy Epidemiology 3:1 ratio males to females 70% occur during 2-4th decades of life Occur in 14-22% of all skull injuries Pathophysiology 1,875 lb lateral force for longitudinal fractures Fractures take path of least resistance 60% considered open Bloody otorrhea, brain herniation, CSF leak, penetrating wound 8-29% occur bilaterally Classification Longitudinal Parallels long axis of petrous pyramid 70-90% Caused by lateral force to mastoid or squamous bone FN injury in 10-25% Classification Transverse Perpendicular to long axis of petrous pyramid 10-30% C