Right temporal bone fracture

Right temporal bone fractures are often caused by external force and trauma, which can cause great harm to the patient's health. Fracture of the right temporal bone can easily cause damage to the patient's inner ear, blood accumulation, tympanic membrane perforation, etc., and must be treated in time to minimize the damage.

Temporal bone fractures are often accompanied by skull base fractures, which can cause inner ear damage, hematotympanic cavity, and tympanic membrane perforation. In severe cases, they may be accompanied by dural hematoma, cerebral contusion, and subdural hematoma.

If it is a simple temporal bone fracture, the patient can usually be discharged from the hospital after one to two weeks of hospitalization. If accompanied by intracranial hematoma, cerebral contusion, etc., the patient will need to be hospitalized for two weeks to one month.

Temporal bone fractures usually heal through membranous bone formation, which is relatively slow, usually taking one to one and a half years. In some cases, the fracture line may remain for a long time.

Temporal bone fracture is part of skull base fracture, and is often accompanied by varying degrees of damage to intracranial, thoracic, abdominal and other tissues and organs. Among the petrous, squamous and mastoid parts of the temporal bone, fractures of the petrous part are the most common. The reason is that the petrous part contains various pores, ducts and air cells and is relatively fragile. Therefore, one-third of skull base fractures occur here.

Causes

Most of them are caused by traumatic factors, such as traffic accidents, impacts on the temporal and occipital regions, falls, etc.

Clinical manifestations

Temporal bone fractures may have different clinical manifestations depending on the fracture pattern:

1. Longitudinal fractures are mostly caused by impact on the temporal or top part. It is often accompanied by dislocation or fracture of the auditory ossicles. When the tympanic cavity is damaged but the tympanic membrane is not ruptured, blood will accumulate in the tympanic cavity, the tympanic membrane will appear blue, and there may be blood in the saliva. When the eardrum ruptures, blood will flow out from the external channel. If the meninges rupture, cerebrospinal fluid will leak out of the ear. Long-term CSF otorrhea may cause meningitis. Conductive hearing loss may occur when the middle ear is damaged. In a few cases, the facial nerve is affected, causing facial paralysis and loss of taste in the front 2/3 of the tongue.

2. Transverse fractures are mainly caused by violence to the occipital region. The inner ear is severely damaged, and there is often bleeding in the cochlea and semicircular canals. When the labyrinth is damaged, there will be severe vertigo, nausea, and vomiting. Examination may show tilting and spontaneous nystagmus, which may last for several weeks and disappear after compensation by the contralateral side. Vestibular function examination showed functional loss on the affected side and sensorineural hearing loss. The middle ear is rarely injured. Occasionally, the labyrinth is injured and the inner wall of the middle ear is ruptured at the same time, resulting in rupture of the cochlear window membrane and accumulation of blood in the tympanic cavity. About half of the cases suffer from facial paralysis.

3. Petrous apex fracture is rare, but it can damage cranial nerves II, III, IV, V, and VI, causing eye symptoms such as amblyopia, ptosis, smaller palpebral fissure, pupil dilation, diplopia, strabismus, restricted eye movement, or symptoms of trigeminal neuralgia. If the internal carotid artery is damaged, massive bleeding may occur, which is life-threatening.

treat

First of all, the respiratory tract should be kept open, bleeding should be stopped, shock should be prevented, symptoms of brain tissue damage and changes in vital signs should be observed, and timely treatment should be carried out to prevent secondary infection. If the patient's condition permits, detailed examinations, imaging examinations, neurological examinations, etc. should be performed. Local treatment should be performed under sterile conditions to remove earwax, blood and dirt from the external auditory canal. When the eardrum is damaged, keep the external auditory canal clean and dry, and avoid using any medication or flushing to prevent middle ear infection. If there is cerebrospinal fluid otorrhea, the external auditory canal should be kept sterile and should not be packed. Most cases can heal themselves with sufficient systemic application of broad-spectrum antibiotics. The patient had cerebrospinal fluid otorrhea that did not heal for a long time and underwent meningeal repair after the condition improved. If bleeding in the external auditory canal does not stop, damage to the large intracranial blood vessels should be considered and neurosurgery should be sought. The external auditory canal should not be packed. If there is a perforated eardrum or damage to the auditory ossicles, eardrum repair or tympanoplasty can be performed to improve hearing. If combined with otitis media, treat it as otitis media. If facial nerve paralysis cannot be recovered, facial nerve decompression or repair surgery can be performed when the patient's condition permits. People with vestibular symptoms can lie still and be given sedatives.