复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Fracture of temporal bone

Fracture of temporal bone Chunfu dai m,d ph. d Otolaryngology yy Department Fudan University

Fracture of temporal bone Chunfu Dai M.D & Ph.D Otolaryngology Department Fudan University

Classifications 1. Longitudinal fractures 2.Transverse fractures 3 Mixed fractures

Classifications 1. Longitudinal fractures 2. Transverse fractures 3. Mixed fractures

Longitudinal fractures 80%0 of Temporal Bone fractures Lateral Forces along suti the petrosquamous /oniterosayorich Groove ot greater petrosalre Geniculum of facial nery cochlea suture line Plane of anterior (supe Cochlear nery semicircular canal 15-20% Facial Nerve involvement Vestibulocochlear nerve vIID Lateral horizontal EAC laceration estibular nerve xternal wpstihul Plane ot postenor or endolymphatic out semicircularcanal

Longitudinal fractures ◼ 80% of Temporal Bone Fractures ◼ Lateral Forces along the petrosquamous suture line ◼ 15-20% Facial Nerve involvement ◼ EAC laceration

Transverse fractures 20%of Temporal Bone fractures Forces in the Antero- Posterion【w水 r Groove of greater petrosal rer direction on floor of skull Geniculum of farial nerv Inner ear injury ane of anterior(suo Cochlear nerve 50% Facial nerve taal nerve ( vI Opening of intemal Involvement Vestibulocochlear nerve (vIll) Lateral (horizontal) EAC intact semicircular canal Petrous part semicrcular canal

Transverse fractures ◼ 20% of Temporal Bone Fractures ◼ Forces in the Antero-Posterior direction ◼ Inner ear injury ◼ 50% Facial Nerve Involvement ◼ EAC intact

Physical Examination Tuning Fork exam Pneumatic Otoscopy

Physical Examination ◼ Tuning Fork exam ◼ Pneumatic Otoscopy

Imaging HRCT MRI Angiography/ MRA SYSacT 1582370 I:3 2004 DFUV 20 Oon F:1.9

Imaging ◼ HRCT ◼ MRI ◼ Angiography/ MRA

symptoms Hearing Loss tinnitus Dizziness CSF Otorrhea and Rhinorrhea Facial Nerve Injuries

symptoms ◼ Hearing Loss & tinnitus ◼ Dizziness ◼ CSF Otorrhea and Rhinorrhea ◼ Facial Nerve Injuries

Hearing loss Formal Audiometry Vs, Tuning Fork 71% of patients with Temporal Bone Trauma have hearing loss TM Perforations CHL> 40db suspicion for ossicular discontinuity

Hearing loss ◼ Formal Audiometry vs. Tuning Fork ◼ 71% of patients with Temporal Bone Trauma have hearing loss ◼ TM Perforations ◼ CHL > 40db suspicion for ossicular discontinuity

Hearing loss perior projection of right osseous labyrinth Groove ot greater petrosal on floor of skull Geniculum ot facial nerve Longitudinal Fractures Plane of anterior (suno Cochlear ne Conductive or mixed facal nerve vIl Opening of internal hearing loss Vestibulocochlear nerve IVI lateral horizontal 80% of CHL resolve vestibular nerve spontaneously y of temporal bone Transverse fractures S oi posterior Sensorineural hearing loss s likely to improve

Hearing loss Longitudinal Fractures ◼ Conductive or mixed hearing loss ◼ 80% of CHL resolve spontaneously ◼ Transverse Fractures ◼ Sensorineural hearing loss ◼ Less likely to improve

Dizziness Otic capsule fracture, labyrinthine concussion, Perilymphatic Fistula Perilymphatic Fistulas Fluctuating dizziness and or hearing loss Tulio° s Phenomenon 口 Management 40%o spontaneously close Surgical management

Dizziness ◼ Otic capsule fracture, labyrinthine concussion, Perilymphatic Fistula ◼ Perilymphatic Fistulas ◼ Fluctuating dizziness and/or hearing loss ◼ Tulio’s Phenomenon ◼ Management ◼ 40% spontaneously close ◼ Surgical management