Temporal Bone Fracture: Evaluation and Management in the Modern Era

Temporal bone fractures occur from high-energy mechanisms, typically but not limited to motor vehicle accidents. However, as the automotive industry continues to introduce improved safety measures, violence and falls account for a larger proportion of cases. Given the great forces involved, temporal bone fractures rarely occur in isolation and initial evaluation must focus on the fundamental ABCs of Advanced Trauma Life Support with special attention to Glasgow Coma Scale, intracranial injury, and cervical spine injury. Subsequent evaluation relies on physical examination, high-resolution CT, and electrodiagnostic testing to address the neurotologic consequences of temporal bone fracture, including cerebrospinal fluid leak, facial nerve injury, and injury to the peripheral hearing and balance organs. Management algorithms must address immediate (eg, ABCs, neurosurgical issues), short-term (eg, cerebrospinal fluid leak, facial nerve injury, hearing loss), long-term (eg, facial nerve injury, hearing loss, vestibular injury), and delayed (eg, encephalocele, cholesteatoma, late meningitis) issues. This article reviews the current state of temporal bone fracture evaluation and management with special attention to mechanisms of injury, clinical presentations and emergency evaluation, and diagnostic workup, including the evolution of radiographic fracture classification systems and electrodiagnostic testing. Discussion of treatment approaches address management of immediate, short-term, long-term, and delayed complications.