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Pictorial Review of CT Temporal Bone Fractures and its Complications

Authors: Dr. Noamaan Muhammed, Dr. Pallavi Rao, Dr. Arjun Kalyanpur 

Institution: Teleradiology Solutions and Image Core Lab

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Introduction

  • Temporal bone fractures are commonly associated with head trauma and can cause potentially devastating complications. 

  • The standard evaluation protocol in head injury using multidetector computed tomography (CT) has revolutionized the ability to evaluate the intricate anatomy of the temporal bone, enabling immediate detection of fractures and their complications.

  • The objective of the study is to analyse a large series of temporal bone fractures from our teleradiology practice with emphasis on typical imaging features, types, associated complications, and compile a pictorial review.

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Materials and Methods

Pictorial review of CT temporal bone fractures and its complications

Retrospective evaluation of 949 CT studies which were positive for temporal bone fractures as per the emergency radiology report.

Study images were analyzed and imaging findings of temporal bone fractures and its complications were compiled into a pictorial review.  

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Results

Types: In our study the most common type was mixed fracture followed by longitudinal and transverse.

The most common complication in temporal bone fracture is extra-axial hemorrhage, of which subdural hemorrhage was the most common.

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Results

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Longitudinal Fracture

Longitudinal Fractures - Longitudinal fractures are usually a resultant of temporal impact and  start from the temporal squamosa extending towards to the petrous apex 

Transverse Fractures - They result from occipital impact and are perpendicular to the long axis of the petrous bone extending towards the jugular foramen and temporal fossa

Mixed Fractures - They result from motor vehicle collisions often and are difficult to classify as longitudinal or transverse as they have both longitudinal and transverse elements. 

Transverse Fracture

Mixed Fracture

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Case 1

Case 1:

Axial and sagittal sections of a male patient aged 66 years demonstrate right temporal bone fracture involving the Otic capsule and vestibule. Also seen is acute mildly displaced occipital bone fracture.

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Case 3

Case 2

Case 3:

Axial  section of a male patient aged 17years demonstrates fracture of the anterior aspect of the jugular foramen with small air loculus in the left jugular foramen.

Case 2:

Axial sections of a female patient aged 36 years demonstrate transverse fracture, with fracture line seen passing through the tympanic segment of facial nerve canal.

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Case 4

Case 4: 

Coronal, axial, and sagittal sections of an unidentified male patient demonstrate Longitudinal fracture extending across the mastoid. Hemorrhagic contusions are noted in the bilateral basi-frontal lobes and left anterior temporal lobes with adjacent acute sulcal subarachnoid hemorrhages. 

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Case 5

Case 5: 

Sagittal, coronal, and axial sections of a female patient aged 36years demonstrate acute mildly displaced fracture of left temporal bone extending to greater wing of sphenoid . A 2.7 x 1.6 cm acute epidural hematoma in the anterior aspect of the left middle cranial fossa is seen. 

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Case 6

Case 6: 

Axial and coronal sections of a female patient aged 45 years demonstrate acute nondisplaced longitudinal fracture involving the anterior aspect of the mastoid and the temporal bone. An acute hyperdense 7 mm subdural hemorrhage along the right cerebral convexity. 

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Case 7

Case 7:

Sagittal and axial sections of a male patient aged 26 years partial thrombosis of the right sigmoid and transverse sinuses with gas locules. There is right frontal intraparenchymal hemorrhage. 

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CASE 8

Case 8:

Axial sections of a female patient aged 36 years demonstrates  incudo-malleolar disruption.

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Conclusion

  • CT scan is a highly accurate, non-invasive imaging investigation in detection of temporal bone fracture and its complications. 

  • Emergency Teleradiology reporting plays an important role in the early detection of complications and helps to improve patient outcomes.

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References

  1. Zayas JO, Feliciano YZ, Hadley CR, Gomez AA, Vidal JA. Temporal bone trauma and the role of multidetector CT in the emergency department. RadioGraphics 2011;31(6):1741–1755.

  • Meltzer DE. Temporal bone fractures. In: Koch BL, Hamilton BE, Hudgins PA, Harnsberger HR, eds. Diagnostic imaging head and neck. 3rd ed. Philadelphia, Pa: Elsevier, 2017; 968–971.

  • Kurihara et al.Temporal Bone Trauma: Typical CT and MRI Appearances and Important Points for Evaluation.RadioGraphics 2020; 40:1148–1162