Assunta Scuotto* and Michele Rotondo
Neuroradiology, Department of Neuroscience, Second University of Naples; CTO Hospital, Viale Colli Aminei, 21, 80131 Naples, Italy
Received: 24 June, 2016; Accepted: 24 August, 2016; Published: 26 August, 2016
Assunta Scuotto, MD, Aggregate Professor, Neuroradiology, Department of Neuroscience, Second University of Naples, CTO Hospital, Viale Colli Aminei, 21, 80131, Naples, Italy, Tel: 39 0812545575; Fax: 39 0817414288; E-mail:
Scuotto A, Rotondo M (2016) Temporal Bone Trauma: To Pull Down the Wall of Incommunicableness. Arch Otolaryngol Rhinol 2(1): 053-55. DOI: 10.17352/2455-1759.000025
© 2015 Dacey E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Temporal bone trauma; Computed tomography; Magnetic resonance Imaging
In the past decades, treatment of the temporal bone traumas (TBTs) was undeniably improved by advances in neuroradiological and in neuro-oto-surgical fields. However, these advances did not systematically enhance the quality of the approach to TBTs. Maybe they did not systematically target towards treatment- guidelines standardization. We suggest a simplified approach to TBTs, trying to enhance the communication among the different specialists involved in the matter, above all between the radiologists and not-radiologists.
The recent availability of efficient neuroimaging procedures, i. e. multidetector Computed Tomography (CT) and Magnetic Resonance (MR), provided a crucial support to the treatment of TBTs both in the acute and chronic stage.
Sometimes, classification of temporal bone fractures in general categories became the core of radiographic interpretation, undervaluing substantial clinical implications and forgetting crucial interactions with non-radiologists. Although fractures categorization is needed i.e. to predict trauma-associated complications (hearing loss, vestibular dysfunction ,facial nerve weakness, cerebrospinal fluid leakage, vascular injuries) , the identification of injury to significant structures is more important for guiding management and determining prognosis .
Clinical scene and practical vademecum
Temporal bone (TB) anatomy is complex and rich in relationships with critical structures - cranial nerves (V to XI) - vascular elements (sigmoid sinus- internal jugular vein, internal carotid artery)-ear components (conductive and sensorineural compartment), Middle and Posterior Cranial Fossae. Therefore TBTs can produce injuries to local, regional, and intracranial structures. This distinctive feature strongly affects the neurological picture when a trauma occurs. At this regard, the TBTs might be considered as head traumas, thus requiring the same accurate imaging, sometimes even in the acute phase without neglecting the urgent need to evaluate the brain.
Generally speaking, CT plays a fundamental role in the initial evaluation of patients with polytrauma recognizing significant structural injuries that may have devastating complications, and helping to determine the priority of treatment when concomitant diseases exist.
MR examination can be supplementary required to better investigate CT findings and/or to look for possible lesions missing on CT.
When head trauma occurs, neuroradiological procedures preliminarily consist of emergency brain CT. In our opinion, head CT examination should routinely include additional thin scans dedicated to temporal bone at least:
-when a petro-mastoid fracture is detected on routine head CT
It is useful to remind ourselves that approximately 30% of head trauma patients receive skull fractures and approximately 18% of all skull fractures involve TB .
-when there is clinical suspicion of TB involvement (i.e. otorrhagia, relevant cranial nerve dysfunction, haematoma in mastoid region).
This demeanor should allow a prompt governance of loco-regional complications as impairment of facial nerve (FN), that is the cranial nerve most often injured during head trauma .At this regard, TB CT scan is indicated in all cases of immediate onset of FN palsy to assess the relationship between the fracture line and the bony facial nerve canal, thus suggesting the indication for early surgical intervention. MR is required for cases of FN paralysis unexplained by CT findings because of its sensitivity in demonstrating the facial nerve itself and possible pathologic changes , (Figures 1,2).
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