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Brain herniation into the middle ear following temporal bone fracture
Suetaka Nishiike1, Yasuyoshi Miyao, Seiichi Gouda
1Department of Otolaryngology, Suita Municipal Hospital, Suita, Japan. nishiike@concerto.plala.or.jp
Acta Oto-Laryngologica
|September 15, 2005
Summary
Cerebrospinal fluid otorrhea and meningitis resulted from brain herniation into the middle ear after a temporal bone fracture. Surgical intervention confirmed brain tissue penetration, highlighting the need for prompt diagnosis and management of such rare injuries.
Area of Science:
- Neurosurgery
- Otolaryngology
- Trauma Surgery
Background:
- Traumatic temporal bone fractures can lead to rare complications.
- Encephalic herniation into the middle ear is a severe consequence of temporal bone trauma.
- Cerebrospinal fluid (CSF) otorrhea and meningitis indicate a breach in the central nervous system barrier.
Observation:
- A 33-year-old male presented with CSF otorrhea and meningitis.
- The condition stemmed from an encephalic herniation into the middle ear.
- Computed tomography (CT) revealed a complex left temporal bone fracture involving the tegmen tympani.
Findings:
- The fracture was mixed-type, with longitudinal and posterior oblique components.
- A splinter from the fractured tegmen tympani lodged in the epitympanum near the incus.
- Middle cranial fossa surgery confirmed brain herniation between the incus and lateral semicircular canal.
Implications:
- This case underscores the critical importance of early diagnosis in traumatic temporal bone fractures with suspected intracranial complications.
- Prompt surgical intervention is crucial for managing encephalic herniation and preventing further neurological damage.
- Understanding the complex anatomy is vital for successful surgical repair and patient recovery.