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A comparison of temporal bone fracture classification systems
M A Rafferty1, R Mc Conn Walsh, M A Walsh
1Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.
Objectives:
To compare the traditional and otic capsule classification system of temporal bone fractures for clinical relevance.
Design:
A retrospective review of all patients with a radiological diagnosis of a skull-base fracture over a 5-year period.
Setting:
All patients were seen at Beaumont Hospital, the national tertiary referral centre for Neuro-otology.
Participants:
Patients with a clinical diagnosis of skull fracture were identified from the hospitals in patient enquiry (HIPE) database. Of 338 patients, 31 (9%) were identified as having a temporal bone fracture on high-resolution CT scanning.
Main Outcome And Measures:
The rate and distribution of each major clinical complications within each classification system to establish if either one was more clinically useful.
Results:
Fractures were classified as mixed in 14 (45%), longitudinal in 9 (29%) and horizontal in 8 (26%). Alternatively, 2 (7%) were otic capsule violating and 29 (93%) were otic capsule sparing. Seventeen patients (54.8%) sustained a hearing loss. Seven patients (23%) sustained a facial nerve injury. Four (13%) developed a cerebrospinal fluid (CSF) leak. Of all clinical findings only sensorineural hearing loss occurred significantly more often in the horizontal as opposed to the longitudinal group (P = 0.029) and in the otic violating as opposed to the otic sparing group (P = 0.013).
Conclusions:
We acknowledge that the relatively small size of our cohort diminishes the statistical power of our conclusions. However, we found that the otic capsule-based classification system was not significantly better than the traditional system in predicting the likelihood of sustaining specific injuries from fractures of the temporal bone.
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