[Fractures of the petrous bone. An evaluation of 123 cases]

Out of 2,888 blunt head injuries that were treated at the Hermann Hospital Trauma Center of the University of Texas at Houston, only 123 temporal bone fractures were diagnosed in 110 patients. The clinical diagnosis was confirmed with high resolution computerized tomography of the temporal bones. Three main categories of fractures were identified: oblique in 74%, longitudinal in 13% and transverse in 13%. The clinical manifestations included hemotympanum in 83%, cerebrospinal fluid otorrhea in 21% and Battle's sign in 10.6%. One third of the patients had conductive hearing loss, 1/2 had mixed hearing loss and the rest sensorineural loss. On exploration, the most frequent middle ear pathology was incudostapedial joint dislocation. Immediate facial paralysis was observed in 64 patients. Only 11 patients needed facial nerve exploration following signs of denervation, the rest recovered spontaneously. Thirteen patients who had delayed facial paralysis also recovered spontaneously. One third of the patients had persistent unsteadiness 6 weeks following the injury. Other unusual complications encountered include 6 cases of abducent paralysis, 2 cases of trigeminal paralysis and 2 cases of aseptic sigmoid sinus thrombosis.