Temporal bone fractures: a clinical diagnosis.

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiology

Background:

• Temporal bone fractures can lead to serious complications such as intracranial hemorrhage, cerebrospinal fluid (CSF) leakage, infection, and damage to cranial nerves VII and VIII.
• Early and accurate diagnosis is crucial for timely intervention and management of these potential complications.

Purpose of the Study:

• To highlight the challenges in diagnosing temporal bone fractures, particularly when initial standard skull radiographs are negative.
• To emphasize the importance of clinical examination in identifying temporal bone fractures despite negative imaging.

Main Methods:

• Retrospective review of eight cases with temporal bone fractures over a 12-month period.
• Analysis of initial clinical presentations, diagnostic methods used, and subsequent development of complications.
• Evaluation of the role of clinical examination, including otoscopy and cranial nerve assessment, in diagnosis.

Main Results:

• Five out of eight temporal bone fractures were initially missed, with diagnosis only made after complications arose.
• Standard skull radiographs failed to detect the fracture in all initially undiagnosed cases.
• Clinical signs, including otoscopy and cranial nerve deficits, were key indicators for further investigation.

Conclusions:

• The absence of a visible fracture on plain skull radiographs does not rule out a temporal bone fracture.
• A thorough clinical examination, focusing on otoscopy and cranial nerve function (VII and VIII), is essential for diagnosing temporal bone fractures.
• Patients with clinical suspicion of temporal bone fracture require appropriate investigation and management regardless of initial radiographic findings.