Concomitant Temporal and Facial Bone Fractures: Patterns, Outcomes, and Cushion Effect Hypothesis

To investigate injury patterns, clinical features and outcomes in patients with concomitant temporal bone fractures (TBFs) and facial bone fractures (FBFs). To evaluate these findings in the context of the cushion effect hypothesis.

Retrospective cohort analysis of patients with radiographically confirmed TBFs at a tertiary care medical center. Patients were grouped by presence or absence of concomitant FBFs. Characteristics including trauma mechanism, findings on evaluation, and TBF complications were compared at presentation and follow-up. Multivariate logistic regression analysis was performed controlling for age, gender, and trauma mechanism.

Of 219 TBF patients from February 2011 to November 2023, 61 had concomitant FBFs. Motor vehicle collision was the most common trauma mechanism in the TBF/FBF group (50.82%) and fall was predominant in the TBF alone group (43.67%). Concomitant FBFs were associated with a reduced rate of hemotympanum (OR = 0.338, p = 0.001) and subjective hearing loss on follow-up evaluation (OR = 0.284, p = 0.001). Specifically, mandibular fractures in the TBF/FBF cohort were associated with a decreased risk of intracranial hemorrhage (ICH) (OR = 0.127, p = 0.005). No differences were observed for other TBF complications.

TBF patients presenting with concomitant FBFs sustained more severe initial trauma, but had lower rates of hemotympanum and hearing loss. Mandibular fractures in the TBF/FBF cohort were independently associated with lower rates of ICH. These findings are compatible with the cushion effect hypothesis; however, causality cannot be inferred. Further prospective and biomechanical studies are warranted to clarify these relationships.

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