How to Crack Temporal Bone Fractures

Congress:

ECR 2018

Poster Number:

C-2659

Type:

Educational Exhibit

Keywords:

Neuroradiology brain, CT, Diagnostic procedure, Trauma

Authors:

B. Del Rio¹, S. Santos¹, C. Garcia¹, L. Rivera Valladares², I. Romero Novo¹, M. D. Esteba-Bech-de-Careda¹; ¹Terrassa/ES, ²Barcelona/ES

DOI:

10.1594/ecr2018/C-2659

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2659

Fig. 2: 3D reconstruction of the temporal region. 1: Petrous Apex, 2: Gasser's ganglio...

$Fig. 11: Oblique fracture with opacification of the mastoid cell and tympanic cavity.$

Fig. 11: Oblique fracture with opacification of the mastoid cell and tympanic cavity.

Fig. 15: Lesion to the incudomalleolar junction. The icecream cone shape is lost.

Fig. 18: Diagram of the spatial relation of the V, VI, VII cranial nerves and the...

Learning objectives

Describe in detail the anatomy of the temporal area and the relationships between the different anatomical structures. Define the most frequent fracture patterns and possible complications. Analyse the different classifications, their clinical significance and their value for prognosis.

Background

Traumatic braininjury (TBI) is one of the most frequent pathological conditions encountered in our ER. Temporal bone fractures usually occur in patients who have suffered high-energy trauma, with a reported incidence of 18-22%. The most frequent causes are traffic accidents, especially between pedestrians and motorcyclists, followed by accidents at work, and falls. Since an important impact force is needed to fracture the temporal bone, this phenomenon very often cannot be studied due to the severity of the lesions

Findings and procedure details

For the assessment of temporal fractures, cranial CT is a fundamental initial diagnostic modality because of its speed and accessibility. If a temporal fracture is suspected, we have to perform multi-planar reconstructions with the bone window. ANATOMY OF THE TEMPORAL AREA Temporal bone has a complex anatomy, divided into five bony divisions, which include the squamous part, the petrous bone, the tympanic part, the mastoid process, and the styloid process. Internal anatomy (Fig. 01) It comprises various structures, such as: Cranial nerves: CN V (semilunar...

Conclusion

To arrive at the most accurate diagnosis, temporal bone fractures should be described in detail, classified according to their spatial morphology (longitudinal, transverse or oblique/mixed). It is also necessary to specify whether or not they affect the otic capsule. In cases where we do not see fracture lines, we must look for the indirect signs such as the opacification of mastoid cells or small peritemporal air bubbles.

Personal information

References

Imaging review of the temporal bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplasic conditions. Amy F. Juliano MD et al.Radiology 2015; 3:655-672. Temporal Bone Trauma and the Role of Multidetector CT in the Emergency Department. Julio O. Zayas et al.RadioGraphics 2011; 31:1741–1755. High resolution CT of Temporal Bone Trauma. Betsy A. Holland et al.AJNR 1984;5:291-295. Interactive Web-Based Learning Module on CT of the Temporal Bone: Anathomy and Pathology.Grace S. Phillips et al.RadioGraphics 2012; 32:E85–E105 Fracture Mimics on Temporal Bone CT: A Guide for the Radiologist.Yune...