A 22 year old young man was brought in emergency room after scuffle in which he was punched over his face by a hooligan road side. The patient was conscious and blood was trickling from right ear. The bleeding was controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of temporal bone fracture the patient has?
Longitudinal Middle cranial Fossa is involved in 60%-80% of fracture of skull base. Types of Temporal bone fracture include Longitudinal, Transverse. Mixed, Oblique and Unusual. a. Longitudinal : * The longitudinal is one where fracture line runs parallel to the Petrous ridge, that is longitudinal axis of the bone. it constitutes 85% of all the Temporal Bone . 23% are bilateral. Fracture begins in Squamous Temporal Bone & continues towards the Petrous apex, coursing around the dense Otic capsule bone. Hearing loss is common after the injury; it is usually mixed hearing loss. * These invariably results in laceration of the roof of the External Auditory Canal and often the tympanic membrane blood from the middle ear appears in the of External Auditory Canal, leading to a-dictum, that bloody Otorhea after head injury usually represents a longitudinal temporal bone until proved otherwise. If the Dura is disrupte CSF may leak through a disrupted Tegmen Tympani, resulting in CSF Otorrhea. * Spontaneous Nystagmus is Rare. * Facial N. is usually spared * Most extends along the Fallopian Canal rather than across it. Facial weakness after this is usually incomplete and is most often delayed, secondary. to the edema rather than disruption of the nerve. b. Transverse : * This runs right angle to the longitudinal axis of the Petrous bone. * Caused by: - Blow on the Occipul or less commonly a direct frontal blow. Transverse has a higher moality than longitudinal and greater force is required to generate them. * The "Classical' Transverse begins in Posterior Cranial Fossa, usually in the region of Foramen Lacerum or Foramen Spinosum. * The hearing loss in transverse is usually Sensorineural, caused by disruption of the integrity of the labrynth or the neurovascular bundle in the internal auditory canal. Veigo with spontaneous Nystagmus & post traumatic common after it.Facial n. paresis is also common (50%), it is immediate and greater intensity than longitudinal . Mixed : Involves a combination of several of the routes, described. Oblique : a recent study (not confirmed) shows that these types of are actually the most common (75%). Other of temporal Bone: of anterior wall of External Auditory Canal can occur in conjugation with injuries to the Mandible.
Longitudinal
Transverse
Oblique
Mixed