Facial paralysis in longitudinal versus oblique and otic-sparing versus non otic-sparing temporal bone fractures

Objective@#To compare the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis.@*Methods@#Design: Retrospective Case Series. Setting: Tertiary Government Hospital. Participants: Records of 49 patients diagnosed with temporal bone fracture in our institution from August 2016 to June 2018. @*Results@#A total of 41 records of patients with temporal bone fractures, 32 males, 9 females, aged 5 to 70 years-old (mean 37.5-years-old) were included. In terms of laterality 23 (56%) involved the right and 17 (41%) the left side. Traditionally classified, 32 (78%) were longitudinal and 9 (22%) were transverse. Using newer classification based on otic involvement and non-otic involvement, 38 (93%) were otic-sparing and 3 (7%) were non otic-sparing. Only 9 (22%) out of 41 total fracture patients developed facial paralysis, involving 7 of the 32 longitudinal fractures and 2 of the 9 transverse fractures, or 8 of the 38 otic-sparing and 1 out of 3 non otic-sparing fractures. @*Conclusion@#Because of the small sample size, no conclusions regarding the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis can be drawn in this study.

Facial Paralysis in Longitudinal versus Oblique and Otic-Sparing versus Non Otic-Sparing Temporal Bone Fractures

OBJECTIVE: To compare the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis.METHODS:        Design:           Retrospective Case Series        Setting:         Tertiary Government Hospital       Participants:         Records of 49 patients diagnosed with temporal bone fracture in our institution from August 2016 to June 2018.RESULTS: A total of 41 records of patients with temporal bone fractures, 32 males, 9 females, aged 5 to 70 years-old (mean 37.5-years-old) were included.  In terms of laterality 23 (56%) involved the right and 17 (41%) the left side.  Traditionally classified, 32 (78%) were longitudinal and 9 (22%) were transverse. Using newer classification based on otic involvement and non-otic involvement, 38 (93%) were otic-sparing and 3 (7%) were non otic-sparing. Only 9 (22%) out of 41 total fracture patients developed facial paralysis, involving 7 of the 32 longitudinal fractures and 2 of the 9 transverse fractures, or 8 of the 38 otic-sparing and 1 out of 3 non otic-sparing fractures.CONCLUSION: Because of the small sample size, no conclusions regarding the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis can be drawn in this study.KEYWORDS: head injuries; head trauma; skull fracture; temporal bone fracture; motor vehicles; traffic accidents; facial paralysis

Management of Post Traumatic Facial Nerve Palsy: A Hospital Based Study

Background: Facial nerve loss of motion by injury is normal cause after idiopathic. Facial paralysis accordingly of intra cranial, intra fleeting and additional transient limit harm or break and both. Sudden and prompt facial nerve paralysis require early surgical intervention for better result. Facial nerve decompression and termino- terminal anastomosis surgical intervention had done in present study. Methods: A prospective study of the 15 cases of traumatic facial nerve palsy attending Department of Otorhinolaryngology, Government Medical College, Shivpuri, MP. The complete clinic examination, otoscopic, audio logical, topo diagnostic, and radiological evaluation were done in all the patients. The outcome of these patients were done on the House-Brackmann nerve grading system. Results: All patients have infra nuclear type of facial nerve palsy. The maximum incidence of facial nerve paralysis found in the age group between 26 to 35 years. Out of 15 patients ,12 patients were normal hearing. Suprachordal (54%) involvement is the most common site of lesion in traumatic facial nerve paralysis. Conclusions: Sudden and immediate onset facial nerve paralysis need early surgical intervention for better outcome .facial nerve decompression were better outcome comparing to termino terminal anastmosis. The facial nerve paralysis prognosis depends upon degree of paralysis, duration of paralysis, site of injury and patients’ factors.

Advance in Facial Nerve Decompression for Facial Palsy Resulting from Zygomatic Fractures (review) / 中国康复理论与实践

@#The facial nerve is the longest nerve shaped the bone tube, which has many turnings and narrow path. About 7% to 10% of patients with temporal bone fracture have facial paralysis. Most of the patients showed loss of frontal lines, inability to close eyes, and deflection of the teeth. Facial nerve decompression has been an effective way to relieve the symptoms and restore facial nerve functions. However, the issue of surgical indications, timing of surgery, and scope of decompression still need further research.

Facial nerve decompression in treatment of patients with early peripheral traumatic facial paralysis / 局解手术学杂志

Objective To explore the effect of facial nerve decompression via mastoid-epitypanum approach on the treatment of early peripheral traumatic facial paralysis caused by temporal bone fracture.Methods The data of 21 patients with early peripheral traumatic facial paralysis caused by temporal bone fracture in our hospital from October 2011 to June 2016.The facial nerve electrogram and the blink reflex of the injured facial nerve of 21 patients who treated facial nerve decompression via mastoid-epitypanum approach were compared before and after operation.The degree of facial nerve function recovery was evluated by H-B grading method.Results The facial nerve function of all patients had improved in different degrees,85.7% patients recovered to Ⅰ~Ⅱ level.Compared with those before operation,the latency,amplitude and latent period of blink reflex of the ipsilateral facial electroneurography were significantly improved(P<0.05).Conclusion The facial nerve decompression has good effect in the treatment of early peripheral traumatic facial paralysis.

Motorcycle related cranio-maxillofacial injuries at a tertiary hospital in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the type and determine the number of motorcycle related cranio-maxillofacial injuries that were seen by the ORL service in the emergency room of a tertiary hospital from January 2013 to December 2013.<br /><strong>METHODS: </strong> <br /><strong>Design:</strong> Cross sectional retrospective chart review<br /><strong>Setting:</strong> Tertiary National University Hospital<br /><strong>Participants:</strong> One hundred nine (109) charts of patients seen atr the emergency room from Jnuary 2013 to December 2013 were reviewed<br /><strong>RESULTS:</strong> Of the 109 charts of patients involved in vehicular accidents, there were 76 documented cases of motorcycle related accidents. Of these, 91% involved males and 9% involved females. Seventy one percent (71%) did not wear helmets of whom 36% were young adult males between the ages of 18-30 years. Those that wore helmets had a total of 27 different facial fracture sites: 19% zygomatic tripod fractures, 15% temporal bone fractures and 11% with no fractures noted. Among those who did not wear helmets 75 fractures were noted. Twenty four percent (24%) were tripod fractures, 15% temporal bone fractures and 12% maxillary fractures. only one did not incur any fractures.<br /><strong>CONCLUSION:</strong> Most cranio-maxillofacial fractures seen at the emergency room were from motorcycle related injuries (70%). Despite implementation of Republic Act 10054 (The Motorcycle Helmet Act of 2009) majority of motorcycle-related accidents are still incurred by riders without helmets.</p>

A Case of Cochlear Implantation after Bilateral Temporal Bone Fracture / 대한이비인후과학회지

The incidence of bilateral temporal bone fractures are reported in 9% to 20%. Otic capsule violating temporal bone fractures are highly related to sensorineural hearing loss, when compared with otic capsule sparing fractures. Patients with bilateral temporal bone fractures and profound bilateral sensorineural hearing loss may benefit from cochlear implantation. We present the case of a 44-year-old male with bilateral profound sensorineural hearing loss caused by bilateral temporal bone fractures who achieved successful auditory rehabilitation after a cochlear implantation.

The diagnostic value of high resolution CT in assessment of temporal bone traumatic facial nerve paralysis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the diagnostic value of high resolution CT for temporal bone traumatic facial nerve paralysis and the guidance significance for surgery.Method:Twenty-nine patients of traumatic facial nerve paralysis were investigated.The predictive diagnosis was made according to the clinical data and the image features of HRCT,then a comparative analysis of the preoperative image features and the surgical findings were carried out.Result:The trend of temporal bone fracture displayed on the CT scan was basically consisted with the surgical findings.The direct CT signs of facial nerve injury include the bone fracture line went through the tube,bone tube rupture or continuity interruption,while the indirect CT signs include local incrassation of the facial nerve,lower bone density of the tube,geniculate fossa expansion,oppressed facial nerve,et al.The predictive diagnostic accordance rates of all the image features were above 90%as to the surgical findings.Conclusion:High resolution CT could localize the trend of temporal bone fracture,and is helpful to estimate the extent of facial nerve injury and other complications.High resolution CT could provide reliable basis for clinical diagnosis and trotment.

A Case Report of Brain Herniation into the Middle Ear Mimicking as Secondary Cholesteatoma Following Temporal Bone Fracture / 대한이비인후과학회지

Brain herniation into the middle ear cavity is a rare entity that occurs mostly as a complication of otologic surgery. Other causes include a congenital skull base defect, infection, trauma, neoplasm and irradiation. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, tinnitus, meningitis and other neurologic symptoms. Such patients tend to be misdiagnosed as having chronic otitis media and are often treated for long periods with inadequate conservative therapy. We report a case of brain herniation into the middle ear following traumatic temporal bone fracture, which was treated surgically via a transmastoid approach.

Cochlear Implantation in a Deaf Patient with Bilateral Temporal Bone Fractures / 대한이비인후과학회지

Transverse temporal bone fracture can make a profound sensorineural hearing loss. This temporal bone fracture usually happens in the single side; however, the bilateral temporal bone fracture can make the postlingual deafness. Therefore, the deafness from bilateral temporal bone fractures can be one of the indications for the cochlear implantation. We report on the experience of the cochlear implantation in a deaf patient after bilateral temporal bone fractures.

Fracture of the temporal bone: A tomographic v/s autopsy study.

The present study was conducted in the Dep’t. of Forensic Medicine & Toxicology, SMS Medical College Jaipur (Raj), in the period from 15 Dec. 2001 to 4 April 2002. With the aim to find out the correlation of X-ray (Skull), CT scan (Head), Surgical intervention findings with the autopsy findings in the cases of acute Head trauma. Total of 140 cases of acute head trauma were selected irrespective of age, sex, religion caste etc. who had been admitted in Neurosurgery dep’t. And X-ray, CT scan head and /or surgical intervention had been done, subsequently died & autopsy was performed. X- ray skull gave batter information on fracture of skull than CT Scan, particularly when the fracture is located on the vault or base of skull and is of linear variety [1]. 27 cases of fracture of the temporal bone were specially studied, out of these 140 cases. All these cases had the features of triad, indicating of fracture of petrous part of temporal bone i.e. CSF Otorrhoea 14(51.1%), 7th nerve palsy 9(33.3%), serve middle ear bleeding 18(66.6%) & conducting hearing loss 5(85%). The plain X-ray demonstrated the fracture of temporal bone in 21 cases (79%) and the CT Scan demonstrated their in 24 cases (88%) Longitudinal fractures are common in 18 cases (66%) and procedure of choice for their demonstration is lateral tomography, Transverse fracture alone was uncommon (2 cases) and can only be demonstrated in anterior posterior tomographic projections and is usually associated with occipital fractures. CT Scan Examination give better information in detection of fracture of temporal bone as well as the type of fracture [2] which is essential for planning the surgical intervention or treating the patient conservatively in order to avoid the complications like, persistent CSF otorrhoea, posterior meningitis or even death.

Fracture of the temporal bone: A tomographic v/s autopsy study.

The present study was conducted in the Department of Forensic Medicine & Toxicology, SMS Medical College Jaipur (Raj), in the period from December 15, 2001 to April 4, 2002. With the aim to find out the correlation of X-ray (Skull), CT scan (Head), surgical intervention findings with the autopsy findings in the cases of acute Head trauma. Total of 140 cases of acute head trauma were selected irrespective of age, sex, religion caste etc. who had been admitted in Neurosurgery dep’t. And X-ray, CT scan head and /or surgical intervention had been done, subsequently died & autopsy was performed. X- ray skull gave batter information on fracture of skull than CT Scan, particularly when the fracture is located on the vault or base of skull and is of linear variety. [1] Twenty seven cases of fracture of the temporal bone were specially studied, out of these 140 cases. All these cases had the features of triad, indicating of fracture of petrous part of temporal bone i.e. CSF Otorrhoea 14(51.1%), 7th nerve palsy 9(33.3%), serve middle ear bleeding 18(66.6%) & conducting hearing loss 5(85%). The plain X-ray demonstrated the fracture of temporal bone in 21 cases (79%) and the CT Scan demonstrated their in 24 cases (88%) Longitudinal fractures are common in 18 cases (66%) and procedure of choice for their demonstration is lateral tomography, Transverse fracture alone was uncommon (2 cases) and can only be demonstrated in anterior posterior tomographic projections and is usually associated with occipital fractures. CT Scan Examination give better information in detection of fracture of temporal bone as well as the type of fracture [2] which is essential for planning the surgical intervention or treating the patient conservatively in order to avoid the complications like, persistent CSF otorrhoea, posterior meningitis or even death.

Surgical Management of Facial Paralysis Following Temporal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Controversy persists in regard to the management of traumatic facial paralysis. We reviewed the cases of decompression of traumatic facial nerve according to the type of fracture, injury site of nerve, injured state of nerve, surgical timing, surgical approach and opening of epineurium to determine good prognostic factors and propose in this article a rationale of management. SUBJECTS AND METHOD: The authors reviewed retrospectively 35 cases of the decompression of traumatic facial paralysis at the Department of Otorhinolaryngology, Yonsei University College of Medicine from January 1991 to December 2002. RESULTS: The most common site of the injury was perigeniculate area. The most common fracture type was longitudinal fracture. The results of immediate facial nerve decompression were excellent in functional recovery. The surgical findings of injured facial nerve were, in order, edematous swelling, bony impingement, fibrosis and partial transection, traumatic neuroma. Decompression with nerve sheath slitting appeared to provide better outcomes. The approach for decompression according to the injured sites was sufficiently adequate. CONCLUSION: According to our surgical experiences of traumatic facial paralysis, the important prognostic factors are timing of surgical intervention, injured state of the nerve and the slitting of the nerve sheath.

Risk Factors of Late Post-traumatic Seizure

OBJECTIVE: The goal of our study was to identify and evaluate risk factors for late post-traumatic seizure. METHODS: This study is a retrospective clinical analysis of 52cases of late post-traumatic seizures among 1472 head injury patients treated in our institute from July 1986 to June 1996 and at least followed up over 2 years after head injury. RESULTS: 1) The incidence of late post-traumatic seizure was 3.5% of patients treated for head injury. 2) The factors affecting the incidence of late post-traumatic seizure were initial low Glasgow coma scale(3-8), subdural hematoma, depressed skull fracture(p<0.05). 3) Skull fracture located in temporal area showed higher incidence of late post-traumatic seizure(p<0.05). CONCLUSION: The risk factors for post-traumatic seizure are subdural hematoma, initial low Glasgow coma scale, depressed skull fracture and temporal bone fracture. Both newer antiepileptic drugs and therapies aimed at prevening the brain damage that underlies the development of seizures need to be studied to find an effective way of preventing late post-traumatic seizure through prospective study.

Pattern of Ossicular Disruption after Head Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mechanization and reliance on motorized transportation place everyone in our society at risk for head injury. Temporal bone trauma is usually the result of blunt head injury in patients suffering from multiple body injury. Hearing problems can be neglected initially, but many patients complain of hearing difficulties later after the head trauma. If hearing loss is conductive, there is the possibility of the ossicular disruption. The ossicular disruption after the head trauma can develop with or without the temporal bone fracture line. The aim of this study was to analyze the types of ossicular disruption and to review their pathophysiology. MATERIALS & METHODS: In the present study, we analyzed 23 cases of ossicular disruption following head trauma (mean age: 20.2 years, Male: female=14:9). The diagnosis was based on medical history, physical examination, findings of temporal bone CT and confirmed with operative findings. RESULTS: Among 6 types of ossicular disruption, we encounted 10 cases of complete incus dislocation, which was the most common type of ossicular disruption (43.5%). The most common cause of head injury was car accident. The fracture line of the temporal bone was found in 15 cases. In the 8 cases, we could not find any evidence of fracture. CONCLUSIONS: Incus dislocation is the most common type of ossicular disruption after head trauma and the I-S joint is the weakest point of ossicular chain because of its anatomical structure.

Labyrinthine Ossification (Report of 2 Cases) / 听力学及言语疾病杂志

Two cases of labyrinthine ossification were founded in temporal bone exploration and in cochlear implantation. One was caused by temporal bone fracture, the other had bilateral profound sensorineural hearing loss but the reason for labyrinthine ossification was unknown. In this case,unilateral total labyrinthine ossification was not confirmed in preoperative CT scan.