Management of complications from 820 temporal bone fractures.
OBJECTIVE
To review the incidence of complications resulting from temporal bone fractures and analyze the outcomes from surgical and nonsurgical management.


METHODS
A retrospective review of 699 patients with 820 temporal bone fractures occurring over a 5-year period.


METHODS
A single level 1 trauma center.


METHODS
All patients with clinical or radiologic evidence of a temporal bone fracture.


RESULTS
A total of 820 fractured temporal bones resulted in 58 facial nerve injuries, 122 CSF fistulae, and 15 cases of meningitis. The two most important prognostic factors in recovery of facial paralysis were severity and delay of onset. All patients with incomplete paralysis recovered. All but one of the delayed onset palsies had good recovery of function. A total of 40% of patients with immediate onset complete paralysis had poor recovery of function. Ninety-five of the 122 CSF fistulae closed spontaneously within 1 week. CSF fistulae persisting for > 7 days had a significantly increased risk of developing meningitis (23%) compared with patients whose fistulae closed within 7 days (3%) (p = 0.001). Another important risk factor for the development of meningitis was concurrent infection.


CONCLUSIONS
Facial function following temporal bone fractures should be evaluated in the emergency room. If facial motion is noted at any time after the injury, surgical intervention is rarely indicated. Prophylactic antibiotics should be considered in temporal bone fractures when CSF fistulae are present. Surgical closure of a CSF fistula is indicated if it persists for > 7-10 days.
Brodie
H A
HA
Department of Otolaryngology, Head and Neck Surgery, University of California, Davis, Medical Center 95616, USA.
Thompson
T C
TC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002558:Cerebrospinal Fluid Otorrhea / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005154:Facial Nerve / Q000473:pathology; D005158:Facial Paralysis / Q000209:etiology / Q000473:pathology; D005260:Female; D005402:Fistula / Q000150:complications; D050723:Fractures, Bone / Q000150:complications*; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D012189:Retrospective Studies; D013701:Temporal Bone / Q000293:injuries*
D000900:Anti-Bacterial Agents