Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations.
OBJECTIVE
To assess the practicality and utility of the traditional classification system for temporal bone fracture (transverse vs. longitudinal) in the modern Level I trauma setting and to determine whether a newer system of designation (otic capsule sparing vs. otic capsule violating fracture) is practical from a clinical and radiographic standpoint.


METHODS
The University of Massachusetts Medical Center Trauma Registry was reviewed for the years 1995 to 1997. Patients identified as sustaining closed head injury were reviewed for basilar skull fracture and temporal bone fracture. Clinical and radiographic records were evaluated by using the two classification schemes.


RESULTS
A total of 2,977 patients were treated at the trauma center during this time. Ninety (3%) patients sustained a temporal bone fracture. The classic characterization of transverse versus longitudinal fracture (20% vs. 80%, respectively) was unable to be determined in this group; therefore, clinical correlation to complications using that paradigm was not possible. By using the otic capsule violating versus sparing designation, an important difference in clinical sequelae and intracranial complications became apparent. Compared with otic capsule sparing fractures, patients with otic capsule violating fractures were approximately two times more likely to develop facial paralysis, four times more likely to develop CSF leak, and seven times more likely to experience profound hearing loss, as well as more likely to sustain intracranial complications including epidural hematoma and subarachnoid hemorrhage.


CONCLUSIONS
The use of a classification system for temporal bone fractures that emphasizes violation or lack of violation of the otic capsule seems to offer the advantage of radiographic utility and stratification of clinical severity, including severity of Glasgow Coma Scale scores and intracranial complications such as subarachnoid hemorrhage and epidural hematoma.
Dahiya
R
R
Department of Otolaryngology-HNS, University of Massachusetts Medical School, Worcester 01655, USA.
Keller
J D
JD
Litofsky
N S
NS
Bankey
P E
PE
Bonassar
L J
LJ
Megerian
C A
CA
D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D003051:Cochlea / Q000293:injuries*; D007758:Ear, Inner / Q000293:injuries*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D050723:Fractures, Bone / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging*; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications / Q000000981:diagnostic imaging; D006311:Hearing Disorders / Q000209:etiology; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006801:Humans; D008297:Male; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020205:Skull Fracture, Basilar / Q000150:complications / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D013701:Temporal Bone / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers