title: Temporal bone fracture: Evaluation in the era of modern computed tomography.
abstract: BACKGROUND
  Temporal bone fractures (TBFs) are harbingers of high energy head trauma that can result in a variety of significant complications of the auditory, vestibular, nervous, and vascular systems. Multiple cohort studies have identified the incidence and proper evaluation of these fractures. We hypothesize that these have changed with the advent of modern high resolution computer tomography (CT) imaging.
  
  
  METHODS
  We performed a retrospective review of all TBFs admitted to an urban level one trauma center between June 1, 2011 and May 31, 2015. A database was compiled including demographics, physical exam findings, imaging performed and results, morphology and directionality of fracture as well as outcomes and follow-up.
  
  
  RESULTS
  One hundred thirteen patients were identified, representing 4.7% of skull fractures and 35.9% of skull base fractures. Most were subsequent to falls (41.6%) followed by pedestrian vehicular trauma (19.5%). The majority of TBF patients (67.3%) had additional fractures of the skull and 77.9% of TBF patients also had some kind of intracranial hemorrhage. The morphology of TBF and the overall mortality (7.9%) was consistent with previous reports. The incidence of facial nerve paralysis (1.6%), CSF leak (1.7%), and hearing loss (18.6%) were all lower than previously reported. Trauma imaging was able to identify 98.6% of TBF, calling the utility of routine temporal bone CT imaging into question.
  
  
  CONCLUSIONS
  TBFs are less common than they once were and though they still carry a mortality rate similar to previously reported cohorts, the incidence of complications among survivors has dramatically improved. Additionally, modern CT imaging is very capable of identifying these injuries and dedicated temporal bone CT may only be of utility in cases where facial nerve injury or vascular injury is suspected.
  
  
  METHODS
  Epidemiologic study, Level III.
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States. Electronic address: sschubl@jhmc.org.
authors.forename: S D
authors.initials: SD
authors.lastname: Schubl
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: T R
authors.initials: TR
authors.lastname: Klein
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: R J
authors.initials: RJ
authors.lastname: Robitsek
authors.affiliation: Department of Radiology, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: S
authors.initials: S
authors.lastname: Trepeta
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: K
authors.initials: K
authors.lastname: Fretwell
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States; Division of Otolaryngology, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: D
authors.initials: D
authors.lastname: Seidman
authors.affiliation: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States; Division of Otolaryngology, Jamaica Hospital Medical Center, Jamaica, New York, United States.
authors.forename: M
authors.initials: M
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D003051:Cochlea / Q000000981:diagnostic imaging / Q000293:injuries; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D007758:Ear, Inner / Q000000981:diagnostic imaging / Q000293:injuries; D020220:Facial Nerve Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006319:Hearing Loss, Sensorineural / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D013701:Temporal Bone / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D014193:Trauma Centers; D014481:United States; D014717:Vertigo / Q000209:etiology
keywords: Cerebrospinal fluid leak; Diagnosis; Facial nerve injury; Head injury; Hearing loss; Temporal bone fracture