Most temporal bone fractures are managed conservatively by observation.
The fractures themselves rarely require direct intervention and when they do it is for reduction of the cranial component (squamosa).
It is important however, to identify complications and manage sequelae of injuries to the visceral structures that pass through or are housed in the temporal bone.
|Non- or minimally displaced fractures without CNS or vascular injury, and stable neurological status.|
- No evidence of an intracranial mass lesion (bleeding), CSF leak (CSF rhinorrhea), or increase in intracranial pressure
- Stable neurological status (high Glasgow coma scale GSC)
|Displaced fractures with evidence of CNS/vascular injuries.|
- Injuries to the visceral structures that pass through or are housed in the temporal bone (i.e.: facial nerve, hearing loss)
Note: Facial nerve injuries are more controversial and an analysis of which would benefit from surgical decompression is beyond the scope of the AOCMF Surgery Reference.
|Delayed management of hearing loss|
|Persistent conductive hearing loss suggesting damage to the middle ear.|
Note: Hearing evaluation is generally performed six weeks after the trauma to allow time for blood in the middle ear to be absorbed. Depending upon the severity and location of the fracture, a conductive, sensorineural or mixed hearing loss may be seen.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|