Executive Editor: Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, Co-author: A Di Ieva

Skull base & Cranial vault - Temporal bone (lateral skull base)

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Glossary

General considerations

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.

Observation
Main indication Skill Equipment
Non- or minimally displaced fractures without CNS or vascular injury, and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • 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)
Surgical management
Main indication Skill Equipment
Displaced fractures with evidence of CNS/vascular injuries. Highly experienced and skilled surgeon Simple surgical and imaging resources

Further indication

  • 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
Main indication Skill Equipment
Persistent conductive hearing loss suggesting damage to the middle ear. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

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.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2011-05-14