0:01

Let's conclude the temporal bone discussion with a review of

0:05

those potential complications of temporal bone fractures.

0:07

They include vascular injury either to the

0:10

jugular vein or to the carotid artery,

0:12

ossicular disruption with ossicular dislocation or fracture,

0:17

facial weakness because of facial nerve injury,

0:20

sensorineural hearing loss when we have

0:23

an otic capsule violating fracture.

0:26

Intracranial injury if the tegmen timpany is violated.

0:30

And then we have CSF leakage and potential meningitis.

0:34

Late complications include cholesteatomas,

0:37

meningoencephalocele and perilymphatic fistula.

0:41

Here we have an oblique fracture which is otic capsule-sparing,

0:47

but it leads to a fracture of the short process of

0:51

the incus, as well as malleo-incudal dislocation.

0:56

This is the head of the malleus, too far medial.

0:59

Should be sitting as the ice cream on the ice cream

1:02

cone with the short process of the incus.

1:06

Here we have an otic capsule violating fracture, which goes

1:11

across the vestibule with a little bit of pneumolabyrinth.

1:15

And you see that the patient is likely to have conductive

1:18

hearing loss due to blood products

1:20

accumulating in the middle ear.

1:22

So this patient likely would have a mixed conductive and

1:26

sensory neural hearing loss from two different mechanisms. One,

1:30

the blood causing a conductive hearing loss and the other

1:34

crossing the otic capsule leading to a sensory neural

1:39

hearing loss. Another example. Here we have the fracture,

1:43

which is somewhat comminuted,

1:45

has a separate segment which is going across the vestibule.

1:49

And we likely have a fracture which goes to

1:53

the stapes as it inserts on the vestibule.

1:57

And here we have the otic capsule violating fracture,

2:00

which leads to the pneumolabyrinth of the cochlea.

2:04

Here we have intracranial hemorrhage,

2:07

subarachnoid space hemorrhage, which is associated with the

2:11

communication of the fracture, here and here, with the

2:14

intracranial compartment and the blood products

2:17

seen in front of the brain stem.

2:19

Another example of a head of the malleus which is disarticulated

2:24

from the short process of the incus and is lying

2:27

too far anteriorly and too far medially.

2:30

Here, fracture of a short process of the incus.

2:34

Here we have widening of the incudomalleolar joint,

2:38

and we have the oblique fracture involving it.

2:41

Want to make sure that we look at the facial nerve.

2:44

Here's a little drop of air right along the

2:46

temporal portion of the facial nerve.

2:49

And this portion of the tympanic portion of the facial

2:52

nerve is thickened, likely because it is contused.

Case 8 - Temporal Bone Fracture Summary

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