Temporal bone fracture and facial nerve palsy

8/7/2019 Temporal bone fracture and facial nerve palsy

1/23

Nik Nur Farah Ain BintiYasin.050100840


2/23


3/23

1. Longitudinal fractures

2. Transverse fractures

3. Mixed frac

tures


4/23


5/23

Perpendicular to long

axis of petrous

pyramid

10-30% Fronto-occipital

impact

FN injury in 30-50%


6/23

Otic Capsule Sparing OticCapsule

Disrupting

94.2 - 97.5% 2.5 - 5.8%

Blow to temporoparietal

region

Blow to occipital region

FN paralysis 6-13% FN paralysis 30-50%

Conductive or Mixed HL SNHL

CSF leak less likely CSF leak 2-4 x more likely


7/23

History: Detaisl of injury, the time of onset

of any facial nerve weakness or paralysis

Applic

ation of ATLSPhysical examination: head and neck

exam including the cranial nerves

HRCT scan temporal bone

Audiometric testElectrodiagnostic testing (ENoG, EMG)


8/23

` Otorrhea

` Hemotympanum

`

TM perforation` Facial palsy

` Raccoon Sign

` Battles Sign


9/23

High-resolution CT (HRCT): assess injuries

complicated by CSF leak, facial paralysis, or

suspected vascular injury

MRI: assessment of the intrac

ranialc

ontents ora nerve palsy not explained by the HRCT.

Axial high-resolution CT of the right temporal bone that represents alon itudinal fracture line that extends from the roof of the external auditor


10/23


11/23

hearing loss

CSF fistula

fac

ial nerve paralysisexternal auditory canal stenosis

cholesteatoma formation

vascular injuries.

Treat the complication.


12/23


13/23

Central: Brain abscess, Pontine glioma, Poliomyelitis,Multiple scleros is

Intacranial part: Acoustic neuroma, Meningioma,MetastaticCA, Meningitis

Intratemporal part: Idiopathic (Bells palsy, Melkerssons syndrome) Infections: Herpes ZosterOticus Trauma: Surgical (Mastoidectomy, Stapedectomy), Accident

(temporal bone)

Neoplasms: Glomus jugulare tumour, Facial nerve neuroma,MetastaticCA

Extracranial part:Parotid gland CA, Parotid glandsurgery,Parotid gland injury Neonatal facial nerveinjury

Systemic: DM, Hypothyroidism, Uremia,PAN,Wegeners granulomatosis, Sarcoidosis, Leprosy,Leukemia


14/23

UMNL

Only lower face

Spastic paralysis

Involuntarymovements are

spared

Other neurologic

manifestations Electric tests=

normal

LMNL

Upper and lower face

Flaccid paralysis

All movements arelost

No other neurologic

manifestations

Electric tests=abnormal


15/23

History (onset, otologic symp. & dis.,

trauma, systemic dis.)

Symptoms: Hacusis Otalgia

Gustatory disturbance

Facial musle paresis/paralysis Synkinesis


16/23

Lab evaluation: Lab test: screen for infectious dis

Audiometric testing (pure-tone, speech &

immitance measurement)Other

Shirmers test

Stapedial reflex

Taste test Salivaton

Radiology: MRI and CT scan


17/23

EnoG

EMG for intraops. monitoring of facial

nerve func

tionMagnetic stimulation


18/23

Criteria

Unilateral

Peripheral

Acute onset

No apparent cause

Does not involve any

other cranial nerve

Symptoms

Retroauricular pain

No systemic

manifestations Hacusis

Dysgeusia

lacrimation


19/23

Complication

Corneal damage

Treatment

Corticosteroid

Antiviral agent

(4000mg/24hrsdivided into 5 doses

for 7 to 10 days)

Corneal mostunization

& protec

tion Gold plate

Facial nerve

decompression


20/23

Diagnosis: History

Immediate vs delayed Site of lesion (CTs)Immediate paralysis Surgically

explore

Delayed paralysis

neuralcompression from increasing edema/hematoma. Treat initially withcorticosteroid


21/23


22/23


23/23

Documents

Temporal bone fracture and facial nerve palsy