颞骨骨折及其中、内耳损伤48例回顾性研究

目的　探讨颞骨骨折及中、内耳损伤的特点及救治。　方法　对 1989年 1月～ 1999年 11月收治的 48例颞骨骨折的临床资料进行回顾性分析。　结果　 (1) 4 8例颞骨骨折占同期颅-颅面骨折的 17% ,其中交通事故所致的颞骨骨折 32例 (6 7% ) ;(2 )本组合并中、内耳和 (或 )颅脑损伤 37例 (77% ) ,2 3例 (4 8% )出现听力下降或耳鸣 ;(3)纵行骨折致脑脊液耳漏 12例 (36 % )、面瘫1例 (3% ) ;横行骨折致面瘫 3例 (37% ) ,脑脊液耳漏 2例 (2 5 % ) ;(4 )早期急救手术占 96 % ,其中颅脑手术占所有急救手术的 46 % ,Ⅱ期手术占 17% ,存活 43例 (90 % ) ,死亡 5例 (10 % )。　结论　(1)交通伤是造成颞骨骨折的首要高危因素 ;(2 )骨折易并发中、内耳或颅脑损伤 ,其中听力下降或耳鸣是常见的耳并发症 ;(3)纵行骨折的脑脊液耳漏多见 ,横行骨折易造成面瘫 ;(4 )早期救治应该着重抢救生命 ,保证呼吸道通畅 ,维持循环系统功能。     

外伤性面瘫的多层螺旋CT研究

目的探讨多层螺旋CT(MSCT)在外伤性面瘫中的应用价值。方法用MSCT对41例外伤性面瘫的颞骨行高分辨率轴面扫描。用Ph ilipsMx8000MSCT工作站,行岩锥感兴趣区的多平面重建(MPR)及面神经管的曲面重建(CPR)。观察骨折类型,骨折线的走行,中耳腔、乳突积血及外耳、中耳、内耳和面神经管的受累情况。结果41例患者中,39例颞骨有不同部位、不同类型的骨折,其中岩骨纵行骨折34例,横行骨折2例,混合型2例,1例岩骨无骨折,但颞骨鳞部骨折,2例未发现骨折。其中2例为双侧岩骨骨折。面神经管的CPR及MPR显示21例患者面神经管受累,9例可见骨碎片。结论MSCT扫描及重建技术能清晰显示面神经管的全貌及其损伤,对外伤性面瘫的诊断有重要意义。     

外伤性脑膜炎14例治疗分析

颅脑损伤并发颅内感染,是一种严重的并发症，预后较差，文献报道死亡率高达29％～50％。近年来，新型抗生素应用于临床，对降低死亡率起到了重要作用。我们就本院1987年5月～1994年10月对颅脑损伤并发颅内感染14例的处理、抗生素应用以及预后进行回顾性分析。1临床资料1.1互一般情况本组男互2例，女2例；年龄17～59岁，平均28．4岁。从受伤至感染平均间隔26．9d。10例（71．4％）有明显的颅底骨折，4例为无骨折的闭合颅脑损伤。发生脑脊液耳或鼻漏8例（57．l％）；发生脑积水2例（l．6％）。1．2细菌学检查及药敏试验脑脊液培养阳性者13例，…     

53例颅脑创伤患者耳部损伤的临床表现与多层螺旋CT发现的相关性研究

目的探讨颅脑创伤病人耳部损伤的临床表现与多层螺旋CT发现的相关性。方法对53例颅脑创伤疑有耳部和面神经管损伤的患者进行了耳部CT扫描和3D图像重组,统计、分析各型颞骨骨折CT所见与临床症状、体征的相关性。结果本组53例颞骨骨折,其中纵行骨折34例(64.2%),混合性骨折14例(26.4%),横行骨折5例(9.4%);内耳完整型48例(90.6%),内耳受损型5例(9.4%)。脑挫裂伤或(和)脑内血肿21例:其中单侧颞叶损伤11例、双侧5例,弥漫性轴索损伤1例,脑干损伤1例;硬膜外或(和)硬膜下血肿8例,蛛网膜下腔积血6例。结论多层螺旋CT(MSCT)3D成像技术立体、直观、真实地再现了耳部及面神经管细微、复杂的影像学解剖和病理改变,可为临床早期诊断,及时选择合理、恰当的治疗方案以及预后评估等提供较好的影像学依据。     

高分辨率CT对诊断颞骨骨折的价值：附50例报告

目的：对高分辨率ＣＴ诊断颞骨骨折的作用进行评价。材料和方法：对５０例颞骨外伤，临床有耳出血、脑脊液漏、面神经麻痹或感觉性耳聋的患者均行高分辨率ＣＴ横断及冠状面扫描，１例同时行矢状面扫描。结果：发现乳突、鼓室部骨折４０例，外耳道骨折８例，听骨脱位１８例，面神经管骨折１７例，骨迷路骨折６例，内耳道底骨折３例，累及前庭导水管及颈静脉孔各３例。结论：高分辨率ＣＴ能确定骨折部位，并显示软组织变化，如中耳出血及脑脊液漏。高分辨率ＣＴ可为诊断颞骨外伤提供可靠依据。     

听骨链损伤

Toynbee在1886年可能已经知道外伤形成的听骨链损伤。Kelemen(1944)叙述了颞骨骨折尸检听骨链断裂。Cawthorne等(1956)报告探察7例外伤性面神经麻痹,有6例为钻骨脱位。Schuknecht等(1956)描述颞骨纵行骨折、鼓膜和听骨损伤合并传导性耳聋。 颞骨骨折分为两种类型——纵型骨折和横行骨折。两种类型都常有发生。多数学者认为,约80％为纵行型骨折,并合并听骨损伤。     

交通事故伤与碰撞类型的关系

对５１１例交通事故伤住院病人的损伤模式和碰撞类型进行了流行病学分析。伤员构成为：摩托车人员占３６．０％、行人占３４．２％、自行车人员占１８．２％和汽车内人员占１１．６％。不同碰撞类型颅脑损伤发生率明显不同（Ｐ＜０．０１）：行人被摩托车撞颅脑损伤发生率高于行人被汽车撞；摩托车人员自身事故颅脑损伤发生率高于骑摩托车被汽车撞者；德国人员颅脑损伤发生率高于摩托车人员。笔者指出各种碰撞类型的交通事故伤原因及     

高分辨率CT诊断颞骨骨折及其并发症（附41例报告）

笔者用高分辨率ＣＴ诊断颞骨骨折４１例，其中纵形骨折２９例，横形骨折４例，混合型骨折４例，不典型性骨折４例。主要并发症：听骨链损伤２０例，面神经管损伤６例，内耳迷路损伤４例，耳液瘘３例。该检查方法具有重要的临床意义。     

车祸致严重颅脑损伤183例临床特点及救治

我院1982～1990年共收治严重颅脑损伤320例，其中车祸致伤者183例，现将其临床特点及救治情况报告如下。临床资料本组男151例，女32例；年龄6个月~80岁；入院时格拉斯哥计分3～8分。其中多发伤127例，占69．4％；而同期非车祸伤137例中多发伤19例，占13．9％。车祸伤中有并发症者86例，占46．9％；非车祸伤并发症仅17例，占12．4％。车祸伤者死亡61例，占33．3％；非车祸伤死亡者19例，仅占13．90％。讨论一、车祸致严重颅脑损伤的机制和临床特点1．合并其他都使损伤是车祸致严重颅脑构伤的突出特点．由于受伤方式的多样化，伤员在短时间内…     

道路交通事故致急性颅脑损伤临床流行病学分析

道路交通事故致急性颅脑损伤临床流行病学分析刘敬业只达石靳永恒张赛焦春风道路交通事故是造成急性颅脑损伤及其死亡的重要原因．笔者报告天津市５家医院１９９３年收治的４８８例颅脑交通伤（占同期９３３例的５２．３％），结合天津市交通管理局当年的统计资料分析如下...     

先天性自发性脑脊液耳鼻漏临床分析

目的探讨自发性脑脊液耳鼻漏的病因特点、诊断及治疗方法。方法回顾性分析1986年6月-2001年7月收治的13例先天性自发性脑脊液耳鼻漏经手术治愈的临床资料。结果13例均伴有复发性脑膜炎发作,9例表现为脑脊液鼻漏,13例均为全聋,CT检查显示13例均为内耳发育畸形,前庭囊性扩大,经行鼓室探查,11例为前庭窗漏,1例为圆窗漏,1例为前庭窗和圆窗同时漏,其中1例为双耳前庭窗漏,经采用筋膜、肌肉、脂肪呈哑铃状封堵前庭窗及圆窗,全部治愈。结论对复发性脑膜炎伴耳聋和鼻流清水史的患者应行颞骨CT和鼓室穿刺检查进行及时的正确诊断,鼓室探查脑脊液漏修补是本病治疗的主要方法,瘘口周围黏膜的处理及哑铃状封堵瘘口等方法是手术成功的关键。     

Traumatic temporal bone fracture with middle ear effusion: A case report

Temporal bone fracture is a relatively rare but significant complication of traumatic head injury. We present a rare and unique case of traumatic temporal bone fracture with middle ear effusion, in a 76-year-old woman, following a fall. Physical examination on presentation was remarkable for a superficial scalp hematoma in the occipital region, without any focal neurological deficits. An initial non-contrast head CT revealed a large posterior scalp hematoma and subtle changes suggestive of artifact vs. hemorrhage within the right temporal lobe. Over two days, she developed a worsening headache, with new hearing impairment and reduced right sided bone-conduction on auditory testing. A repeat head CT confirmed a right hemorrhagic temporal lobe contusion as well as a right mastoid and middle ear effusion. A dedicated temporal bone CT scan was performed, which revealed an acute longitudinal fracture through the right mastoid bone without extension into the middle ear cavity. She was evaluated by neurosurgery, managed symptomatically, and observed closely. Her neurological status remained stable, and she was discharged with planned outpatient follow-up with her primary care provider and the consulting neurosurgeon. This case illustrates sequalae of traumatic temporal bone fracture, as well as the value of clinical history and heightened clinical concern for an occult, easily overlooked region during imaging.     

Temporal bone fractures and complications: Correlation between high-resolution computed tomography and audiography

Acute head trauma in the emergency room is managed primarily by the trauma surgeon or neurosurgeon. Temporal bone fractures with the complications of hearing loss and facial nerve paralysis may not be promptly evaluated. The otolaryngologist may not be consulted until late in the hospitalization. Traditionally, longitudinal fractures have been associated with conductive hearing loss and transverse fractures with sensorineural hearing loss. The purpose of this study was to correlate the type of fracture with audiometric findings of hearing loss. We also studied the incidence of facial nerve paralysis and its associated fracture types. A total of 2906 head trauma patients admitted to the emergency room from March 1994 to May 1996 were reviewed. All patients had a head computed tomographic (CT) examination. High-resolution CT of the temporal bones was performed in patients suspected of having a temporal bone fracture. Temporal bone fractures were found in 48 patients (2%) and were classified as longitudinal, transverse, or mixed. Audiometry was performed by the Department of Otolaryngology in 23 of the patients with temporal bone fractures. Patients with longitudinal fractures had conductive hearing loss in 43% and sensorineural loss in 23%. Of patients with transverse fractures, 57% had conductive hearing loss, and 29% had sensorineural loss. Facial nerve paralysis was found in 11% of patients. Patients with transverse fractures were found to have facial paralysis in 2 of 11 (18%), whereas those with longitudinal fractures had paralysis in 3 of 36 (8%). Our study found conductive hearing loss to be more frequent than sensorineural loss in patients with longitudinal and transverse fractures. This finding differs from traditional associations. We found the fracture orientation as defined by high-resolution CT scanning of the temporal bones to be a poor predictor of associated hearing loss. Facial nerve paralysis can occur with both transverse and longitudinal fractures, and extension of fractures to the geniculate ganglion should be sought on high-resolution CT scans of the temporal bone. The emergency room physicians should be notified of this potential complication. This paper was presented at the annual meeting of the American Society of Emergency Radiology, March 1997.     

Temporal bone fractures and their complications

Summary A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution CT (HRCT) a few hours to 21 months after the initial trauma. Axial HRCT disclosed 63 longitudinal, 13 transverse, 10 complex and 3 atypical fractures. The diagnosis of a temporal bone fracture was established by axial HRCT in almost every case. However, for the precise topographic analysis of the course of the fracture, additional coronal HRCT proved helpful. The most common, surgically treatable complication of temporal bone fracture is disruption of the ossicular chain. Twenty-three such lesions were demonstrated by combined axial and coronal HRCT; 22 lesions of the facial canal could be demonstrated in 27 patients presenting with facial nerve palsy. The most common site of injury to the facial canal was the region of the geniculate ganglion. The only life-threatening complication of a temporal fracture may be otorhinoliquorrhea. This was present in 9 cases. The most common site of leakage identified was the tegmen tympani. With Metrizamide-HRCT precise localisation of the dural laceration was possible in 7 of these 9 cases.     

Fracture of the temporal bone. Evaluation of 123 cases

Out of 2,888 blunt head injuries that were treated at the Hermann Hospital Trauma Center of the University of Texas at Houston, only 123 temporal bone fractures were diagnosed in 110 patients. The clinical diagnosis was confirmed with high resolution computerized tomography of the temporal bones. Three main categories of fractures were identified: oblique in 74%, longitudinal in 13% and transverse in 13%. The clinical manifestations included hemotympanum in 83%, cerebrospinal fluid otorrhea in 21% and Battle's sign in 10.6%. One third of the patients had conductive hearing loss, 1/2 had mixed hearing loss and the rest sensorineural loss. On exploration, the most frequent middle ear pathology was incudostapedial joint dislocation. Immediate facial paralysis was observed in 64 patients. Only 11 patients needed facial nerve exploration following signs of denervation, the rest recovered spontaneously. Thirteen patients who had delayed facial paralysis also recovered spontaneously. One third of the patients had persistent unsteadiness 6 weeks following the injury. Other unusual complications encountered include 6 cases of abducent paralysis, 2 cases of trigeminal paralysis and 2 cases of aseptic sigmoid sinus thrombosis.     

Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography.

BACKGROUND AND PURPOSE: Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography. METHODS: We retrospectively reviewed the imaging studies and medical records of all patients who were evaluated for CSF leak during a 7-year period. Forty-two patients with rhinorrhea and/or otorrhea underwent high-resolution CT of the face or temporal bone and then had CT cisternography and radionuclide cisternography via lumbar puncture. The results of the three studies were compared and correlated with the surgical findings in 21 patients. RESULTS: High-resolution CT showed bone defects in 30 of 42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement. CONCLUSION: Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects.     

High-resolution CT of temporal bone trauma

Computed tomographic (CT) findings in 18 patients with temporal bone trauma were reviewed. Eight patients suffered longitudinal fractures of the petrous bone, which were associated with ossicular dislocation in two patients. Transverse fractures were detected in six patients, with a contralateral mastoid fracture in one patient. In four patients, the fractures were restricted to the mastoid region. Of the 14 patients in whom adequate neurologic evaluation was available, seven had a permanent facial nerve or hearing deficit while five suffered at least a transient neurologic deficit related to the temporal bone trauma. Routine head CT (10 mm sections) demonstrated only eight of 19 petrous bone injuries. Clues to such injury included opacification of the mastoid air cells (10 patients), sphenoid sinus (11 patients), external canal and middle ear air space (10 patients), and local pneumocephalus (five patients). Evidence of brain trauma or extraaxial hematoma was seen in 12 patients. In 13 cases, high-resolution CT was also performed, demonstrating temporal bone injuries in all. This latter technique allows rapid and detailed evaluation of temporal bone trauma. Reports of radiographic evaluation of temporal bone trauma tend to deal with a somewhat skewed population, selected on the basis of clinical symptomatology. In a major trauma center equipped with high-resolution CT, it was found that temporal bone fractures may be seen incidentally, or in patients in whom symptomatology related to temporal fracture is obscured by much more serious neurologic compromise.     

Revisiting the indirect signs of a temporal bone fracture: air,air, everywhere

Background and purpose

The standard head CT protocol makes detection of a temporal bone fracture difficult. The purposes of our study are to revisit the finding of air in various locations around the temporal bone as an indirect sign of fracture and determine if findings could predict fracture pattern.

Materials and methods

We searched the radiology reports for the keyword “temporal bone fracture.” We recorded the presence of air in multiple locations around the temporal bone and pneumocephalus, opacification of the mastoid air cells or the middle ear cavity, and dominant fracture pattern. Statistical analyses were performed using statistical software.

Results

A total of 135 patients (mean age 40 ± 20.1 years, 101 male, 34 female, range 1–91) had 152 fractures. At least one indirect finding was present in 143 (94.1%) fractures. Air was present adjacent to the styloid process in 94 (61.8%), in the temporomandibular joint in 80 (52.6%), adjacent to the mastoid process in 57 (37.5%), and along the adjacent dural venous sinus in 33 (21.7%) fractures. Mastoid opacification was present in 139 (91.4%) fractures. Opacification of the middle ear cavity was present in 121 (79.6%) fractures. A complex fracture significantly and positively correlated with pneumocephalus.

Conclusion

In the setting of trauma, air around the temporal bone and opacification of the mastoid air cells or middle ear cavity should prompt consideration of a temporal bone fracture even if the fracture line is not visible. The presence of pneumocephalus predicts a higher chance of complex fracture pattern.