Types of trauma:
1. Temporal bone # ( the most common cause)
2. Penetrating trauma
3. Iatrogenic trauma
temporal bone # most often occur in conjugation with multiple bone injury
1. Longitudinal 80%
2. Transverse 10-15%
3. Mixed/oblique: 5-10%
Otic disturbing #:
Battle sign: indicates skull base fracture and occur due to blood in the mastoid air
cells
The most posttraumatic ossicular injury: Subluxation of the incudostapedial joint
The overall incidence of facial nerve palsy form all types of fractures is 3%
What is the incidence of facial nerve injury after transverse fracture of the
temporal bone?
50%.
What is the incidence of facial nerve paralysis in patients with longitudinal
temporal bone fractures?
20.
Which of these accounts for the majority of facial nerve injuries?
Longitudinal.
Which of these fractures is most likely to result in facial nerve paralysis?
Transverse.
In transverse fractures:
1. distal labyrinthine and tympanic segments are most commonly injured.
Transverse temporal bone fractures are generally associated with more severe
AND IMMEDIATE injury to the facial nerve, including transection
Paralysis causes:
a. intraneural haematoma
b. compression by a bony spicule
c. transection of nerve
Approach:
1. Longitudinal: perigenigulate: Transmastoid
2. Transverse with otic sparing: labyrinth segment: middle cranial
fossa
Transverse with otic involvement: translabyrinthe
3.
CSF Leak:
Hearing loss:
The most common type of hearing loss in temporal bone # is:
Temporary CHL
the most common mechanism of CHL in longitudinal fractures is
Incudostapedial joint dislocation.
Iatrogenic:
Mechanism of injury:
1. direct mechanical injury
2. Heat generated from drilling.
Birth trauma
Forceps delivery with compression of the facial nerve against the spine
Note: facial nerve exposure in case of Temporal bone # via middle cranial fossa
Management:
partial injuries (< 50%) are best treated by decompression proximal and
distal to injury injuries
> 50% require primary anastomosis or cable grafting
Nature of injury:
We do not explore F.N palsy ass with penetrating injury medial to the
lateral canthus as the regeneration is excellent in this area
Types of repair:
When the nerve ends are separated by more than 1 cm and cannot be
easily released, a nerve graft should be considered to avoid repairing
the nerve under tension
Types of Graft
The outcome:
Pre-request:
irreversible facial nerve injury
intact mimetic function
intact motor endplate function
intact proximal donor nerve
intact distal facial nerve
د.دياال المارديني