Background Historic methods of classifying temporal bone fractures have been shown to poorly correlate with clinical findings. Due to the mechanisms of injury associated with these fractures, complete examination of patients can be difficult. An effective and simple way of correlating radiological findings in temporal bone fractures with complications like facial nerve weakness and paralysis will better guide physicians in treatment of their patients. We hypothesize that a classification system based on the medial extent of a fracture will best predict facial nerve injuries.
Study Design and Methods A retrospective chart review identified 109 patients with 131 temporal bone fractures. Temporal bone CT scans and a record of facial nerve evaluation was available in 115 fractures (99 patients). CT scans were reviewed and fractures were classified by our proposed system and by the traditional system (longitudinal, transverse, and mixed). Our proposed system is as follows: Group A is a lateral fracture involving the mastoid, external auditory canal, and/or temporomandibular joint; Group B involves the tympanic cleft; Group C involves the course of the facial nerve; and Group D involves the otic capsule. A final rating of A-D was given based on the medial most extent of the fracture line. Fractures were grouped according to the classification schemes and correlated with clinical reports of facial nerve dysfunction.
Results In 115 temporal bone fractures, 16 patients with facial nerve weakness or paralysis were identified. Using the new classification scheme, facial nerve injury was present as follows: Group A fractures - 0/20, Group B - 5/55 (9%), Group C - 6/31 (19%), Group D - 5/9 (56%). Using the traditional classification system, facial nerve dysfunction was present as follows: 11/72 (13%) of longitudinal fractures, 4/21 (19%) of transverse fractures, and 3/22 (14%) of mixed fractures.
Conclusion When compared to the traditional classification system for temporal bone fractures, these results demonstrate that the new system appears to have a higher predictive value with facial nerve function. This simple system can help physicians to triage patients and guide treatment even if a complete examination of the patient is not possible.
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