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A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol

Published online by Cambridge University Press:  03 March 2020

H Kanona ,
C Anderson ,
A Lambert ,
R Al-Abdulwahed ,
L O'Byrne ,
N Vakharia ,
D Motter ,
C Offiah ,
A Adams  and
K Seymour
...Show all authors
H Kanona*
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
C Anderson
Affiliation:
University College London Ear Institute, UK
A Lambert
Affiliation:
Department of ENT, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, UK
R Al-Abdulwahed
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
L O'Byrne
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
N Vakharia
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
D Motter
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
C Offiah
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
A Adams
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
K Seymour
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
M J Wareing
Affiliation:
Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK
*
Author for correspondence: Ms Hala Kanona, Department of ENT, Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Rd, LondonWC1X 8DA, UK E-mail: hkanona@yahoo.co.uk
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Abstract

Objective

To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.

Methods

A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention.

Results

Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients.

Conclusion

Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.

Keywords

Temporal BoneSkull FracturesPatient Care ManagementFacial PalsyCerebrospinal Fluid RhinorrheaHearing Loss
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 3 , March 2020 , pp. 205 - 212
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Ms H Kanona takes responsibility for the integrity of the content of the paper

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