Johnson Freedom, Semaan Maroun T, Megerian Cliff A
Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Otolaryngol Clin North Am. 2008 Jun;41(3):597-618, x. doi: 10.1016/j.otc.2008.01.006.
Temporal bone fractures occur from high-energy mechanisms, typically but not limited to motor vehicle accidents. However, as the automotive industry continues to introduce improved safety measures, violence and falls account for a larger proportion of cases. Given the great forces involved, temporal bone fractures rarely occur in isolation and initial evaluation must focus on the fundamental ABCs of Advanced Trauma Life Support with special attention to Glasgow Coma Scale, intracranial injury, and cervical spine injury. Subsequent evaluation relies on physical examination, high-resolution CT, and electrodiagnostic testing to address the neurotologic consequences of temporal bone fracture, including cerebrospinal fluid leak, facial nerve injury, and injury to the peripheral hearing and balance organs. Management algorithms must address immediate (eg, ABCs, neurosurgical issues), short-term (eg, cerebrospinal fluid leak, facial nerve injury, hearing loss), long-term (eg, facial nerve injury, hearing loss, vestibular injury), and delayed (eg, encephalocele, cholesteatoma, late meningitis) issues. This article reviews the current state of temporal bone fracture evaluation and management with special attention to mechanisms of injury, clinical presentations and emergency evaluation, and diagnostic workup, including the evolution of radiographic fracture classification systems and electrodiagnostic testing. Discussion of treatment approaches address management of immediate, short-term, long-term, and delayed complications.
颞骨骨折由高能机制导致，通常但不限于机动车事故。然而，随着汽车行业不断引入改进的安全措施，暴力和跌倒导致的病例占比更大。鉴于涉及的力量巨大，颞骨骨折很少单独发生，初始评估必须聚焦于高级创伤生命支持的基本ABC，尤其要关注格拉斯哥昏迷量表、颅内损伤和颈椎损伤。后续评估依靠体格检查、高分辨率CT和电诊断测试来处理颞骨骨折的神经耳科后果，包括脑脊液漏、面神经损伤以及外周听觉和平衡器官损伤。管理方案必须解决即刻问题（如ABC、神经外科问题）、短期问题（如脑脊液漏、面神经损伤、听力损失）、长期问题（如面神经损伤、听力损失、前庭损伤）以及延迟问题（如脑膨出、胆脂瘤、晚期脑膜炎）。本文回顾了颞骨骨折评估和管理的现状，特别关注损伤机制、临床表现和急诊评估以及诊断检查，包括影像学骨折分类系统和电诊断测试的发展。治疗方法的讨论涉及即刻、短期、长期和延迟并发症的管理。
