Role of HRCT in temporal bone trauma vis-à-vis site of facial nerve injury: a pilot study

Manish Munjal; Anju Mehndiratta; Harneet Khurana; Shubham Munjal; Ajit Singh Khurana; Shivam Kalra; Ishan Bansal; Robin Sharma

doi:10.18203/issn.2454-5929.ijohns20205618

Authors

Manish Munjal Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Anju Mehndiratta Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Harneet Khurana Department of Physiology, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Shubham Munjal Department of Physiology, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Ajit Singh Khurana Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Shivam Kalra Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Ishan Bansal Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India
Robin Sharma Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20205618

Keywords:

High resolution CT scan, Facial nerve injury, Fracture

Abstract

Background: Facial nerve paralysis in head injuries has a lesion in the bony fallopian canal. The line of fracture and site of lesion was studied using high resolution computed tomography.

Methods: A prospective study of 37 subjects of facial nerve paralysis following head injury was undertaken. The patients were selected from the neurosurgical trauma centre of a tertiary care facility, of Dayanand Medical College, Ludhiana, during a period of one and a half years. HRCT was performed taking 2 mm axial and coronal cuts of temporal bone for all patients to analyse the type and site of fracture of the bony facial canal.

Results: Total 19 (51.3%) patients had longitudinal fractures while transverse fracture was seen in 7 (18.9%) patients and 11 (29.7%) patients showed comminuted fracture on HRCT. Perigeniculate region was involved in 4 (44.4%) patients. Tympanic segment was affected in 3 (33.3%) patients and the mastoid segment in 4 (44.4%). The tympanic and the mastoid segments were involved simultaneously in two patients. These findings correlated with those observed on HRCT. 500 patients of head injury were screened and 48 (9.6%) patients were found to have facial nerve paralysis. 44 (91.67%) of these were males and 4 (8.33%) females. Majority of the patients (62.5%) were between the age group of 21-40 years.

Conclusions: In the present study of facial paralysis post head injury, longitudinal facial fractures were commonest followed by mixed and transverse on HRCT. The pregeniculate and the mastoid segments showed an equal incidence followed by the tympanic segment.

Metrics

Metrics Loading ...

Author Biography

Manish Munjal, Department of ENT and HNS, Dayanand Medical College Ludhiana, Ludhiana, Punjab, India

Professor and Head, Deptt of ENTHNS

References

Dahiya R, Keller JD, Litofsky NS, Bankey PE, Bonassar LJ, Megerian CA. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Traum Acut Care Surg. 1999;47(6):1079.

Touei H, Furuse M, Nakashima N, Ohsawa T, Yokoyama K, Takata Y. High-resolution CT in evaluation of temporal bone trauma. Rinsho hoshasen. Clinic Radiogr. 1990;35(11):1375-80.

Schubiger O, Valavanis A, Stuckmann G, Antonucci F. Temporal bone fractures and their complications. Neuroradiology. 1986;28(2):93-9.

Kahn JB, Stewart MG, Diaz-Marchan PJ. Acute temporal bone trauma: utility of high-resolution computed tomography. Otol Neurotol. 2000;21(5):743-52.

Saraiya PV, Aygun N. Temporal bone fractures. Emergen Radiol. 2009;16(4):255-65.

Betz BW, Wiener MD. Air in the temporomandibular joint fossa: CT sign of temporal bone fracture. Radiology. 1991;180(2):463-6.

Holland BA, Brant-Zawadzki M. High-resolution CT of temporal bone trauma. American journal of roentgenology. 1984;143(2):391-5.

Abele TA, Wiggins RH. Imaging of the temporal bone. Radiolog Clin. 2015;53(1):15-36.

Schuknecht B, Graetz K. Radiologic assessment of maxillofacial, mandibular, and skull base trauma. Europ Radiol. 2005;15(3):560-8.

Ohlrogge M, Francis HW. Temporal bone fracture. Otol Neurotol. 2004;25(2):195-6.

Peng KA, Ahmed S, Yang I, Gopen Q. Temporal bone fracture causing superior semicircular canal dehiscence. Case Rep Otolaryngol. 2014;2014.

Exadaktylos AK, Sclabas GM, Nuyens M, Schröder D, Gallitz B, Henning P, et al. The clinical correlation of temporal bone fractures and spiral computed tomographic scan: a prospective and consecutive study at a level I trauma center. J Traum Acut Care Surg. 2003;55(4):704-6.

Cannon CR, Jahrsdoerfer RA. Temporal bone fractures: review of 90 cases. Arch Otolaryngol. 1983;109(5):285-8.

Alvi A, Bereliani A. Acute intracranial complications of temporal bone trauma. Otolaryngol Head Neck Surg. 1998;119(6):609-13.

Alvi A, Bereliani AT. Trauma to the temporal bone: diagnosis and management of complications. J Cranio-maxillofac Traum. 1996;2(3):36-48.

Barreau X. Imaging features of temporal bone fractures. J Radiol. 2011;92(11):958-66.

Asha'Ari ZA, Ahmad R, Rahman J, Kamarudin N, Wan Ishlah L. Contrecoup injury in patients with traumatic temporal bone fracture. J Laryngol Otol. 2011;125(8):781.

Azad TD, Veeravagu A, Corrales CE, Chow KK, Fischbein NJ, Harris OA. Abducens nerve avulsion and facial nerve palsy after temporal bone fracture: A Rare concomitance of injuries. World Neurosurg. 2016;88:689-e5.

Casselman JW. Temporal bone imaging. Neuroimag Clin North Am. 1996;6(2):265-89.

Jones RM, Rothman MI, Gray WC, Zoarski GH, Mattox DE. Temporal lobe injury in temporal bone fractures. Arch Otolaryngol Head Neck Surg. 2000;126(2):131-5.

Nishiike S, Miyao Y, Gouda S, Shimada N, Nagai M, Nakagawa A, et al. Brain herniation into the middle ear following temporal bone fracture. Acta oto-laryngologica. 2005;125(8):902-5.

Schubiger O, Valavanis A, Stuckmann G, Antonucci F. Temporal bone fractures and their complications. Neuroradiology. 1986;28(2):93-9.

Hough JV, McGee MM. Otologic trauma. Otolaryngology. 1980;2:1656-79.

Aguilar III EA, Yeakley JW, Ghorayeb BY, Hauser M, Cabrera J, Jahrsdoerfer RA. High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures. Head Neck Surg. 1987;9(3):162-6.

Lambert PR, Brackmann DE. Facial paralysis in longitudinal temporal bone fractures: A review of 26 cases. Laryngoscope. 1984;94(8):1022-6

Coker NJ, Kendall KA, Jenkins HA, Alford BR. Traumatic infratemporal facial nerve injury: Management rationale for preservation of function. Otolaryngol Head Neck Surg. 1987;97(3):262-9.