Pediatric Temporal Bone Fracture

Etiology: Trauma
Imaging: Fractures that extend through the skull base can affect the structures of the middle ear
Imaging CT Longitudinal temporal bone fracture:
— More common temporal bone fracture (70-90%)
— Fracture line parallel to petrous temporal bone long axis
— Otic capsule spared
— Ossicles often involved resulting in conductive hearing loss
— Involvement of tympanic membrane
— Possible facial nerve involvement (~25%)
Imaging CT Transverse temporal bone fracture:
— Less common temporal bone fracture (10-30%)
— Fracture line perpendicular to petrous temporal bone long axis
— Otic capsule often involved resulting in sensorineural hearing loss
— Ossicles and tympanic membrane usually spared
— Probable facial nerve involvement (~50%)
DDX:
Complications: Can cause sinus venous thrombosis
Treatment:
Clinical:
— Can present with blood at the external auditory canal
— If there is conductive hearing loss and blood at ear look for disruption of inner ear bones

Radiology Cases of Temporal Bone Fracture

Radiology Cases of Longitudinal Temporal Bone Fracture

CT of longitudinal temporal bone fracture — Axial CT without contrast of the temporal bones shows a fracture line running parallel to the long axis of the right petrous temporal bone. Disruption of the ossicles is also present.

Radiology Cases of Transverse Temporal Bone Fracture

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line perpendicular to the right petrous temporal bone long axis (left) and a small amount of intracranial air (right). The mastoid air cells are opacified.

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line oriented perpendicular to the long axis of the petrous temporal bone that goes through both walls of the carotid canal. There was a small amount of intracranial air. The right interal carotid artery was normal in appearance on a subsequent CT angiogram.