Resident Manual of Trauma to the Face, Head and Neck

Chapter 6: Temporal Bone Fractures

2. Transverse Fractures Transverse fractures cross the petrous ridge and have a higher inci- dence of otic capsule involvement. These fractures require more energy and classically result from a blow to the occipital region. Transverse fractures are more often associated with inner ear injury, resulting in SNHL, and have a higher incidence of facial nerve injury. Figure 6.4 demonstrates the radiologic appearance of a transverse fracture. This patient sustained his fracture in a motor vehicle accident and had normal facial nerve function but lost all hearing. Although this system is simple and easy to understand, many fractures have mixed patterns, limiting this system’s utility.

Figure 6.4 Axial view of the right temporal bone with a transverse fracture (red dashed line) crossing the petrous bone and involving the lateral aspect of the IAC.

B. Otic Capsule-Sparing versus Otic Capsule-Involving Classification This classification system is based on the presence or absence of involvement of the otic capsule. This system was introduced to empha- size the functional sequelae of the fracture. Results from the two series proposing this classification scheme indicate that 2.5–5.8 percent of fractures involve the otic capsule. Figure 6.3 illustrates an otic capsule- sparing fracture, while figure 6.4 illustrates an otic capsule-involving fracture.

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Resident Manual of Trauma to the Face, Head, and Neck