Other signs of temporal bone fracture include: Importantly, any facial nerve palsy immediately after injury is likely as a result of direct damage to the nerve and has a low chance of recovery (delayed onset facial nerve palsy post-trauma is more likely to represent a neuropraxia, secondary to tissue oedema). *A more clinically useful categorisation would be classification relating to otic capsule involvement involvement of the otic capsule carries an increased risk of permanent sensorineural hearing loss, facial nerve palsy, and CSF leakĬlinical signs suggesting a temporal bone fracture should be assessed for, perhaps the most important of which is facial nerve injury. Transverse temporal bone fractures occur from fronto-occipital head trauma and are usually associated with sensorineural hearing loss or facial nerve injury.Longitudinal temporal bone fractures are the more common type (~80%), typically occurring from a lateral blow to the head and are usually associated with conductive hearing loss. Temporal bone fractures can be categorised* as either longitudinal or transverse (many are mixed), depending on their relation to the axis of the ear canal: However, to have sustained a temporal bone fracture, the patient must have had a relatively high impact injury, therefore ATLS principles with an A to E assessment is essential for all such patients. CT imaging of the temporal bones provides the initial mainstay of investigation (Figure 4). Patients presenting with a head injury and suspected temporal bone fracture need prompt investigation and management. *In small haematomas presenting early, one can consider simple needle aspiration, although this can carry an increased risk of incomplete haematoma evacuation This will apply pressure onto the perichondrial space, aiming to prevent the re-accumulation of blood and restoring cartilage perfusion. There are mutliple additional methods to prevent re-accumulation of the haemaotoma a common technique involves placing a dental roll either side of the auricle and secure these in place using tight mattress sutures around the rolls and through the pinna (Fig. If required, the cavity can be washed out with saline (mixed with iodene if needed). Drainage of a Pinna HaematomaĮnsure an appropriate aseptic field is prepared (ideally in an operating theatre) and instill local anaesthetic (not containing adrenaline) to provide a regional block of the pinna.Īn incision along the inside of the helical rim (the point where most fluctuant and least aesthetic compromise) should be made, allowing for the evacuation of the haematoma*. These patients should be reviewed again in a week to remove the pressure dressing, and to ensure that repeat drainage can be done if there is any re-accumulation. If the haematoma re-accumulates, it will require re-drainage. Due to risk of avascular necrosis, drainage of the haematoma should be performed within 24 hours of the injury.Īfter evacuation of a haematoma, gauze padding should be placed over the ear and a tight headband applied. Principles of management for auricular haematoma include draining of the haematoma, and pressure dressing after to prevent re-accumulation of haematoma. Figure 2 – A patient with an auricular haematoma
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