![]() The most common temp bone fracture (80%) Results from forces applied in the lateral projection, then traveling along the path of least resistance with the petrosquamous suture line anterior to the otic capsule.In the case of penetrating injuries, if there is any concern of risk to the internal Carotid artery, angiography or MRA is necessary. In a study by Haberkamp, gadolinium enhanced MRI was found to be helpful in accurately predicting the site of facial nerve injury as a result of trauma with focal enhancement of the lesion. MRI evaluation of the facial nerve has been of interest in Bell’s Palsy, and is gaining some interest in evaluation of nerve edema/compression in trauma evaluation. MRI is becoming more prominent in identification of subclinical CNS injuries, especially in patients that are considered for surgical intervention for facial nerve lesions by documenting preexisting CNS injury and determining the risk of potential morbidity in patients undergoing middle cranial fossa approach for facial nerve injury. High resolution CT scanning with bone windows are the standard in diagnosis for identifying and classifying lesions of the middle and inner ear.Likewise, Pneumatic otoscopy may initiate the nystagmus and vertiginous symptoms of a PLF, or even reveal a subtle fracture of the malleus. The tuning fork exam is a quick way to evaluate hearing in the emergency room setting.The external canal and TM is more commonly lacerated in Longitudinal fractures which allows for blood or CSF otorrhea Whereas the intact external canal assoc w/ transverse fractures may lead to a buildup of blood or CSF behind and intact TM The classic PE findings of a Basilar skull fracture are Periorbital Ecchymosis (raccoon’s eyes), Mastoid ecchymosis (battle’s sign) and Hemotympanum. A complete physical examination will often reveal the type of injury even before radiographic evidence can confirm it.Foreign bodies are more accountable for injuries to the TM, Ossicles and Facial Nerve without temporal bone fractures. Of course a thorough H&P consisting of a thorough and well document Head and Neck exam is necessary. ![]() Patients with multiple systems trauma must proceed according to the ATLS protocol and often the otolaryngologist is notified after its been completed, but should not be overlooked in the fundamental approach to evaluation of a trauma patient.
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