Author(s)
Mackenzie J. Noonan
Gauri Mankekar, MD,PhD
Gauri Mankekar, MD,PhD
Affiliation(s)
LSU Health Shreveport; Louisiana State University - Shreveport;
Abstract:
Introduction: High-force injuries to the skull can fracture the temporal bone and place underlying structures at risk for injury. Facial nerve (FN) deficits and hearing loss are among the most common complications following temporal bone fractures (TBF). Evolution in evaluation of TBF has most recently yielded a radiographic classification system that correlates with functional outcome and divides TBF into otic capsule sparing (OCS) or otic capsule violating (OCV). Consistent descriptions and clear recommendations for the management of FN deficits following TBF is not widely agreed upon.
Objectives: The aim of this study was to determine if patients with OCV TBF had poorer facial nerve outcomes compared to patients OCS TBF.
Methods: We retrospectively reviewed electronic health records of 335 TBF patients presenting to our Level I trauma care center over ten years. Demographics, cause of trauma, loss of consciousness, onset of FN deficits, fracture type (OCS vs OCV), treatment type, and House-Brackmann (HB) scores were analyzed.
Results: 14 out of 335 patients had facial nerve deficits. Mean age was 25.3 years among 7 males and 7 females. Motor vehicle accident was the commonest cause of trauma. 85.7% of patients received steroids, including the 1 patient who underwent facial nerve decompression. 2 patients did not receive any treatment. 2 patients had OCV and 12 had OCS TBF. FN deficits improved in both of the OCV TBF patients, with both recovering good clinical outcome. FN deficits improved in 10 out of 12 OCS TBF patients (with 8 of these attaining good clinical result). Average initial HB was 5.07 +/- 1.2 which significantly improved to 2.21 +/- 1.5 across entire cohort (p= 0.00003). Overall, 64 % recovered with good FN function, 21% with fair function, and 14% with poor function.
Conclusions: We found that facial nerve deficits occur in both OCS and OCV type of TBF. No statistical significance was found between FN outcome in patients with OCV TBF compared to patients with OCS TBF.