Temporal bone imaging

1. TEMPORAL BONE IMAGING
AN
OTOLOGIC SURGEION’S
VIEW
By
Dr.Muhammad A.Sherwani

2. TRAUMA
TO THE
TEMPORAL BONE

3. Longitudinal fracture Transverse fracture
 10-30%
 Frontal or occipital truama
 Perpendicular to long axis
 Labyrinth often involved (vertigo
 and SNHL)
 Tympanic membrane usually
 spared
 Facial paralysis (40-50%) often
immediate and complete
 Ossicles often spared (no CHL )
 70-90%
 Temporoparietal Truama
 Parallel to long axis
 Labyrinth usually spared
 Tympanic membrane usually
involved
 Facial paralysis (10-20%) often
delayed and incomplete
 Ossicles commonly involved
(CHL)
Axial view best for identification of type of fracture
(transverse, longitudinal or mixed)

4. Temporal bone pseudo fractures
 Extrinsic sutures/fissures.
 Intrinsic fissures
 Intrinsic channels

5. Extrinsic sutures/fissures

6. Extrinsic sutures/fissures

7. Extrinsic sutures/fissures
occipito-mastoid suture

8. Extrinsic sutures/fissures
Petro-occipital suture

9. Intrinsic fissure

10. Intrinsic channels
 Vestibular aquiduct
 cochlear aquiduct
 singular nerve

11. Singular nerve

12. Level 4

13. Level 7

14. Longitudinal fracture
70-90%

15. Longitudinal fracture

16. Recent longitudinal fracture of temporal
bone

17. Transverse fracture
10-30%

18. Transverse fracture
lateral type

19. Transverse fracture of the
temporal bone
lateral type

20. Transverse fracture of the
temporal bone
lateral type

21. Transverse fracture
medial type

22. Complication of the fracture
temporal bone
 Vertigo
 Hearing loss
 Fascial nerve paralysis
 Perilymph fistula

23. vertigo
 Vertigo after head trauma are due to:
1. Transection of the vestibule
2. Vestibular nerve
3. Vestibular aqueduct
4. Perilymph fistula
 Vertigo with out obivuous fracture line are
1. Labyrinthine concussion
2. cupololithiasis

24. Transection of the IAC

25. Perilymph fistula

26. Hearing loss
 SNHL may be due to (transverse
fracture):
1. Fracture pass through the IAC
2. Bony labyrinth
3. Fluctuated SNHL in perilymph fistula.
 SNHL in (longitudinal fracture):
Develop in sever concussive force (labyrinthine
concussion)

27. Hearing loss
 Conductive hearing loss due to
(longitudinal fracture):
1. Tympanic membrane perforation
2. Hemotympanium
3. Ossicular discontinuity

28. Ossicular discontinuity

29. Ossicular discontinuity

30. Incus dislocation

31. Fascial nerve paralysis
 Immediate fascial paralysis
 Delayed fascial paralysis

32. In Transverse Fracture
 Lateral subtype: commonly involve the
perigeniculate region
 Medial subtype involve the labyrinthine
segment between the fundus of IAC and
genciulate ganglion.

33. In Longitudinal fracture
 Mostly found at the tympanic part of the
fascial nerve distal to the geniculate ganglion
at the mdi-tympanic part

34. Value of imaging in trauma to the temporal
bone:
 diagnosis of the type of fracture •
 delineation of the fracture line
 involvement of the inner ear & internal auditory
canal
 site of fascial nerve injury •
 detection of other associated intracranial
traumatic lesions •
 possible identification of ossicle disruption

35. Thanks to all

37. Inf tmpanic canliculid