Temporal bone fractures and their complications. Examination with high resolution CT.

A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution CT (HRCT) a few hours to 21 months after the initial trauma. Axial HRCT disclosed 63 longitudinal, 13 transverse, 10 complex and 3 atypical fractures. The diagnosis of a temporal bone fracture was established by axial HRCT in almost every case. However, for the precise topographic analysis of the course of the fracture, additional coronal HRCT proved helpful. The most common, surgically treatable complication of temporal bone fracture is disruption of the ossicular chain. Twenty-three such lesions were demonstrated by combined axial and coronal HRCT; 22 lesions of the facial canal could be demonstrated in 27 patients presenting with facial nerve palsy. The most common site of injury to the facial canal was the region of the geniculate ganglion. The only life-threatening complication of a temporal fracture may be otorhinoliquorrhea. This was present in 9 cases. The most common site of leakage identified was the tegmen tympani. With Metrizamide-HRCT precise localisation of the dural laceration was possible in 7 of these 9 cases.