Abstract
ObjectivesWe hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF).MethodsCharts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction.ResultsPatients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025).ConclusionsThe degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.
Highlights
In humans, temporal bone pneumatization (TBP) begins during prenatal development [1].Pneumatization refers to both the process by which the epithelium expands into developing bone and the resulting interconnected air cells within the temporal bone [2]
Temporal bone pneumatization (TBP) classifications and fracture types were correlated with temporal bone fracture (TBF) complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction
The degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone
Summary
Temporal bone pneumatization (TBP) begins during prenatal development [1].Pneumatization refers to both the process by which the epithelium expands into developing bone and the resulting interconnected air cells within the temporal bone [2]. Temporal bone pneumatization (TBP) begins during prenatal development [1]. Humans and primates have pneumatized spaces such as the mastoid air-cell system in temporal bones [3]. Studies suggested that the extent of pneumatization has decreased over the course of human evolution and usually limited to the mastoid, the petrous apex, and the perilabyrinthine regions in human temporal bones [4]. Poor pneumatization in temporal bone is closely associated with increased incidence and poor prognosis of these pathologic conditions. To explain this relationship, people have long debated the function of TBP and a number of theories have been proposed: 1) pressure buffer, 2) gas reserve, and 3) shock absorption spaces
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