Abstract
A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal literature, we could not find any publications on this topic. Tympanal bone fracture may lead to chronic complications (including external auditory canal stenosis and conductive hearing loss), with an important impact in both the medical and judiciary fields (e.g., chronic disabilities with loss of income). We decided to investigate the prevalence and mechanisms of tympanal bone fractures by means of a retrospective observational study on living victims who underwent head computed tomography after blunt head trauma and clinical forensic investigation at our center. We selected 159 cases of living victims with blunt head trauma (following an assault, traffic accident, or work accident) between January 2016 and December 2020. Re-examination of head imaging revealed 12 cases of tympanal bone fracture. Seven individuals showed cranial fractures involving the petrous bone (on the same side as the tympanal bone fracture). Three individuals had a temporomandibular fracture after a fall with chin impact. Only two victims exhibited an isolated tympanal bone fracture.
Highlights
Tympanal bone fracture (TBF) is an uncommon complication of blunt head trauma and is mostly associated with a mandibular or petrous bone fracture [1,2,3,4,5,6,7,8,9,10]
All the included cases were victims of high-energy blunt head trauma: four were victims of assault, with all of them characterized by kicks to the head; two were involved in a traffic accident, as a non-helmeted cyclist hit by a car and a fall from a moving tractor, respectively; two were victims of a work accident
It may be useful to underline here that in 10 out of 12 cases, both medical and forensic radiologists had detected TBF when present, as this was confirmed during the re-evaluation performed for the purpose of the present study
Summary
Tympanal bone fracture (TBF) is an uncommon complication of blunt head trauma and is mostly associated with a mandibular or petrous bone fracture [1,2,3,4,5,6,7,8,9,10]. It can lead to several complications, including external auditory canal (EAC) stenosis [2, 5, 11, 12] with conductive hearing loss [8, 11] For this reason, it deserves proper medical follow-up and the attention of the forensic pathologist due to the risk of long-term disability and loss of income. Intrigued by the observation of an isolated TBF after highenergy blunt chin impact in a victim who underwent clinical forensic investigation, we performed a review of the literature and found that this type of fracture is quite uncommon. Upon the arrival of paramedics, the young man was unconscious (Glasgow Coma Scale 8/15) He was intubated and transported to the Geneva University Hospitals for medical care. Head CT performed at the hospital for clinical purposes showed an isolated fracture of the left tympanal bone, interpreted as the consequence of blunt trauma with high-energy impact to the chin.
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