Unusual course of otobasal fractures with liquorrhea

Abstract

In the literature the persistence of cerebrospinal Liquorrhea after temporal bone fractures is a rare event. Between 1989 and 1992 four cases of temporal bone fractures with dural involvement were operated at the University ENT Department Mainz. These temporal bone fractures showed delayed or persistent symptoms of dural lacerations between three and sixty months after head injury. During operation we found larger bone-dura defects (1-1.5 cm in diameter) and brain herniations in all cases. Strohm stated that only in rare cases a temporal bone fracture produced a larger gap in the tegmen tympani or antri. Therefore, we assumed that in our cases such larger bone-dura defects were caused by a gradual widening of the bony gap by a local elevation of intracranial pressure. Ferguson described this phenomenon in cases with spontaneous cerebrospinal Liquorrhea. Our cases showed that the cessation of cerebrospinal Liquorrhea is not a reliable sign of a healed dura defect. Therefore we propose that temporal bone fractures should be controlled closely in the first twelve months after trauma even if the dura defect seems to close spontaneously.