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Head and Neck Imaging

Longitudinal fracture, temporal bone

fracture more or less along the long axis of the temporal bone. Such a fracture typically originates from a blow to the temporoparietal portion of the skull, with inferior propagation of the fracture line through the mastoid into the lateral wall of the middle ear, passing behind, through, or in front of the external auditory canal (see external ear) (Fig.1). Depending on the force of impact, the fracture line may extend, deviated by the strong petrous bone, through the anteromedial wall of the middle ear (just lateral to the first genu of the facial canal). In extreme cases, the fracture may run through the central skull base into the opposite orbit.

Findings associated with this type of fracture include disruption of the ossicular chain, facial nerve palsy, concussion of the inner ear and a cerebrospinal fluid leak. A late complication may be post-traumatic cholesteatoma.

RH

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Fig.1

Axial CT-images of right temporal bone. Fracture in the upper lateral wall of the mastoid (a, arrow) extends inferolaterally through the mastoid cells, into the lateral wall of the tympanic cavity (b, arrows) and external auditory canal (c, arrows). Opacification of the mastoid cells, middle ear and external auditory canal: post-traumatic bleeding.
Longitudinal fracture, temporal bone, Fig.1 (a)
Longitudinal fracture, temporal bone, Fig.1 (b)
Longitudinal fracture, temporal bone, Fig.1 (c)