Imaging of Temporal Bone Trauma

Temporal bone trauma is commonly seen in patients with craniofacial injury and can be detected using multidetector computed tomography. A thorough understanding of the different types of temporal bone fracture patterns is needed to accurately describe the trajectory of injury as well as anticipated complications. Fractures should be described based on direction, segment of temporal bone involved, as well as involvement of the otic capsule. More importantly, the radiologist plays an integral role in identifying complications of temporal bone injury, which often have significant clinical implications.

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It is important to identify associated complications related to temporal bone trauma that will guide management. Complications include injury to the tympanic membrane, ossicular chain, vestibulocochlear apparatus, facial nerve, tegmen, carotid canal, and venous system.

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The distal transverse and sigmoid sinuses travel through the posterior fossa within a groove along the medial margin of the mastoid portion of the temporal bone before exiting the skull base at the jugular foramen. These venous structures may also be injured when a fracture violates the sinodural plate or extends into the jugular foramen. It is important to review the soft tissue algorithm images of the posterior fossa as part of the temporal bone CT examination to assess for associated hyperdense venous sinus thrombosis, venous epidural hematoma, as well as associated cerebellar hemorrhage. Further evaluation with either CT venography or MR venography should be performed in those patients with fractures that involve the venous sinuses to assess the integrity of the venous system more comprehensively ( Fig. 16 ).

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