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Resident Manual of Trauma to the Face, Head, and Neck
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B. Facial Nerve Characteristics....................................................... 142
II. Indications of Temporal Bone Injury
............................................. 143
A. Subjective Symptoms................................................................... 143
B. Objective Signs.............................................................................. 143
1. Hearing Loss............................................................................. 143
2. Hemotympanum .................................................................... 143
3. Otorrhea.................................................................................... 143
4. Imbalance..................................................................................144
5. Facial Nerve Dysfunction (Paralysis or Paresis)..............144
6. Auricular Ecchymosis, Lacerations, and Hematomas .....144
III. Classification of Temporal Bone Fractures
..................................144
A. Longitudinal versus Transverse Classification.......................144
1. Longitudinal injuries............................................................... 145
2. Transverse Fractures...............................................................146
B. Otic Capsule-Sparing versus Otic Capsule-Involving
Classification..................................................................................146
IV. Diagnostic Evaluations
...................................................................... 147
A. Full-Body Trauma Assessment ................................................. 147
B. Head and Neck Examination...................................................... 147
C. Hearing Evaluation........................................................................ 147
1. Weber Exam............................................................................. 147
2. Rinne Testing............................................................................148
3. Combined Weber, Rinne, and Audiogram Testing..........148
D. Vestibular Evaluation....................................................................148
E. Facial Nerve Evaluation................................................................149
1. Sunderland Classification of Nerve Injury.........................150
2. Evaluating Facial Paralysis and Paresis..............................150
3. Evaluation with Electromyography and
Electroneuronography............................................................. 151
F. Evaluation of Cerebrospinal Fluid Leaks.................................. 153
1. Diagnostic Tests...................................................................... 153
G. Imaging Studies............................................................................. 153
V. Surgical Management
....................................................................... 155
A. Indications for Surgery................................................................. 155
B. Timing of Surgical Procedures................................................... 155
C. Surgical Exposure Options.......................................................... 155
1. General Requirements for Surgery of the
Temporal Bone......................................................................... 155
2. Primary Surgical Objectives and Indications in
Temporal Bone Fractures....................................................... 155
3. Surgical Approaches for Accessing Injuries..................... 156
D. Reconstructive Options............................................................... 158