Resident Manual of Trauma to the Face, Head and Neck

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

Resident Manual of Trauma to the Face, Head, and Neck 8