A temporal bone fracture represents roughly 20% of skull fractures. Temporal bone fractures are classified as either longitudinal or transverse. Longitudinal fractures represent the majority of temporal bone fractures. Longitudinal fractures typically manifest with middle-ear injury and result in conductive hearing loss. They are not as likely to injure the facial nerve. Transverse fractures can result in otic capsule involvement causing sensorineural hearing loss and vertigo. They are also more likely to result in facial nerve injury.
The initial evaluation of temporal bone fracture is exceedingly important as the presence or absence of facial nerve injury must be documented. If facial paralysis is present, it is critical to differentiate between immediate versus delayed onset facial paralysis. Delayed onset facial paralysis has a significantly better prognosis for recovery. The presence or absence of a cerebrospinal fluid leak must also be evaluated. Audiological evaluation is performed when the patient is stable.