HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Otolaryngology (ENT)118 papers

Fracture of temporal bone

Last edited: 4/14/2026

Overview

Temporal bone fractures involve injuries to the petrous portion of the temporal bone, often complicating head trauma with potential otological and neurological sequelae. Accurate diagnosis and management are crucial to prevent long-term complications such as hearing loss and facial nerve palsy.

Diagnosis

  • Key Diagnostic Criteria: Clinical signs including otorrhea, facial nerve dysfunction, and hearing impairment.
  • Recommended Tests: High-resolution computed tomography (CT) scans are essential for detailed anatomical assessment 2237.
  • Grading: Traditional classification divides fractures into longitudinal, transverse, and mixed types; however, clinical relevance varies 35.

    • Management

  • First-Line Treatments:
    • - Immediate Care: Stabilize airway, manage intracranial hemorrhage if present 46. - Hearing Assessment: Audiograms are crucial in pediatric patients to monitor hearing loss 15.
  • Adjunctive Treatments:
    • - Surgical Intervention: Indicated for complications such as cerebrospinal fluid (CSF) leaks, severe conductive hearing loss, or facial nerve injuries 424. - Conservative Management: Includes monitoring and supportive care for less severe injuries 37.

    Special Populations

  • Pediatrics: Frequent use of high-resolution CT scans for accurate diagnosis; audiometric monitoring is essential 2225.
  • Elderly: Increased risk of associated intracranial injuries; careful evaluation for complications like cranial nerve palsies 46.
  • Comorbidities: Patients with pre-existing ear conditions may require more vigilant monitoring and intervention 315.

    • Key Recommendations

  • Utilize high-resolution CT scans for definitive diagnosis of temporal bone fractures to identify specific fracture types and associated injuries (Evidence: Strong 2237).
  • Implement audiometric testing in pediatric patients to assess and monitor hearing loss post-fracture (Evidence: Moderate 15).
  • Consider surgical intervention for complications such as CSF leaks, severe hearing loss, or facial nerve paralysis, guided by clinical presentation and imaging findings (Evidence: Moderate 424).
  • Employ structured self-assessment during simulation training to enhance resident performance in temporal bone surgery (Evidence: Moderate 2).
  • Utilize 3D-printed models and virtual reality simulators for training purposes to improve surgical skills and confidence among trainees (Evidence: Moderate 41327).

    • References

    1 Shah B, Xu W, Bartholomew RA, Ben-Shlomo N, Zhang A, Fan G et al.. Augmented Reality for Identification of Temporal Bone Anatomy and Comparison to Conventional Imaging. The Annals of otology, rhinology, and laryngology 2025. link 2 Andersen SAW, Frithioff A, von Buchwald JH, Sørensen MS, Frendø M. Am I doing this right? Structured self-assessment during simulation training of mastoidectomy improves cadaver dissection performance: a prospective educational study. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2023. link 3 Morales Puebla JM, López Juanes N, Varo Alonso M, Sánchez Cuadrado I, Gavilán Bouzas J, Lassaletta Atienza L. Clinical-radiological Correlation in Temporal Bone Fractures. Acta otorrinolaringologica espanola 2021. link 4 Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2021. link 5 Schwam ZG, Kaul VZ, Cosetti MK, Wanna GB. The utility of intraoperative navigation of the temporal bone for otolaryngology resident training. The Laryngoscope 2020. link 6 McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW et al.. Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. The Annals of otology, rhinology, and laryngology 2020. link 7 Shekhrajka N, Moonis G. Imaging of Nontraumatic Temporal Bone Emergencies. Seminars in ultrasound, CT, and MR 2019. link 8 Freiser ME, Ghodadra A, Hirsch BE, McCall AA. Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2019. link 9 Mowry SE, Woodson E, Gubbels S, Carfrae M, Hansen MR. A simple assessment tool for evaluation of cadaveric temporal bone dissection. The Laryngoscope 2018. link 10 Pisa J, Gousseau M, Mowat S, Westerberg B, Unger B, Hochman JB. Simplified Summative Temporal Bone Dissection Scale Demonstrates Equivalence to Existing Measures. The Annals of otology, rhinology, and laryngology 2018. link 11 Freiser ME, Ghodadra A, Hart L, Griffith C, Jabbour N. Safety of Drilling 3-Dimensional-Printed Temporal Bones. JAMA otolaryngology-- head & neck surgery 2018. link 12 Ioannou I, Zhou Y, Wijewickrema S, Piromchai P, Copson B, Kennedy G et al.. Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2017. link 13 Locketz GD, Lui JT, Chan S, Salisbury K, Dort JC, Youngblood P et al.. Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 14 Takahashi K, Morita Y, Ohshima S, Izumi S, Kubota Y, Yamamoto Y et al.. Creating an Optimal 3D Printed Model for Temporal Bone Dissection Training. The Annals of otology, rhinology, and laryngology 2017. link 15 Frisenda JL, Schroeder JW, Ryan ME, Valika TS, Billings KR. Cost effective use of audiograms after pediatric temporal bone fractures. International journal of pediatric otorhinolaryngology 2015. link 16 Cohen J, Reyes SA. Creation of a 3D printed temporal bone model from clinical CT data. American journal of otolaryngology 2015. link 17 Mowry SE, Jammal H, Myer C, Solares CA, Weinberger P. A Novel Temporal Bone Simulation Model Using 3D Printing Techniques. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2015. link 18 Hochman JB, Rhodes C, Kraut J, Pisa J, Unger B. End User Comparison of Anatomically Matched 3-Dimensional Printed and Virtual Haptic Temporal Bone Simulation: A Pilot Study. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2015. link 19 Wood CP, Hunt CH, Bergen DC, Carlson ML, Diehn FE, Schwartz KM et al.. Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries. AJNR. American journal of neuroradiology 2014. link 20 Hochman JB, Kraut J, Kazmerik K, Unger BJ. Generation of a 3D printed temporal bone model with internal fidelity and validation of the mechanical construct. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2014. link 21 Qureishi A, Garas G, Shah J, Birchall J. A two-cycle prospective audit of temporal bone computed tomography scan requests: improving the clinical applicability of radiology reports. The Journal of laryngology and otology 2014. link 22 Kang HM, Kim MG, Hong SM, Lee HY, Kim TH, Yeo SG. Comparison of temporal bone fractures in children and adults. Acta oto-laryngologica 2013. link 23 Yalçıner G, Kutluhan A, Bozdemir K, Cetin H, Tarlak B, Bilgen AS. Temporal bone fractures: evaluation of 77 patients and a management algorithm. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES 2012. link 24 Cvorovic L, Jovanovic MB, Markovic M, Milutinovic Z, Strbac M. Management of complication from temporal bone fractures. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2012. link 25 Nash R, Sykes R, Majithia A, Arora A, Singh A, Khemani S. Objective assessment of learning curves for the Voxel-Man TempoSurg temporal bone surgery computer simulator. The Journal of laryngology and otology 2012. link 26 Gidley PW, Thompson CR, Roberts DB, DeMonte F, Hanna EY. The oncology of otology. The Laryngoscope 2012. link 27 Zhao YC, Kennedy G, Yukawa K, Pyman B, O'Leary S. Can virtual reality simulator be used as a training aid to improve cadaver temporal bone dissection? Results of a randomized blinded control trial. The Laryngoscope 2011. link 28 Zhao YC, Kennedy G, Hall R, O'Leary S. Differentiating levels of surgical experience on a virtual reality temporal bone simulator. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010. link 29 Wan D, Wiet GJ, Welling DB, Kerwin T, Stredney D. Creating a cross-institutional grading scale for temporal bone dissection. The Laryngoscope 2010. link 30 Saraiya PV, Aygun N. Temporal bone fractures. Emergency radiology 2009. link 31 Fernandez SA, Wiet GJ, Butler NN, Welling B, Jarjoura D. Reliability of surgical skills scores in otolaryngology residents: analysis using generalizability theory. Evaluation & the health professions 2008. link 32 Torgerson C, Brydges R, Chen J, Dubrowski A. Low fidelity simulation of temporal bone drilling leads to improved but suboptimal outcomes. Studies in health technology and informatics 2007. link 33 Butler NN, Wiet GJ. Reliability of the Welling scale (WS1) for rating temporal bone dissection performance. The Laryngoscope 2007. link 34 Suzuki M, Hagiwara A, Ogawa Y, Ono H. Rapid-prototyped temporal bone and inner-ear models replicated by adjusting computed tomography thresholds. The Journal of laryngology and otology 2007. link 35 Ishman SL, Friedland DR. Temporal bone fractures: traditional classification and clinical relevance. The Laryngoscope 2004. link 36 Wiet GJ, Stredney D, Sessanna D, Bryan JA, Welling DB, Schmalbrock P. Virtual temporal bone dissection: an interactive surgical simulator. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2002. link 37 Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. The American journal of otology 1997. link 38 Nageris B, Hansen MC, Lavelle WG, Van Pelt FA. Temporal bone fractures. The American journal of emergency medicine 1995. link90096-9) 39 Gendeh BS, Gibb AG, Khalid BA. How I do it: an improved temporal bone holder. The Journal of laryngology and otology 1995. link 40 Natarajan B, Baxter A. Preparation of a temporal bone exhibit. The Journal of laryngology and otology 1994. link 41 Luker GD, Lee BC, Erickson KK. Spiral CT of the temporal bone in unsedated pediatric patients. AJNR. American journal of neuroradiology 1993. link 42 Williams WT, Ghorayeb BY, Yeakley JW. Pediatric temporal bone fractures. The Laryngoscope 1992. link 43 Ghorayeb BY, Yeakley JW. Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures. The Laryngoscope 1992. link 44 Hlozková M, Hlozek Z. Method of treatment of temporal bone for teaching and autoeducative purposes. Acta Universitatis Palackianae Olomucensis Facultatis Medicae 1991. link 45 Dolan KD. Temporal bone fractures. Seminars in ultrasound, CT, and MR 1989. link 46 Waldron J, Hurley SE. Temporal bone fractures: a clinical diagnosis. Archives of emergency medicine 1988. link 47 Aguilar EA, Yeakley JW, Ghorayeb BY, Hauser M, Cabrera J, Jahrsdoerfer RA. High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures. Head & neck surgery 1987. link

    Original source

    1. [1]
      Augmented Reality for Identification of Temporal Bone Anatomy and Comparison to Conventional Imaging. — Shah B, Xu W, Bartholomew RA, Ben-Shlomo N, Zhang A, Fan G et al. The Annals of otology, rhinology, and laryngology (2025)
    2. [2]
      Am I doing this right? Structured self-assessment during simulation training of mastoidectomy improves cadaver dissection performance: a prospective educational study. — Andersen SAW, Frithioff A, von Buchwald JH, Sørensen MS, Frendø M European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023)
    3. [3]
      Clinical-radiological Correlation in Temporal Bone Fractures. — Morales Puebla JM, López Juanes N, Varo Alonso M, Sánchez Cuadrado I, Gavilán Bouzas J, Lassaletta Atienza L Acta otorrinolaringologica espanola (2021)
    4. [4]
      3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. — Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2021)
    5. [5]
      The utility of intraoperative navigation of the temporal bone for otolaryngology resident training. — Schwam ZG, Kaul VZ, Cosetti MK, Wanna GB The Laryngoscope (2020)
    6. [6]
      Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. — McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW et al. The Annals of otology, rhinology, and laryngology (2020)
    7. [7]
      Imaging of Nontraumatic Temporal Bone Emergencies. — Shekhrajka N, Moonis G Seminars in ultrasound, CT, and MR (2019)
    8. [8]
      Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery. — Freiser ME, Ghodadra A, Hirsch BE, McCall AA Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2019)
    9. [9]
      A simple assessment tool for evaluation of cadaveric temporal bone dissection. — Mowry SE, Woodson E, Gubbels S, Carfrae M, Hansen MR The Laryngoscope (2018)
    10. [10]
      Simplified Summative Temporal Bone Dissection Scale Demonstrates Equivalence to Existing Measures. — Pisa J, Gousseau M, Mowat S, Westerberg B, Unger B, Hochman JB The Annals of otology, rhinology, and laryngology (2018)
    11. [11]
      Safety of Drilling 3-Dimensional-Printed Temporal Bones. — Freiser ME, Ghodadra A, Hart L, Griffith C, Jabbour N JAMA otolaryngology-- head & neck surgery (2018)
    12. [12]
      Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator. — Ioannou I, Zhou Y, Wijewickrema S, Piromchai P, Copson B, Kennedy G et al. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2017)
    13. [13]
      Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence. — Locketz GD, Lui JT, Chan S, Salisbury K, Dort JC, Youngblood P et al. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2017)
    14. [14]
      Creating an Optimal 3D Printed Model for Temporal Bone Dissection Training. — Takahashi K, Morita Y, Ohshima S, Izumi S, Kubota Y, Yamamoto Y et al. The Annals of otology, rhinology, and laryngology (2017)
    15. [15]
      Cost effective use of audiograms after pediatric temporal bone fractures. — Frisenda JL, Schroeder JW, Ryan ME, Valika TS, Billings KR International journal of pediatric otorhinolaryngology (2015)
    16. [16]
      Creation of a 3D printed temporal bone model from clinical CT data. — Cohen J, Reyes SA American journal of otolaryngology (2015)
    17. [17]
      A Novel Temporal Bone Simulation Model Using 3D Printing Techniques. — Mowry SE, Jammal H, Myer C, Solares CA, Weinberger P Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2015)
    18. [18]
      End User Comparison of Anatomically Matched 3-Dimensional Printed and Virtual Haptic Temporal Bone Simulation: A Pilot Study. — Hochman JB, Rhodes C, Kraut J, Pisa J, Unger B Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2015)
    19. [19]
      Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries. — Wood CP, Hunt CH, Bergen DC, Carlson ML, Diehn FE, Schwartz KM et al. AJNR. American journal of neuroradiology (2014)
    20. [20]
      Generation of a 3D printed temporal bone model with internal fidelity and validation of the mechanical construct. — Hochman JB, Kraut J, Kazmerik K, Unger BJ Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2014)
    21. [21]
      A two-cycle prospective audit of temporal bone computed tomography scan requests: improving the clinical applicability of radiology reports. — Qureishi A, Garas G, Shah J, Birchall J The Journal of laryngology and otology (2014)
    22. [22]
      Comparison of temporal bone fractures in children and adults. — Kang HM, Kim MG, Hong SM, Lee HY, Kim TH, Yeo SG Acta oto-laryngologica (2013)
    23. [23]
      Temporal bone fractures: evaluation of 77 patients and a management algorithm. — Yalçıner G, Kutluhan A, Bozdemir K, Cetin H, Tarlak B, Bilgen AS Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES (2012)
    24. [24]
      Management of complication from temporal bone fractures. — Cvorovic L, Jovanovic MB, Markovic M, Milutinovic Z, Strbac M European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2012)
    25. [25]
      Objective assessment of learning curves for the Voxel-Man TempoSurg temporal bone surgery computer simulator. — Nash R, Sykes R, Majithia A, Arora A, Singh A, Khemani S The Journal of laryngology and otology (2012)
    26. [26]
      The oncology of otology. — Gidley PW, Thompson CR, Roberts DB, DeMonte F, Hanna EY The Laryngoscope (2012)
    27. [27]
      Can virtual reality simulator be used as a training aid to improve cadaver temporal bone dissection? Results of a randomized blinded control trial. — Zhao YC, Kennedy G, Yukawa K, Pyman B, O'Leary S The Laryngoscope (2011)
    28. [28]
      Differentiating levels of surgical experience on a virtual reality temporal bone simulator. — Zhao YC, Kennedy G, Hall R, O'Leary S Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2010)
    29. [29]
      Creating a cross-institutional grading scale for temporal bone dissection. — Wan D, Wiet GJ, Welling DB, Kerwin T, Stredney D The Laryngoscope (2010)
    30. [30]
      Temporal bone fractures. — Saraiya PV, Aygun N Emergency radiology (2009)
    31. [31]
      Reliability of surgical skills scores in otolaryngology residents: analysis using generalizability theory. — Fernandez SA, Wiet GJ, Butler NN, Welling B, Jarjoura D Evaluation & the health professions (2008)
    32. [32]
      Low fidelity simulation of temporal bone drilling leads to improved but suboptimal outcomes. — Torgerson C, Brydges R, Chen J, Dubrowski A Studies in health technology and informatics (2007)
    33. [33]
      Reliability of the Welling scale (WS1) for rating temporal bone dissection performance. — Butler NN, Wiet GJ The Laryngoscope (2007)
    34. [34]
      Rapid-prototyped temporal bone and inner-ear models replicated by adjusting computed tomography thresholds. — Suzuki M, Hagiwara A, Ogawa Y, Ono H The Journal of laryngology and otology (2007)
    35. [35]
      Temporal bone fractures: traditional classification and clinical relevance. — Ishman SL, Friedland DR The Laryngoscope (2004)
    36. [36]
      Virtual temporal bone dissection: an interactive surgical simulator. — Wiet GJ, Stredney D, Sessanna D, Bryan JA, Welling DB, Schmalbrock P Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2002)
    37. [37]
      Management of complications from 820 temporal bone fractures. — Brodie HA, Thompson TC The American journal of otology (1997)
    38. [38]
      Temporal bone fractures. — Nageris B, Hansen MC, Lavelle WG, Van Pelt FA The American journal of emergency medicine (1995)
    39. [39]
      How I do it: an improved temporal bone holder. — Gendeh BS, Gibb AG, Khalid BA The Journal of laryngology and otology (1995)
    40. [40]
      Preparation of a temporal bone exhibit. — Natarajan B, Baxter A The Journal of laryngology and otology (1994)
    41. [41]
      Spiral CT of the temporal bone in unsedated pediatric patients. — Luker GD, Lee BC, Erickson KK AJNR. American journal of neuroradiology (1993)
    42. [42]
      Pediatric temporal bone fractures. — Williams WT, Ghorayeb BY, Yeakley JW The Laryngoscope (1992)
    43. [43]
      Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures. — Ghorayeb BY, Yeakley JW The Laryngoscope (1992)
    44. [44]
      Method of treatment of temporal bone for teaching and autoeducative purposes. — Hlozková M, Hlozek Z Acta Universitatis Palackianae Olomucensis Facultatis Medicae (1991)
    45. [45]
      Temporal bone fractures. — Dolan KD Seminars in ultrasound, CT, and MR (1989)
    46. [46]
      Temporal bone fractures: a clinical diagnosis. — Waldron J, Hurley SE Archives of emergency medicine (1988)
    47. [47]
      High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures. — Aguilar EA, Yeakley JW, Ghorayeb BY, Hauser M, Cabrera J, Jahrsdoerfer RA Head & neck surgery (1987)
    Share:TwitterRedditLinkedIn

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG