TRAUMA

FRAKTUR TULANG
TEMPORAL
Basis tulang tengkorak: os sphenoid, os
temporal, os occipital, os frontal
Fraktur os temporal 20%
Epidemiologi & etiologi:
FR: pria, <21thn
Etiologi sering: kecelakaan motor / sepeda,
terjatuh, kejang

Temporal Bone Fracturs

Longitudinal (80%)vs. Transverse
Oblique
Symptom:
facial nerve paralysis (partial or complete)
hearing loss (conductive, sensorineural, or mixed),
vertigo, dizziness, otorrhagia, cerebrospinal fluid
CSFotorrhea, tympanic membrane perforation,
hemotympanum and canal laceration
75% of all motor vehicle accidents.

Feature

Longitudinal Fractures

Transverse Fractures

Incidence

Approximately 80%

Approximately 20%

Mechanism

Temporal or parietal trauma

Frontal or occipital trauma

CSF otorrhea

Common

Occasional

Tympanic
membrane
perforation

Common

Rare

Facial nerve
damage

20% (most often temporary and

frequently delayed in onset)

50% (severe, usually

permanent, and immediate in
onset)

Hearing loss

Common (conductive type and

possibly high tone neurosensorial
secondary to concomitant inner
ear concussion)

Common (severe
sensorineural or mixed)

Hemotympanum

Common (associated with

otorrhagia)

Possible (not associated with

otorrhagia)

Nystagmus

Common (usually
spontaneous, usually less
intense [first or second
degree] or positional;
nystagmus absence also
possible)

Common (intense [third

degree], spontaneous,
fast component beating to
the opposite ear, long
lasting; positional
nystagmus also possible
before and after
compensation period)

 trauma tumpul ke lateral tengkorak (sering) fraktur

longitudinal (80%)
Mengikuti axis CAE ke celah telinga tengah
berjalan ke anterior bersama2 dg ganglion
geniculatus, tuba eustachian berakhir / mengarah
ke foramen lacerum
Disini otik kapsul tidak terkena
Trauma ke occipital terdorong ke arah f. magnum
fraktur temporal transversal (20%)
Fraktur menyeberang langsung ke arah petrous
fraktur kapsul otik

Gambaran Klinis &

Pemeriksaan
Tanda & Gejala:
Hearing loss, mual-muntah, vertigo
Battle sign (ekimosis postaurikuler)
Racoon sign (periorbital ecchimosis) fraktur melibatkan fossa cranial
anterior / medial

Pemeriksaan:
Laserasi CAE, bony debris di canal, hemotympanum
CSF otorrhea / rhinorrhea, paralisis n.7 kadang2

Pem. Penunjang lain:

CT scan kepala u/ cek perdarahan intrakranial (bth op segera)
hRCTscan os temporal hanya u/ kasus yg kemungkinan komplikasi (fraktur
otik kapsul, cedera n.7, kebocoran CSF)
Ps dg hemotimpanum, tanpa nistagmus & CSF, weber lateralisasi ke telinga
sakit, n.7 normal (-) perlu CT temporal

Pemeriksaan Lain
Audiometri
Harus dilakukan, namun tak perlu segera
kecuali: (+) tanda & gejala disfungsi telinga
dalam
Apabila pem: gg konduktif, (-) ada fraktur
kapsul otik audiometri dapat dilakukan
bbrp mgg setelahnya memberi waktu
hemotimpanum sembuh

Facial nerve testing

COMPLICATIONS

Conductive hearing loss

Sensorineural hearing loss
Mixed hearing loss
Vertigo/ nystagmus
Perilymphatic fistula
Traumatic endolymphatic hydrops
Meningitis
Posttraumatic benign paroxysmal positional vertigo
Facial paralysis

Komplikasi
Gg pendengaran konduktif
(sering) ok hemotimpanum. Kadang ok perforasi
m.timpani, diskontinuitas osikula ( dislokasi
incudostapedial)
Gg pendengaran sensorineural
Fraktur transversal dg keterlibatan fraktur otic capsule,
bs juga tanpa fraktur otic (ok conccusion labirin)
Concussion labirin gg membran koklear / sel rambut
ok tekanan gg pendengaran frekuensi tinggi
Cedera n. VII
Fraktur longitudinal (20%), fraktur transversal (50%)
Ada onset akut / delayed. Sering (-) disadari ok ps
sering ditemukan dalam keadaan koma

 Kebocoran CSF (20%) biasanya 48 jam

pasca trauma
Post traumatic encephalocele
Dapat terjadi ok defek besar pada dasar fosa
cranial media herniasi dura & lobus
temporal t. tengah & mastoid
Kadang terlihat di otoskop massa putih dg
p.d dibelakang m.timpani
Perilymphatic fistula
Apabila tdp fraktur kapsul optik, atau
subluksasi stapes ke jendela oval
Gejala: vertigo fluktuatif & tuli sensorineural