A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic
by
,
Walter M. Jongbloed
1,*, 
Desiree Campbell
1,
Chia-Ling Kuo
2,
Kelin Zhong
2 and
Norman J. Cavanagh
3 1
Department of Otolaryngology, Head and Neck Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
2
The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
3
Department of Oral and Maxillofacial Surgery, Hartford Hospital, Hartford, CT 06106, USA
*
Author to whom correspondence should be addressed.
Surgeries 2025, 6(2), 33; https://doi.org/10.3390/surgeries6020033
Submission received: 13 February 2025
/
Revised: 23 March 2025
/
Accepted: 25 March 2025
/
Published: 9 April 2025
Abstract
:Background/Objectives: This study identifies and characterizes temporal bone fractures over a five-year period at a level one trauma center, focusing on the injury mechanism, otic capsule involvement, facial nerve involvement, fracture orientation, and the impact of the COVID-19 pandemic on skull base trauma. Methods: This retrospective cross-sectional study from a single level one trauma center reviewed skull base fractures from March 2018 to July 2023, identified with ICD-10 codes. Temporal bone fractures were categorized as otic capsule-sparing or -involving and by orientation (transverse, longitudinal, or oblique). Data were grouped into before, during, and after the COVID-19 lockdown period to address the impact of the COVID-19 pandemic. Data were also grouped into facial nerve injury and no facial nerve injury. Fisher’s exact test (5% significance) and descriptive statistics were used to compare groups. Results: A total of 364 fractures were identified. Facial nerve injuries (6.1%) were more likely in otic-capsule-involving (p < 0.001) and transverse or oblique fractures (p < 0.001). During the COVID-19 lockdown, hospital stays (p = 0.011) and ICU days (p = 0.035) were shorter. Among 22 facial nerve injury cases, half received high-dose steroids, but 6 died before evaluation. Six had complete paralysis; all received steroids, and three had surgical decompression. Only two had documented recovery. Of the 10 patients with partial paralysis, 5 received steroids, but only 2 showed improvement. All patients with incomplete eye closure received protective measures. Conclusions: Temporal bone fractures involving the otic capsule or transverse/oblique patterns are more likely to result in facial nerve injury. There are treatment discrepancies, which highlight a lack of a standard approach to treating those with facial nerve injury. An analysis of the impact of the COVID-19 pandemic revealed shorter hospital and intensive care stays during this time.
1. Introduction
There are limited data on how global events, such as the COVID-19 pandemic, influence trauma patterns, particularly skull base injuries. This study aims to fill this gap by examining the impact of the pandemic on temporal bone fractures, providing valuable insights to enhance future trauma preparedness and care strategies. Specifically, the study compares the characteristics of temporal bone fractures before, during, and after the COVID-19 lockdown period to evaluate whether community mitigation measures influenced the factors associated with these fractures, including patients’ hospital courses.
Social distancing, a key intervention to curb the spread of infectious diseases, was widely implemented during the pandemic [1,2]. While specific policies varied by region, the period from March 2020 to July 2020 is broadly recognized as the COVID-19 lockdown [3]. The existing literature highlights significant shifts in trauma patterns during this time. For instance, fractures resulting from assaults increased, while those from falls decreased [4]. Additionally, there was a notable rise in facial fractures caused by gun violence, alongside a decrease in blunt trauma and an increase in penetrating injuries [4]. Researchers attribute the overall decline in facial trauma cases during the lockdown to reduced mobility and more time spent at home, lowering the likelihood of sustaining such injuries [4].
Most temporal bone fractures are secondary to high-energy blunt head trauma, such as motor vehicle accidents, assaults, and falls [5,6,7]. Temporal bone fractures can be classified according to the involvement of the otic capsule. Those fractures that involve the otic capsule may involve the cochlea, vestibule, and semicircular canals, which can therefore be associated with facial nerve injury, cerebrospinal fluid leak, and sensorineural hearing loss [8]. This system has largely replaced the more traditional system of transverse versus longitudinal versus oblique (Figure 1), as the otic capsule classification demonstrates better predictive ability for serious clinical outcomes [8,9,10]. Longitudinal fractures typically run parallel to the external auditory canal, through the middle ear, anterior to the otic capsule, and parallel to the petrous ridge, whereas transverse fractures run perpendicular to the petrous ridge, often including the internal auditory canal. Longitudinal fractures tend to result from lateral blows to the temporal or parietal skull, while transverse fractures are more associated with frontal or occipital blows. The third type, the oblique fracture, crosses the petrotympanic fissure.
The primary aim of this study is to evaluate the impact of the COVID-19 lockdown on the characteristics of temporal bone fractures and the hospital course of trauma patients. The secondary aims include a contribution to the existing literature on the management of temporal bone fractures, particularly regarding fracture patterns, associated complications, and treatment approaches. Furthermore, this study highlights the lack of standardization in corticosteroid recommendations for the treatment of facial nerve injury.
2. Materials and Methods
A retrospective cohort study was designed. The study sample was composed of patients who presented to Hartford Hospital in Hartford, Connecticut, USA, between March 2018 and July 2023 who were admitted to the hospital with any traumatic injury. ICD-10 codes corresponding to skull base fractures were included: S00.401A, S00.409A, S00.412A, S01.312A, S02.0XXA, S02.0XXB, S02.101A, S02.101B, S02.102A, S02.102B, S02.109A, S02.109B, S02.113A, S02.113B, S02.118A, S02.118B, S02.119A, S02.119B, S02.11AA, S02.11BA, S02.11CA, S02.11DA, S02.11FA, S02.11GA, S02.11GB, S02.11HA, S02.11HB, S02.121A, S02.121B, S02.122A, S02.122B, S02.129A, S02.19XA, S02.19XB, S02.81XA, S02.82XA, S02.91XA, S02.91XB, S02.81XA, S02.82XA, S02.91XA, S02.91XB, S03.00XA, S03.01XA, S03.02XA, S03.03XA, S03.40XA, S03.41XA, S03.42XA, S03.43XA, S04.61XA, S09.20XA, S09.21XA, S09.22XA, S09.301A, S09.302A, S09.309A, S09.391A, S09.392A, S09.399A, S09.91XA. The electronic medical record was then searched, and those patients with temporal bone fractures identified on computed tomography scans were included. Variables were extracted from the institutional trauma registry and the electronic medical records. Patient demographics (Table 1) and variables associated with temporal bone fracture were extracted from the trauma registry (Table 2). Variables associated with the hospital stay were also retrieved from the registry (Table 3). More detailed characteristics of the fracture (orientation and otic capsule involvement), treatment recommendations, and steroid dosing were extracted from the electronic health record. The Hartford Hospital Institutional Review Board approved this study (HH IRB# E-HHC-2023-0249).
The demographics of patients with temporal bone fractures and the characteristics of their fractures were descriptively summarized across the time periods before, during, and after the COVID-19 lockdown using frequencies and percentages. The presence of alcohol, hospital length of stay, days in the intensive care unit, days on a ventilator, and mortality status were summarized for each period and compared across the three periods using Kruskal–Wallis tests. Additionally, patients with facial nerve injury were compared with those without facial nerve injury regarding temporal bone fracture characteristics using Fisher’s exact tests. A logistic regression model was used to model the factors individually associated with facial nerve injury. Odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were reported. Lastly, the treatments received by patients with facial nerve injury were descriptively characterized. All hypothesis tests were two-sided, with p-values assessed at a significance level of 0.05. Analyses were conducted using R software, version 4.2.2.
3. Results
A total of 364 patients were identified with temporal bone fractures between March 2018 and July 2023. There were 32 temporal bone fractures during the COVID-19 lockdown period from March 2020 to 31 July 2020. The demographics of patients with temporal bone fractures in each group are shown in Table 1. Table 1 shows that most patients were non-Hispanic white males between the ages of 40 and 60. The characteristics of temporal bone fractures in this study population are shown in Table 2, including the injury location, injury type, mechanism of injury, laterality of the fracture, involvement/injury of the facial nerve, fracture orientation, and otic capsule involvement. There was no significant difference between periods (before, during, or after the COVID-19 lockdown) in terms of injury location (p = 0.787), mechanism of injury (p = 0.165), or injury type (p = 0.780). Across the three periods, the most common injury location was a street or highway, followed by private residence. For the mechanism of injury, fall was the leading mechanism. Overall, blunt injuries prevailed over penetrating injuries. Injury to the facial nerve was rare, ranging between 4.4% and 9.4%; overall, 22 of 364 temporal bone fractures resulted in facial nerve injury, or 6.0%. Figure 1 shows fracture orientation and involvement of the otic capsule. The majority (75.9%) of fractures were longitudinal in orientation, and 94.5% spared the otic capsule (Figure 1). Figure 2 details representative CT images of longitudinal and transverse temporal bone fractures.
There were differences between the before, during, and after periods of COVID-19 lockdown when considering the elements of hospital stays. Table 3 highlights the differences in hospital stays between these periods, detailing the presence of alcohol, hospital length of stay, days in intensive care unit, days on ventilator, and overall disposition. Across the three periods, about one-third of patients were positive for alcohol on arrival to the hospital. The hospital length of stay was shorter during the COVID-19 lockdown (p = 0.011), and the metric of days spent in the intensive care unit was also shorter (p = 0.035). Overall, patients with temporal bone fractures had a 20.1% risk of mortality (75/364) in our study population. The mortality rate did not significantly differ among the three time periods.
A comparison of those with and without facial nerve injury reveals differences in fracture patterns. Table 4 highlights the differences between those with facial nerve injuries and those without facial nerve injuries. There was no significant difference in the location of injury (p = 0.868), mechanism of injury (p = 0.739), or injury type (p = 0.227). However, fracture orientation was significantly different between groups, with higher incidence of longitudinal fractures in those without facial nerve injuries, while transverse and oblique fractures were frequently observed in those with facial nerve injuries (p < 0.001). Likewise, otic capsule involvement was much more common in those with facial nerve injuries than those without (p < 0.001). Fracture orientation and otic capsule involvement were each individually associated with facial nerve injury. In a logistic regression model including both variables, otic capsule involvement remained statistically significant (p = 1.24 × 10−5). The odds ratio for otic capsule involvement (compared to sparing) was 29.87 (95% CI: 6.51–137.02). In contrast, fracture orientation was no longer statistically significant (p = 0.267), although the odds ratios comparing transverse and oblique fractures with longitudinal fractures were substantial: 2.43 (95% CI: 0.58–10.10) and 0.80 (95% CI: 0.14–4.48), respectively.
A subgroup analysis of facial nerve injuries revealed treatment discrepancies. Table 5 details the specific characteristics of those with facial nerve injuries (n = 22). Of the four patients with documented cerebrospinal fluid leaks, they were resolved. The time to resolution ranged from 7 to 15 days. Treatment in all patients included head of bed elevation and stool softeners, while one required lumbar drain placement. Half of the patients with facial nerve injury were treated with high-dose steroids. Table 6 details the various steroid regimens which were used in this setting, highlighting a lack of a standardized treatment protocol. Overall, complete paralysis was documented in six patients, all of whom were treated with high-dose steroids. Three patients with complete paralysis had surgical decompression, with one of these patients having resolution of paralysis. Only two patients with complete paralysis had documented resolution of facial nerve injury; one had decompression, and the other was treated with high-dose steroids alone. Partial or incomplete paralysis was noted in 10 patients. Five of these patients were treated with high-dose steroids. Two patients with partial paralysis had documented improvement in facial nerve function; one was treated with high-dose steroids, and the other was not. Of the four patients with documented facial nerve recovery, the time to recovery ranged from 2 to 15 days. There were six patients with facial nerve injury that was strongly suggested in radiographic studies but who were deceased before formal evaluation. Therefore, treatment recommendations could not be made. All patients with incomplete eye closure were treated with eye precautions (eye taping at night and lubricating eye drops).
4. Discussion
This study provides a comprehensive analysis of temporal bone fractures over a five-year period at a level one trauma center, with a particular focus on the impact of the COVID-19 lockdown on fracture characteristics and hospital course. Additionally, it highlights significant discrepancies in the management of facial nerve injuries, particularly in corticosteroid use. These findings reinforce the well-established association between otic-capsule-involving fractures and an increased risk of facial nerve injury. In our cohort, these fractures were significantly more likely to result in facial nerve injury compared to otic-capsule-sparing fractures (p < 0.001), aligning with prior studies that reported higher rates of facial nerve injury, CSF leaks, and sensorineural hearing loss (SNHL) in otic-capsule-violating fractures [7,8]. Furthermore, transverse and oblique fractures were more frequently associated with facial nerve injury, a pattern consistent with previous research [8,11]. In the multivariate logistic regression model that included both fracture orientation and otic capsule, only otic capsule remained statistically significant, while fracture orientation did not, despite all odds ratios being practically significant. The wide confidence intervals suggest uncertainty in the odds ratio estimates due to limited power in detecting smaller but meaningful effect sizes, such as those associated with fracture orientation. A larger study is needed to replicate our findings and account for potential confounding factors that may bias the observed associations.
The incidence of otic-capsule-violating fractures in our study (5.5%) closely mirrors the 5.6% reported by Dahiya et al. and is higher than the 2.5% reported by Brodie and Thompson [7,11]. The literature supports an 8-fold increase in CSF leaks in otic-capsule-involving fractures compared to sparing fractures [8]. In our cohort, one patient with a documented CSF leak was treated with broad-spectrum antibiotics, but the use of prophylactic antibiotics to prevent meningitis remains controversial. Prior studies have reported a higher proportion of CSF leaks in otic-capsule-involving fractures [12]. Additionally, sensorineural hearing loss was nearly 7 times more likely in otic-capsule-involving fractures than in sparing fractures [12]. Unfortunately, due to poor patient follow-up, we were unable to effectively measure hearing loss in our patient population.
Another key finding is the lack of standardization in corticosteroid use for facial nerve injury following temporal bone fractures. In our study, half of the patients with facial nerve injuries received corticosteroids, with wide variability in dosing regimens (Table 6). Notably, high-dose corticosteroids are contraindicated in traumatic brain injury (TBI) patients due to increased mortality risk, as demonstrated in the CRASH trial [13]. A 2005 Cochrane Review further advises against steroid use in acute TBI due to poor outcomes [14]. Given the high prevalence of concurrent head trauma in patients with temporal bone fractures, routine use of steroids in this population warrants caution. While steroid dosing in our study was lower than that used in the CRASH trial (methylprednisolone 2 g IV bolus, then 0.4 g/h for 48 h), the safety of the regimens used in our cohort remains uncertain. Within the field of otolaryngology, steroid use is generally more conservative, but it is important to exercise caution when prescribing high-dose corticosteroids in this patient population. This emphasizes a multidisciplinary discussion between the neurological intensive care and otolaryngology teams.
The role of electrophysiological testing in guiding facial nerve injury management is another area of variability. Electroneurography (ENoG) and electromyography (EMG) are valuable prognostic tools for predicting nerve recovery. Gantz et al. recommend ENoG testing within 10–14 days after injury to assess Wallerian degeneration and determine the need for surgical decompression [15,16]. In cases where ENoG shows >90% degeneration, recovery is less likely without intervention [15]. Our findings emphasize the importance of standardized nerve conduction studies in surgical decision making, as only one of the three patients who underwent decompression in our cohort had documented functional recovery.
The COVID-19 lockdown significantly altered hospital resource utilization, with shorter hospital stays (p = 0.011) and ICU days (p = 0.035) compared to pre- and post-lockdown periods. This may reflect hospital policy changes, shifts in trauma mechanisms, and streamlined patient management during the pandemic. However, fracture mechanisms and injury types remained largely unchanged, suggesting that while healthcare utilization was affected, the nature of skull base trauma itself was not significantly altered.
The COVID-19 lockdown had a notable impact on temporal bone fractures, particularly regarding hospital resource utilization and trauma patterns. This study found that while the mechanism and location of temporal bone fractures remained largely unchanged across pre-, during, and post-lockdown periods, there were significant shifts in hospital stays and ICU days during the lockdown. Patients admitted with temporal bone fractures from March to July 2020 had significantly shorter hospital stays and ICU admissions compared to other periods. This trend likely reflects hospital policies aimed at reducing inpatient capacity during the pandemic, prioritizing early discharge when possible. Despite these changes in healthcare utilization, the overall incidence and type of fractures did not drastically shift. Falls remained the most common cause, and blunt trauma predominated over penetrating injuries. Interestingly, while some studies suggested an increase in violence-related injuries during the pandemic, this study did not observe a significant shift in trauma mechanisms. However, the mortality rate among patients with temporal bone fractures remained consistent across all time periods, indicating that expedited hospital discharge did not necessarily compromise patient outcomes. Overall, the findings suggest that while the nature of temporal bone fractures remained stable, the COVID-19 lockdown influenced patient management strategies, reducing hospital resource utilization while maintaining similar clinical outcomes. Future research should explore long-term impacts on patient recovery and refine treatment protocols to improve standardization in the management of skull base fractures.
5. Recommendations
The authors recommend an evidence-based approach to the management of temporal bone fractures, recognizing that certain fracture patterns (otic-capsule-involving, transverse, and oblique) pose a higher risk of damage to critical structures, potentially leading to facial paralysis, CSF leak, and hearing loss. The surgical management of facial nerve injury with complete paralysis remains difficult to characterize due to the limited number of surgical interventions in this study. As prior literature suggests, ENoG and EMG are essential in guiding surgical decisions [15] and assessing facial nerve function, potentially preventing unnecessary intervention. The surgical options for acute facial paralysis include facial nerve decompression via a transmastoid, middle cranial fossa, and translabyrinthine approach, as well as nerve repair with primary or cable grafting [17]. Specific approaches to facial nerve decompression are beyond the scope of this research article; however, detailed approaches have been described [18]. The medical approach to the treatment of temporal bone fractures highlights the need for interdisciplinary discussion between the otolaryngologist and intensivist in the use of high-dose corticosteroids. Additionally, ensuring consistent follow-up with audiometry is critical for assessing hearing outcomes. The lack of follow-up in our cohort highlights a broader challenge in trauma care, where many patients are lost to follow-up, limiting the ability to evaluate long-term auditory sequelae.
6. Study Limitations
This study has several limitations. First, as a retrospective review, it is subject to documentation variability and potential selection bias. Differences in patient management across the time periods may reflect changes in institutional protocols rather than the true impact of COVID-19. Second, the sample size of patients with facial nerve injury was relatively small (n = 22), limiting the feasibility of subgroup analysis by time period. A larger cohort may provide more robust conclusions regarding treatment outcomes. Further, many of these patients with nerve injury were lost to follow-up, or the documentation was insufficient, such that the true rates of facial nerve recovery may be under-reported. Therefore, a full assessment of corticosteroid efficacy and surgical intervention cannot be performed. Future prospective studies should aim to establish standardized treatment guidelines and incorporate long-term follow-up data.
7. Conclusions
This study reinforces the strong association between otic-capsule-involving and transverse/oblique temporal bone fractures with facial nerve injury. The COVID-19 lockdown was associated with shorter hospital and ICU stays, although trauma patterns remained largely unchanged. Most notably, the treatment discrepancies in corticosteroid use highlight the need for standardized guidelines for facial nerve injury management. Given the potential risks of high-dose steroids in patients with traumatic brain injuries, an evidence-based approach is warranted, although the doses and tapers used in this study are well below those discouraged by the CRASH trial. This highlights the importance of a multidisciplinary discussion between the otolaryngology team and the intensivist. Future research should focus on prospective studies evaluating the efficacy of corticosteroids, the role of electrophysiological testing, and optimal surgical indications for facial nerve decompression.
Author Contributions
Conceptualization, W.M.J. and N.J.C.; methodology, W.M.J., C.-L.K. and K.Z.; data analysis and result interpretation, W.M.J. and D.C.; writing—original draft preparation, W.M.J.; writing—review and editing, W.M.J. and N.J.C. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The Hartford Hospital Institutional Review Board approved this study (HH IRB# E-HHC-2023-0249).
Informed Consent Statement
Category 4: Secondary research for which consent is not required: Secondary research uses of identifiable private information or identifiable biospecimens, if at least one of the following criteria is met: iii. The research only involves information collection and analysis involving the investigator’s use of identifiable health information when that use is regulated under 45 CFR parts 160 and 164, subparts A and E [HIPAA], for the purposes of “health care operations” or “research”, as those terms are defined at 45 CFR 164.501, or for “public health activities and purposes”, as described under 45 CFR 164.512 (b).
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Conflicts of Interest
The authors declare no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| COVID-19 | Coronavirus 2019 |
| ICD-10 | International Classification of Diseases, Tenth Revision |
| ICU | Intensive Care Unit |
| CSF | Cerebrospinal Fluid |
| SNHL | Sensorineural Hearing Loss |
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Figure 1.
Temporal bone fracture orientation and involvement of the otic capsule.
Figure 2.
Representative CT imaging of temporal bone fractures. (A) Transverse, otic-capsule-involving fracture (arrow); (B) Longitudinal, otic-capsule-sparing fracture (arrow).
Figure 2.
Representative CT imaging of temporal bone fractures. (A) Transverse, otic-capsule-involving fracture (arrow); (B) Longitudinal, otic-capsule-sparing fracture (arrow).
Table 1.
Demographics of patients with temporal bone fractures.
| Race | Before (n = 136) | During (n = 32) | After (n = 196) | |
|---|---|---|---|---|
| White | 107 (78.7%) | 24 (75.0%) | 137 (69.9%) | |
| Black | 4 (2.9%) | 1 (3.1%) | 18 (9.2%) | |
| Other | 20 (14.7%) | 3 (9.4%) | 28 (14.3%) | |
| Unknown | 1 (0.7%) | 4 (12.5%) | 12 (6.1%) | |
| Asian | 4 (2.9%) | 0 (0.0%) | 0 (0.0%) | |
| American Indian | 0 (0%) | 0 (0.0%) | 1 (0.5%) | |
| Ethnicity | ||||
| Not Hispanic or Latino | 114 (83.8%) | 25 (78.1%) | 151 (77.0%) | |
| Hispanic | 21 (15.4%) | 3 (9.4%) | 31 (15.8%) | |
| Unknown | 1 (0.7%) | 4 (12.5%) | 14 (7.1%) | |
| Gender | ||||
| Male | 96 (70.6%) | 25 (78.1%) | 155 (79.1%) | |
| Female | 40 (29.4%) | 7 (21.9%) | 41 (20.9%) | |
| Age | ||||
| Median | 50.0 | 53.5 | 44.5 | |
| Mean | 49.0 (SD 20.3) | 50.6 (SD 21.2) | 45.6 (SD 19.3) | |
SD: Standard deviation.
Table 2.
Characteristics of temporal bone fracture before, during, and after the COVID-19 lockdown.
| Injury Location | Before (n = 136) | During (n = 32) | After (n = 196) | |
|---|---|---|---|---|
| Street/highway | 56 (41.2%) | 12 (37.5%) | 70 (35.7%) | |
| Private residence | 41 (30.1%) | 9 (28.1%) | 63 (32.1%) | |
| Public location | 17 (12.5%) | 6 (18.8%) | 20 (10.2%) | |
| Unknown | 13 (9.6%) | 5 (15.6%) | 30 (15.3%) | |
| Pedestrian/walkway | 4 (2.9%) | 0 (0.0%) | 9 (4.6%) | |
| Hospital | 2 (1.5%) | 0 (0.0%) | 1 (0.5%) | |
| Construction site | 3 (2.2%) | 0 (0.0%) | 3 (1.5%) | |
| Mechanism of injury | ||||
| Motor vehicle collision | 23 (16.9%) | 6 (18.8%) | 32 (16.3%) | |
| Fall | 54 (39.7%) | 15 (46.9%) | 60 (30.6%) | |
| Motorcycle collision | 20 (14.7%) | 3 (9.4%) | 52 (26.5%) | |
| Bicycle | 3 (2.2%) | 1 (3.1%) | 6 (3.1%) | |
| Pedestrian | 11 (8.1%) | 4 (12.5%) | 13 (6.6%) | |
| Gun | 3 (2.2%) | 1 (3.1%) | 5 (2.6%) | |
| Assault | 10 (7.4%) | 1 (3.1%) | 7 (3.6%) | |
| Unknown | 2 (1.5%) | 0 (0.0%) | 11 (5.6%) | |
| Other blunt mechanism | 9 (6.6%) | 1 (3.1%) | 10 (5.1%) | |
| Injury type | ||||
| Blunt | 131 (96.3%) | 30 (93.8%) | 188 (95.9%) | |
| Penetrating | 5 (3.7%) | 2 (6.3%) | 8 (4.1%) | |
| Fracture laterality | ||||
| Right | 60 (44.1%) | 15 (46.9%) | 78 (39.8%) | |
| Left | 64 (47.1%) | 13 (40.6%) | 92 (46.9%) | |
| Bilateral | 12 (8.8%) | 4 (12.5%) | 26 (13.3%) | |
| Involvement of facial nerve | ||||
| No | 130 (95.6%) | 29 (90.6%) | 183 (93.4%) | |
| Yes | 6 (4.4%) | 3 (9.4%) | 13 (6.6%) | |
| Fracture orientation | ||||
| Longitudinal | 99 (72.8%) | 22 (68.8%) | 155 (79.1%) | |
| Transverse | 14 (10.3%) | 6 (18.8%) | 22 (11.2%) | |
| Oblique | 23 (16.9%) | 4 (12.5%) | 19 (9.7%) | |
| Otic capsule involvement | ||||
| Sparing | 129 (94.9%) | 30 (93.8%) | 185 (94.4%) | |
| Involving | 7 (5.1%) | 2 (6.3%) | 11 (5.6%) | |
Table 3.
Presence of alcohol, hospital length of stay, days in intensive care unit, days on ventilator, and mortality status of patients with temporal bone fractures.
Table 3.
Presence of alcohol, hospital length of stay, days in intensive care unit, days on ventilator, and mortality status of patients with temporal bone fractures.
| Presence of Alcohol | Before (n = 136) | During (n = 32) | After (n = 196) | p-Value | |
|---|---|---|---|---|---|
| No | 87 (64.0%) | 21 (65.6%) | 136 (69.4%) | 0.562 | |
| Yes | 49 (36.0%) | 11 (34.4%) | 60 (30.6%) | ||
| Hospital length of stay (days) | |||||
| Median (IQR) | 130.5 (45.8, 306.8) | 59.0 (20.3, 180.5) | 164.0 (58.5, 413.5) | 0.011 | |
| Mean (SD) | 213.6 (238.5) | 183.1 (277.3) | 300.6 (321.7) | ||
| Days in intensive care unit | |||||
| Median (IQR) | 3.0 (0.0, 7.3) | 0.5 (0.0, 4.0) | 3.0 (0.0, 9.0) | 0.035 | |
| Mean (SD) | 6.1 (11.8) | 3.9 (6.8) | 7.8 (11.7) | ||
| Days on ventilator | |||||
| Median (IQR) | 1.0 (0.0, 5.0) | 1.0 (0.0, 2.0) | 2.0 (0.0, 6.0) | 0.241 | |
| Mean (SD) | 4.7 (8.8) | 3.3 (6.5) | 7.1 (15.7) | ||
| Mortality status | |||||
| Alive | 108 (79.4%) | 23 (71.9%) | 158 (80.6%) | 0.500 | |
| Dead | 28 (20.6%) | 9 (28.1%) | 38 (19.4%) | ||
IQR: Interquartile range; SD: Standard deviation.
Table 4.
Characteristics of temporal bone fractures in those with facial nerve injury versus those without facial nerve injury.
Table 4.
Characteristics of temporal bone fractures in those with facial nerve injury versus those without facial nerve injury.
| Injury Location | Injury to Facial Nerve (n = 22) | No Injury to Facial Nerve (n = 342) | p-Value | |
|---|---|---|---|---|
| Street/highway | 11 (50.0%) | 127 (37.1%) | 0.868 | |
| Private residence | 7 (31.8%) | 106 (31.0%) | ||
| Public location | 1 (4.5%) | 42 (12.3%) | ||
| Unknown | 3 (13.6%) | 45 (13.2%) | ||
| Pedestrian/walkway | 0 (0.0%) | 13 (3.8%) | ||
| Hospital | 0 (0.0%) | 3 (0.9%) | ||
| Construction site | 0 (0.0%) | 6 (1.8%) | ||
| Mechanism of injury | ||||
| Motor vehicle collision | 5 (22.7%) | 56 (16.4%) | 0.739 | |
| Fall | 8 (36.4%) | 121 (35.4%) | ||
| Motorcycle collision | 4 (18.2%) | 71 (20.8%) | ||
| Bicycle | 0 (0.0%) | 10 (2.9%) | ||
| Pedestrian | 1 (4.5%) | 27 (7.9%) | ||
| Gun | 2 (9.1%) | 7 (2.0%) | ||
| Assault | 1 (4.5%) | 17 (5.0%) | ||
| Unknown | 0 (0.0%) | 13 (3.8%) | ||
| Other blunt mechanism | 1 (4.5%) | 19 (5.6%) | ||
| Injury type | ||||
| Blunt | 20 (90.9%) | 329 (96.2%) | 0.227 | |
| Penetrating | 2 (9.1%) | 13 (3.8%) | ||
| Fracture orientation | ||||
| Longitudinal | 8 (36.4%) | 268 (78.4%) | <0.001 | |
| Transverse | 9 (40.9%) | 33 (9.6%) | ||
| Oblique | 5 (22.7%) | 41 (12.0%) | ||
| Otic capsule involvement | ||||
| Sparing | 11 (50.0%) | 333 (97.4%) | <0.001 | |
| Involving | 11 (50.0%) | 9 (2.6%) | ||
Table 5.
Characteristics and treatment of patients with facial nerve injuries (n = 22).
| Characteristics | n (%) |
|---|---|
| Partial/incomplete paralysis | 10 (45.5%) |
| Complete paralysis | 6 (27.3%) |
| Delayed weakness | 4 (18.2%); average time was 6.5 days (range: 3–9 days) |
| Cerebrospinal fluid (CSF) leak | 4 (18.2%) |
| High-dose steroids | 11 (50%) |
| Surgical decompression | 3 (13.6%); one regained function, two did not |
| Eye precautions (taping, lubricating eye drops) | 10 (45.5%); all with incomplete eye closure |
| Deceased before formal evaluation | 6 (27.3%) |
Table 6.
High-dose corticosteroid tapers.
| Dexamethasone 8 mg every 8 h × 7 days, followed by Prednisone 80 mg once daily × 1 day, 70 mg × 1 day, 60 mg × 1 day, 50 mg × 1 day, 40 mg × 1 day, 30 mg × 1 day, 20 mg × 1 day, 10 mg × 1 day |
| Prednisone 60 mg once daily × 7 days, 40 mg × 3 days, 20 mg × 3 days, 10 mg × 2 days |
| Prednisone 60 mg once daily × 5 days, 40 mg × 2 days, 30 mg × 2 days, 20 mg × 2 days, 10 mg × 1 day |
| Prednisone 60 mg once daily × 3 days, 50 mg × 3 days, 40 mg × 2 days, 30 mg × 2 days, 10 mg × 2 days |
| Prednisone 40 mg once daily × 5 days, 60 mg × 2 days, 40 mg × 2 days, 20 mg × 2 days, 20 mg × 2 days 10 mg × 2 days |
| Dexamethasone 8 mg every 8 h × 7 days |
| Dexamethasone 8 mg every 8 h × 3 doses |
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MDPI and ACS Style
Jongbloed, W.M.; Campbell, D.; Kuo, C.-L.; Zhong, K.; Cavanagh, N.J. A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic. Surgeries 2025, 6, 33. https://doi.org/10.3390/surgeries6020033
AMA Style
Jongbloed WM, Campbell D, Kuo C-L, Zhong K, Cavanagh NJ. A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic. Surgeries. 2025; 6(2):33. https://doi.org/10.3390/surgeries6020033
Chicago/Turabian StyleJongbloed, Walter M., Desiree Campbell, Chia-Ling Kuo, Kelin Zhong, and Norman J. Cavanagh. 2025. "A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic" Surgeries 6, no. 2: 33. https://doi.org/10.3390/surgeries6020033
APA StyleJongbloed, W. M., Campbell, D., Kuo, C.-L., Zhong, K., & Cavanagh, N. J. (2025). A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic. Surgeries, 6(2), 33. https://doi.org/10.3390/surgeries6020033
