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Vol. 61. Issue 3.
Pages 204-214 (May - June 2019)
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Vol. 61. Issue 3.
Pages 204-214 (May - June 2019)
Update in Radiology
DOI: 10.1016/j.rxeng.2019.03.007
Traumatic injury of the petrous part of the temporal bone: Keys for reporting a complex diagnosis
Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe
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M. Varo Alonso
Corresponding author
manuelvaro91@gmail.com

Corresponding author.
, C. Utrilla Contreras, Á. Díez Tascón, P.S. García Raya, M. Martí de Gracia
Departamento de Radiología, Hospital Universitario La Paz, Madrid, Spain
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Table 1. Radiological findings according to symptoms.
Table 2. Findings associated with the traditional classification. After several reassessments of the classification, these findings were found not to be so related.
Table 3. Search systematics.
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Abstract

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematisation of the imaging findings, and the classifications used for temporal bone fracture. We emphasise the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Keywords:
Temporal bone injuries
Facial nerve trauma
Ear ossicles injuries
Inner ear injuries
Hearing loss
Basilar skull fracture
Emergency department
Carotid artery trauma
Diagnostic imaging
Resumen

La fractura de peñascos constituye una lesión común de la base del cráneo, y la mayoría son el resultado de traumatismos de alta energía. Su reconocimiento en politraumatizados puede realizarse en las tomografías computarizadas de cráneo y cervicales. Los hallazgos directos e indirectos suelen ser suficientes para establecer el diagnóstico. Su identificación es importante debido a que el hueso temporal contiene estructuras críticas, y es posible errar debido a la complejidad de esta región, y su insuficiente vigilancia. Este trabajo revisa los puntos clave anatómicos, la sistematización de los hallazgos radiológicos y las clasificaciones usadas en fracturas de hueso temporal. Cobra relevancia la identificación y descripción de los hallazgos relativos a estructuras importantes de esta región, la búsqueda de fracturas no visibles sospechadas por signos indirectos, y la identificación de estructuras anatómicas que pueden simular fracturas. Pierden valor las clasificaciones clásicas, aunque siguen condicionando el manejo terapéutico.

Palabras clave:
Hueso temporal/lesiones
Traumatismos del nervio facial
Osículos del oído/lesiones
Oído interno/lesiones
Pérdida auditiva
Fractura craneal basilar
Servicios médicos de urgencia
Traumatismos de las arterias carótidas
Diagnóstico por imagen

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