Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Utility of Brain Computed Tomography in Detecting Fractures of the Temporal Bones Correlated with Patterns of Fracture on High-Resolution Computed Tomography

고해상도 전산화 단층촬영에서 확인된 골절 유형에 따른 측두골 골절의 진단에서 뇌전산화 단층촬영의 유용성

  • Kwon, Bong-Seok (Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Dong-Hyuk (Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Choi, Pil-Cho (Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Han, Sang-Kuk (Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Jeong-Hun (Department of Emergency Medicine, Ilsan Hospital, Dongguk University) ;
  • Song, Hyoung-Gon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 권봉석 (성균관대학교 의과대학 강북삼성병원 응급의학과) ;
  • 신동혁 (성균관대학교 의과대학 강북삼성병원 응급의학과) ;
  • 최필조 (성균관대학교 의과대학 강북삼성병원 응급의학과) ;
  • 한상국 (성균관대학교 의과대학 강북삼성병원 응급의학과) ;
  • 이정훈 (동국대학교 일산병원 응급의학과) ;
  • 송형곤 (성균관대학교 의과대학 삼성서울병원 응급의학과)
  • Received : 2010.06.07
  • Accepted : 2010.06.18
  • Published : 2010.06.30
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Abstract

Purpose: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. Methods: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. Results: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. Conclusion: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

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References

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