Difference between temporal bone fracture types: Longitudinal Vs Transverse: Made Easy

The temporal bone fracture are common with head injury accounting for 30 % of all head trauma and 75 % of all motor vehicle accident. 31% of temporal bone fracture are associated with Motor vehicle accident. 

Longitudinal fracture are common fracture caused by lateral forces over the mastoid and temporal squamosa and fracture line parallels petrous pyramid axis. It is generally anterior and extra-labyrinthine.

NEURAL SYMPTOMS WITH TRANSVERSE #

PHYSICAL SYMPTOMS WITH LONGITUDINAL #

Difference between temporal bone fracture types: Longitudinal Vs Transverse

Nerve Injury or neural component more common with transverse # Facial nerve injury(VII), vertigo(VIII: Vestibular Nerve), Sensorineural hearing loss(VIII: Auditory Nerve) and Nystagmus (vestibular Nerve/ CNS component) are more common and intense with transverse fracture.

Physical damage like bleeding demonstrated as  Hemotympanum and otorraghia , fractures seen as  CSF otorrhea, Conductive hearing loss due o disruption of ossicles and Tympanic membrane perforation, are common with longitudinal fracture. Neural component less common or less intense than it’s contrary.

Differential diagnoses of various otological symptoms

Parameter		Longitudinal Fracture	Transverse Fracture
Direction Of  Fracture		Along The Axis Of Petrous Pyramid	Perpendicular To Petrous Pyramid
Incidence		More Common (80%)	20%
Mechanism		Parieto Temporal Trauma	Fronto Occipital Trauma
Otoraghia	PHYSICAL DAMAGE	Common	Rare
Hemotympanum		Common	Possible
TM Perforation		Common	Rare
CSF Otorrhoea		Common	Occasional
Hearing Loss		Conductive	Sensorineural	NEURAL DAMAGE
Facial Nerve Injury		Less Common (20%) Often Temporary Delayed Onset	More Common (50%) Often Permanent Acute Onset
Vertigo		Common (Less Intense)	More Intense
Nystagmus		Common (Less Intense)	Common Third Degree

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Difference between Preseptal and Orbital Cellulitis

Difference between Preseptal Cellulitis and Orbital cellulitis

		Preseptal Cellulitis	Orbital Cellulitis
Anatomical Location		Anterior to orbital septum	Behind orbital septum
		Only periorbital skin and eyelid involved	Orbit is involved
Causes		Internal Herdeolum Acute Dacrocystitis Lid Trauma Insect Bite	Infected Sinus Spread of infection from teeth, face and lid
Age group			Common in Children
Clincal Features	Proptosis	absent	Axial Type
	Extraocular Movement	Normal	Restricted and painful
	Conjuctival congestion	Absent	Present and Necrotic
	Fever	Present	Present with vomiting and Prostation
	Vision	Normal	May be lost
	Pupillary reaction	Normal	May be lost
Complications		Orbital Cellulitis	Orbital: Subperiosteal and orbital Abscesses
			Ocular Blinding, Optic Neuritis, CRAO, Exposure keratitis
			Temporal, Intracranial or systemic Infection
Management	Medical	Oral Systemic Antibiotics	Ocular emergency Hospital Admission Intensive Broad spectrum antibiotic Therapy
	Surgical		STRONGLY CONTRAINDICATED Needle Aspiration and I and D
		Exploration and debridement	Canthotomy/Cantholysis

Various Types of cellulitis in Eye