Aetiology

• Can be classified as either longitudinal or transverse (many are mixed), depending on their relation to the axis of the ear canal
• Can also be categorised into fractures which involve the optic capsule and those which do not

Longitudinal fractures (80%)

• Typically occurring from a lateral blow to the head
• Fracture line parallel the long axis of the petrous pyramid

Transverse fractures (20%)

• Occur from fronto-occipital head trauma
• Fracture at right angles to the long axis of the petrous pyramid

Clinical features

Important questions to ask

• Injury mechanism
• Hearing loss
• Facial palsy - immediate or delayed
• CSF leak
• Associated injuries

Signs

• Bruising - Battle sign
  • Bruising over mastoid, indicates base of skull fracture
• Condition of TM and ear canal
• Cranial nerve examination, especially CN VII