Comprehensive study on temporal bone fractures

Abstract Background Temporal bone fractures constitute a challenge owing to the complexity and proximity of the temporal bone to neurovascular structures. Our study aims to correlate the traditional and new classification systems of temporal bone fractures, study clinical presentations, and evaluate management strategies and their outcomes. Methods A prospective study at a tertiary care centre conducted from 2022 to 2024, including 40 patients over 12 years with post-traumatic temporal bone fractures. Fractures were classified using both traditional and otic capsule-based systems. Clinical manifestations, facial nerve function, and hearing outcomes were evaluated. Associations between classification types and clinical outcomes were explored through statistical analyses. Results Seventy-five percent of the patients were men and a peak incidence of fractures was noted in the 20–39 age group. 62.5% of cases were due to road traffic accidents. The most common type was longitudinal fracture (82.5%) and otic capsule-sparing fracture (87.5%). 37.5% of cases had hearing impairment and 80% of cases had hemotympanum. Among otic capsule-sparing fractures, fifteen patients had facial nerve palsy, 14 cases (93.3%) had delayed onset, while only 1 case (6.7%) had immediate onset. Among otic capsule-violating fractures, 3 out of 5 cases (60%) had delayed onset, and 2 cases (40%) had immediate onset. Surgical decompression led to a 50% recovery rate, whereas conservative management resulted in 77.5% complete recovery. A statistically significant association was found between classification type and facial nerve palsy outcomes. Conclusion Overall clinical correlations of the otic capsule-based classification are stronger and may serve as a valuable tool for guiding treatment decisions. Treatment for facial nerve palsy is largely conservative and leads to good results in mild-to-moderate cases, with surgical decompression being indicated in severe cases. Personalized treatment is important to ensure proper recovery and to avoid long-term complications.