An Analysis of the Correlation between Temporal Bone Fracture and Potential Complications: Is There a Need for a New Classification System?

Background and Aim: Temporal bone fractures may occur in as many as 75% of all cases of skull base fractures; in 84% of instances, the CT scan demonstrates pathological findings. Traditional classification, according to Ulrich and Blumer, goes back to the 1930s and was established after a series of cadaveric radiographic imaging. Hence, fractures are typically classified as longitudinal (85%) or transverse (15%). Transverse fractures are thought to be associated with the potential appearance of major complications, such as sensorineural or conductive hearing loss, facial nerve paralysis, and CSF leak. However, newer classifications have been recently proposed (otic capsule violating, petrous, nonpetrous, etc.). The aim of this study is to evaluate the traditional classification, especially with regard to its predictive ability to correlate with potential complications. Material and Methods: Cumulative data were collected from all known different retrospective case series through a systematic review of the literature in Medline and other database sources. All cases were statistically reanalyzed using the chi-square test. Results: Based on the available data, a correlation between fracture type and the presence of one of the four main aforementioned complications was calculated. The rate of each individual complication was different between longitudinal and transverse fractures; however, nearly none of the differences was statistically significant ( P > 0.1). Conclusions: The classic classification system may be unable to predict the occurrence of complications because it shows poor correlation to clinical findings. However, the establishment of a satisfying alternative system is still pending.