A 28-year-old man sustains severe head trauma in a road traffic accident. CT shows a fracture line running across the petrous pyramid perpendicular to its long axis. He has complete right facial paralysis immediately after injury, severe vertigo, and sensorineural deafness, but the tympanic membrane is intact. Which statement about his injury is correct?
- A This is a transverse fracture, and facial nerve involvement occurs in about half of cases, often immediately ✓
- B This is a longitudinal fracture, and facial palsy is usually delayed in onset
- C This is a longitudinal fracture, and hearing loss is typically conductive
- D This is a transverse fracture, and facial palsy almost never occurs
Correct answer: A. This is a transverse fracture, and facial nerve involvement occurs in about half of cases, often immediately
Explanation
Transverse fractures run perpendicular to the petrous axis, commonly from occipital blows, and traverse the internal auditory canal and cochlea, producing sensorineural deafness, severe vertigo and an intact tympanic membrane without bleeding from the ear. Facial nerve injury occurs in approximately 50% of transverse fractures, is frequently complete and of immediate onset because the nerve is transected or severely compressed. Longitudinal fractures, the commoner type, cause conductive loss and delayed facial palsy in only about 20%.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.