J Korean Med Sci.  2023 Jul;38(27):e215. 10.3346/jkms.2023.38.e215.

Relationship Between Facial Bone Fractures and the Risk of Posttraumatic Complications: A Hypothesis on the Cushion Effect of the Facial Skeletons in Temporal Bone Fractures

• Kim H
• Han JG
• Park HY
• Choung YH
• Jang JH

• KMID: 2544415
• DOI: http://doi.org/10.3346/jkms.2023.38.e215

Abstract

Background
This study investigated whether concomitant facial bone (FB) fractures reduce temporal bone (TB) injuries, such as posttraumatic facial palsy and vertigo, through an impact absorbing effect, so-called “cushion effect,” in severe trauma patients.
Methods
A total of 134 patients with a TB fracture were included. They were divided into two groups according to their concomitant facial fractures: group I (no FB fracture) and group II (FB fracture). We compared clinical characteristics, such as brain injury, trauma severity, and complications of TB fracture, between the two groups.
Results
In group II, immediate facial palsy was more frequent (11.6% vs. 1.5% in group I), and the Injury Severity Score was higher (19.0 ± 5.9 vs. 16.7 ± 7.3, P = 0.020). Delayed facial palsy (12.3% in group I vs. 4.3% in group II) and posttraumatic vertigo (24.6% vs.7.2%) occurred more often in group I. FB fractures significantly decreased the incidence of posttraumatic vertigo (odds ratio [OR], 0.276; 95% confidence interval [CI], 0.083–0.914). Intraventricular hemorrhage (OR, 20.958; 95% CI, 2.075–211.677), facial nerve canal injury (OR, 12.229; 95% CI, 2.465–60.670), and FB fractures (OR, 16.420; 95% CI, 1.298–207.738) increased the risk of immediate facial palsy.
Conclusion
Concomitant FB fractures reduced the risk of the occurrence of delayed facial palsy and posttraumatic vertigo in injured patients with TB fracture. Particularly, an anterior force may be reduced by the cushion effect of the bony fracture.

Keyword

Temporal Bone Fracture; Facial Bone Fracture; Severe Trauma; Cushion Effect; Facial Palsy; Vertigo

Figure

• 

  Fig. 1 Directions of injury force that could be applied to FBs and the TB. (A) An injury may be applied to the FBs first, and then transmitted to the TB. (B) An injury may be applied to the TB first, and then transmitted to the FBs.FB = facial bone, TB = temporal bone.

• 

  Fig. 2 A decompression effect by the bony fracture. (A) The clear left middle ear space is noted. A soft tissue density is mainly shown in the temporomandibular joint area (white arrow). (B) The soft tissue density (white arrow) only fills the middle ear space.Lt. = left, Rt. = right.

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