(0962) Temporal Bone Ballistic Trauma Requiring Surgical Management: A Case-Based Review

Introduction: Ballistic trauma (gunshot wound/penetrating missile injury) is a rare cause of temporal bone trauma. Patients often suffer comminuted fracture patterns, disruption of the external auditory canal (EAC) and/or Eustachian tube (ET), cranial nerve injuries, and/or craniocutaneous fistulae among other findings. In these cases, spontaneous rates of healing/recovery/resolution are low. As such, surviving patients often require surgical intervention. Although rare, ballistic trauma may be encountered by general/comprehensive otolaryngologists. In this study, we present four consecutive cases of ballistic temporal bone trauma, focusing on key presenting findings and management strategies.

Methods: Four consecutive cases involving clinically and radiographically confirmed ballistic trauma to the temporal bone were reviewed from 2018-present. Demographic, radiographic, operative, and outcomes data were collected retrospectively.

Results: All patients were male, aged 18-54y. All underwent surgery at our level 1 trauma center, and all required multidisciplinary team management. Ballistic injuries were of varying trajectory, all resulted in complex comminution of most or all of temporal bone anatomical subunits and some degree of facial nerve injury. Two patients required canal reconstruction typanomastoidectomy. Three out of four patients regained complete facial function, one required surgical decompression. Three patients developed cranio-cutaneous fistulae, two with active CSF leak requiring obliteration of the ET, tympanic, and mastoid spaces, along with EAC overclosure.

Conclusions: Ballistic trauma to the temporal bone carries high morbidity and mortality rates. Surviving patients often require surgical intervention to improve rates of cranial nerve recovery, close CSF fistulae, and avoid future infection risk. Timely management is important. This case series adds to the limited existing literature devoted to this topic.