Management of Gunshot Wound Injuries to the Lateral Skull Base

Background Gunshot wounds (GSWs) to the lateral skull base can involve several critical neurovascular structures and present dilemmas in management. Chicago and its neighboring suburbs are experiencing a wave of gunshot victims. We review our experience at a Level 1 Trauma Center in the western suburbs of Chicago over the past 10 years of GSW to the temporal bone and lateral skull base and discuss their presentation, management, and patient outcomes.

Objective To review the incidence and presentation of patients with GSW to the temporal bone and lateral skull base. To discuss nonsurgical and surgical management as well as patient outcomes.

Methods Retrospective review of all patients who presented with GSW to the temporal bone and lateral skull base from August 2007 to present at the Loyola University Medical Center. Patients were identified using the ICD-9 diagnosis codes for GSW to the auricle, ear, and head and chart review was performed to identify those patients with involvement of the temporal bone. IRB approval was obtained prior to the start of the study.

Results Data are currently being collected. A total of seven patients were identified, all of whom were male. The average age at presentation was 27 years. Six out of the seven patients denied any prior medical history. One patient reported a history of depression and anxiety disorder. One of the seven injuries was self-inflicted. All GSW involved the temporal bone; the squamous segment was involved in 43% of cases, tympanic segment in 57%, mastoid segment in 71%, and petrous segment in 29%. The otic capsule was involved in four of seven patients and four of seven patients had complete facial paralysis (House–Brackmann’s scale of 6) at presentation. Additional presenting injuries included cerebrospinal fluid (CSF) leak (four of seven), intracranial injury (five of seven), facial fractures (three of seven), and optic nerve injury (two of seven). Fifty-seven percent of patients underwent surgical intervention, which include facial nerve decompression, lateral temporal bone resection, labyrinthectomy, and facial nerve neurorrhaphy for management of GSW to temporal bone. Average time from presentation to surgery was 20 days. Of the patients with complete facial paralysis at presentation who underwent surgical intervention, one patient had HB 6 at 1-month follow-up and the other had HB 3 at 5-month follow-up. None of the patients had audiograms performed at initial presentation. All patients with involvement of the otic capsule had profound sensorineural hearing loss on follow-up. Postoperative complications occurred in two out of seven patients; one patient had a CSF leak and infected carotid pseudoaneurysm and the other had an intracranial abscess and osteomyelitis. One of the seven patients died due to GSW injury.

Conclusion GSW to the temporal bone can have varying presentations depending on the site involved. Injury to facial nerve and otic capsule are common and can have lasting sequelae. Surgical management depends on site of injury and presenting symptoms.