Gunshot injury to the temporal bone: an analysis of thirty-five cases.

By retrospective analysis of 35 surviving gunshot injuries to the temporal bone and by presentation of 6 representative cases, the management and reconstructive procedures of these injuries in the Tulane University affiliated hospitals are presented. The most frequent single injury was facial nerve paralysis (16 cases), followed by external canal injury and conductive hearing loss. Anacusis occurred in 12 cases. In conductive hearing loss the intact posterior wall tympanoplasty with mastoidectomy (16 cases), or the modified radical mastoidectomy (5 cases), allowed middle ear reconstruction. Transmastoid facial canal decompression, combined with the above procedures or with a middle fossa craniotomy, was performed in 6 cases. Delayed facial reconstruction (5 cases) utilized microneural anastomosis between facial-facial and hypoglossal-facial nerves and fascia lata slings. Intracranial complications of thrombosis of internal carotid artery, dural venous lacerations, temporal lobe aphasia, bitemporal hemianopsia, cerebral abscesses and meningitis are also discussed.