The diagnosis and monitoring of patients presenting to an emergency department with blunt temporal bone fracture and complications requiring acute management were reviewed for a four-month period. Of 104 trauma patients with closed head injury, 15 patients were diagnosed with temporal bone fracture, 12 of whom survived their injuries. Four patients developed cerebrospinal fluid (CSF) otorrhea and two patients developed facial nerve paralysis; all patients had resolution of complications with conservative management. Significant shortcomings in the initial evaluation and monitoring of patients with temporal bone fracture were identified. Specific and thorough facial nerve examinations were not initially conducted on temporal bone fracture patients and subsequent inpatient monitoring for facial nerve paralysis and CSF otorrhea was incomplete. The outcome of temporal bone fracture is discussed. This article reminds the emergency physician of the importance of initial diagnosis and documentation of temporal bone fractures.