Temporal bone fractures (TBF) are commonly observed in patients sustaining blunt head trauma, constituting up to 70% of all skull fractures. In battlefield scenarios, these fractures frequently arise from blast injuries related to improvised explosive devices (IEDs) or penetrating trauma to the cranial region. TBF can lead to various complications, including injury to the facial and vestibulocochlear nerves, cerebrospinal fluid (CSF) and perilymphatic fistulas, damage to the vestibular apparatus and cochlea, as well as infections of the inner and middle ear and meningitis. Additionally, these fractures are often associated with significant intra- and extracranial injuries. This report presents a case involving a 62-year-old male patient who sustained a blunt head injury, resulting in a complex fracture of the temporal and occipital skull base. Upon admission, cerebrospinal fluid leakage from the left ear was observed. Conservative management with a sterile ear bandage was initiated. According to current literature, routine antibiotic therapy is not typically administered for such cases. After the CSF fistula persisted for seven days, a lumbar drain was placed for continuous CSF drainage, successfully mitigating the ear leakage. However, the weaning process from the lumbar drain was prolonged, leading to the consideration of combined trans- and retromastoid surgical procedures for definitive treatment. Ultimately, CSF drainage decreased without further surgical intervention, yet the patient subsequently developed bacterial meningitis, prompting the initiation of antibiotic therapy. Despite experiencing incomplete hearing loss, the patient achieved full recovery without additional deficits. This case underscores the potential risks associated with delayed antibiotic treatment in patients with significant CSF fistulas, a topic of ongoing debate within neurosurgical and otolaryngological communities. To establish treatment guidelines for military medical personnel, a systematic review of 210 cases from our military hospital was conducted. The findings are presented alongside current literature and serve as recommendations for the emergency management of TBF both domestically and in deployment settings.