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Predicting complications of pediatric temporal bone fractures
Raj D Dedhia1, Oliver Y Chin2, Matthew Kaufman3
1Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Pediatric temporal bone fractures involving the otic capsule or associated with moderate/severe traumatic brain injury (TBI) have higher complication rates. Glasgow Coma Scale (GCS) predicts facial nerve injury and CSF leaks.
Area of Science:
- Pediatric Otolaryngology
- Neurosurgery
- Trauma Surgery
Background:
- Temporal bone fractures in children are uncommon but can lead to significant complications.
- Understanding risk factors is crucial for managing pediatric head trauma.
Purpose of the Study:
- To characterize complications of pediatric temporal bone fractures.
- To identify predictive risk factors for these complications.
Main Methods:
- Retrospective review of pediatric temporal bone fractures (2003-2017).
- Data collected included demographics, injury mechanism, fracture type, CT findings, and outcomes.
- Outcomes assessed: facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL).
Main Results:
- 117 patients with 129 fractures were analyzed.
- Otic capsule violating (OCV) fractures showed higher rates of CSF leak (20% vs 2%) and FNI (60% vs 5%) than otic capsule sparing (OCS) fractures.
- Moderate/severe traumatic brain injury (TBI) (Glasgow Coma Scale [GCS] < 13) was associated with significantly more complications (23% vs 5%).
Conclusions:
- Otic capsule violating (OCV) and transverse temporal bone fractures are linked to higher complication rates.
- Glasgow Coma Scale (GCS) is a predictive factor for facial nerve injury (FNI) and CSF complications in pediatric temporal bone fractures.
Objective:
Our aim is to characterize complications of pediatric temporal bone fractures and identify predictive risk factors associated with fracture complications.
Methods:
A retrospective review was conducted of all temporal bone fractures diagnosed in children (age less than or equal to 18 years) from a single academic institution between 2003 and 2017. Demographics, mechanism of injury, fracture characteristics, computed tomography evaluation and follow-up duration were recorded on each patient. Outcomes measured include facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL).
Results:
One-hundred-seventeen patients with 129 temporal bone fractures were included in the study. Most fractures were otic capsule sparing (OCS) (96%, n = 124) and longitudinal (71%, n = 91). Otic capsule violating (OCV) fractures were associated with higher CSF leak rates (20% versus 2%, p = 0.14) and FNI rates (60% versus 5%, p = 0.002) compared to OCS fractures. Audiograms were available in 37 patients (34%). Patients with Glasgow coma scale (GCS) consistent with a mild traumatic brain injury (TBI) (GCS > 13) had significantly fewer complications (FNI and CSF leaks) compared to the group with moderate and severe TBI (GCS < 13), 5% versus 23% (p = 0.03).
Conclusions:
Higher complication rates are seen with OCV fractures and transverse fractures. Moderate and severe TBI as measured by GCS is predictive of FNI and CSF complications in pediatric temporal bone fractures.
