Complications After Pediatric Temporal Bone Fractures by Classification System: A Systematic Review and Meta-analysis
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Published on: November 8, 2024
Nicolas S Poupore1, Annie F Britt1,2, Shaun A Nguyen1
1Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Pediatric temporal bone fractures (TBF) commonly cause conductive hearing loss. While neither classification system perfectly predicts complications, the traditional system aids in identifying facial nerve injuries, and the otic capsule violating (OCV) system better predicts sensorineural hearing loss.
Area of Science:
- Pediatric Otolaryngology
- Neurosurgery
- Trauma Surgery
Background:
- Pediatric temporal bone fractures (TBF) are significant injuries with potential for serious complications.
- Accurate classification systems are crucial for predicting outcomes and guiding management.
- Existing systems include longitudinal/transverse/mixed and otic capsule sparing (OCS)/otic capsule violating (OCV) classifications.
Conclusions:
- CHL is the most frequent complication, but neither classification system excelled at predicting it.
- The traditional system better identified FN injuries; the OCS/OCV system was more robust for SNHL.
- Both systems may offer utility, but further research with larger sample sizes focusing on long-term outcomes is warranted.
Objective:
To analyze the rates of complications after pediatric temporal bone fractures (TBF) and the utility of the longitudinal, transverse, and mixed versus the otic capsule sparing (OCS) and otic capsule violating (OCV) classification systems in predicting these complications.
Data Sources:
PubMed, Scopus, and CINAHL.
Review Methods:
Per PRISMA guidelines, studies of children with TBFs were included. Meta-analyses of proportions were performed.
Results:
A total of 22 studies with 1376 TBFs were included. Children with TBF had higher rates of conductive hearing loss (CHL) than sensorineural hearing loss (SNHL) (31.3% [95% confidence interval [CI] 23.2-40.1] vs 12.9% [95% CI 8.9-17.5]). No differences in both CHL and SNHL were seen between longitudinal and transverse TBFs; however, OCV TBFs had higher rates of SNHL than OCS TBFs (59.3% [95% CI 27.8-87.0] vs 4.9% [95% CI 1.5-10.1]). Of all patients, 9.9% [95% CI 7.2-13.1] experienced facial nerve (FN) paresis/paralysis, and 13.4% [95% CI 5.9-23.2] experienced cerebrospinal fluid otorrhea. Transverse TBFs had higher rates of FN paresis/paralysis than longitudinal (27.7% [95% CI 17.4-40.0] vs 8.6% [95% CI 5.2-12.8]), but rates were similar between OCS and OCV TBFs.
Conclusion:
CHL was the most common complication after TBF in children; however, neither classification system was superior in identifying CHL. The traditional system was more effective at identifying FN injuries, and the new system was more robust at identifying SNHL. While these results suggest that both classification systems might have utility in evaluating pediatric TBFs, these analyses were limited by sample size. Future research on outcomes of pediatric TBFs stratified by type of fracture, mainly focusing on long-term outcomes, is needed.
