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Clinical Characteristics and Management Outcomes of Pediatric Temporal Bone Fractures: A Retrospective Cohort Study
Oktay Bulut1, Sultan Şevik Eliçora1, Duygu Erdem2
1Department of Otolaryngology-Head and Neck Surgery, Kocaeli Sağlik ve Teknoloji Üniversitesi, Şevik Eliçora Sultan, Kocaeli City Hospital, Kocaeli.
Insights
Pediatric temporal bone fractures, often from falls, are usually longitudinal and otic capsule sparing (OCS), leading to good recovery. Otic capsule violating (OCV) fractures are rare but cause permanent facial nerve and hearing damage.
Area of Science:
- Otolaryngology
- Pediatric Traumatology
- Neurosurgery
Background:
- Pediatric temporal bone fractures can result in significant complications, including facial paralysis, hearing loss, and cerebrospinal fluid (CSF) leakage.
- Effective management necessitates a thorough understanding of the clinical and radiologic features of these injuries.
Purpose of the Study:
- To analyze the clinical and radiologic characteristics of pediatric temporal bone fractures.
- To correlate fracture patterns with patient outcomes, including facial nerve function, hearing loss, and CSF leakage.
Main Methods:
- Retrospective analysis of 50 pediatric patients with temporal bone fractures (2013-2020).
- Fractures classified using McHugh and Kelly-Tami systems (otic capsule sparing [OCS] vs. otic capsule violating [OCV]).
- Facial nerve function, CSF leakage, and audiological findings (auditory brainstem response, pure-tone audiometry) were assessed.
Main Results:
- Falls were the most common cause of injury in the 50-patient cohort (mean age 7.8 years; 64% male).
- Longitudinal and OCS fractures were most frequent, associated with favorable recovery.
- OCV fractures, though rare, were linked to irreversible facial paralysis and hearing loss; CSF leakage resolved spontaneously in all cases.
Conclusions:
- Pediatric temporal bone fractures are predominantly longitudinal and OCS, often resulting from falls.
- OCV fractures, while uncommon, carry a high risk of permanent facial nerve deficits and cochlear injury.
Background:
Pediatric temporal bone fractures may lead to facial paralysis, hearing loss, and cerebrospinal fluid (CSF) leakage. Understanding their clinical and radiologic characteristics is essential for effective management.
Methods:
This retrospective, single-center descriptive study included 50 pediatric patients diagnosed with temporal bone fractures between 2013 and 2020. Demographic data, mechanisms of injury, fracture types, facial nerve function, CSF leakage, and audiological findings were analyzed. Fractures were classified according to the McHugh system (longitudinal, transverse, and mixed) and the Kelly-Tami classification [otic capsule sparing (OCS) versus otic capsule violating (OCV)]. Hearing was evaluated using auditory brainstem response (ABR) in children under 6 years and pure-tone audiometry (PTA) with age-appropriate behavioral techniques in older children.
Results:
The cohort included 50 patients (mean age: 7.8±3.8 years; 64% boys). Falls were the leading cause of injury, while high-energy traumas such as gunshot and penetrating orbital injuries were rare but associated with complete facial paralysis and total hearing loss. Most fractures were longitudinal and OCS, showing favorable recovery, whereas OCV fractures caused irreversible deficits. CSF leakage occurred in 4 patients, all resolving spontaneously. Surgery was required only for persistent conductive hearing loss, and ossicular reconstruction restored normal hearing.
Conclusion:
Pediatric temporal bone fractures are mostly OCS and longitudinal, typically caused by falls. OCV fractures are uncommon but linked to irreversible facial nerve and cochlear injury.
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