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Management of petrous bone fractures in children: analysis of 127 cases
Insights
Petrous bone fractures (PBF) in children are common after injuries. Most complications are temporary, but prompt, interdisciplinary management is crucial to prevent severe, irreversible deficits.
Area of Science:
- Pediatric Traumatology
- Otolaryngology
- Neurosurgery
Background:
- Petrous bone fractures (PBF) are frequent in children, often resulting from trauma.
- Complications can include hearing loss, cerebrospinal fluid (CSF) leaks, and cranial nerve palsies.
Purpose of the Study:
- To review the complications associated with pediatric PBF.
- To outline current management strategies and recommend new approaches.
Main Methods:
- Analysis of complications in pediatric PBF cases.
- Review of diagnostic and therapeutic interventions.
- Evaluation of surgical and prophylactic measures.
Main Results:
- Hearing disorders (69.1%) and liquorrhea (16.5%) are the most common complications.
- Facial nerve palsy occurred in 9.4% of cases.
- While most complications are transient, 9.4% result in severe, irreversible sequelae.
Conclusions:
- An interdisciplinary approach involving pediatric surgeons and ENT specialists is essential for managing pediatric PBF.
- Routine vaccination against Streptococcus pneumoniae and subtotal petrosectomy for transverse fractures are recommended to reduce meningitis incidence.
- Aggressive management is vital for severe complications to minimize long-term morbidity.
Abstract:
Petrous bone fractures (PBF) in children are relatively frequent. They are mostly diagnosed after collisions and falls. The complications typically associated with PBF were different types of hearing disorders in 69.1% of the patients who had audiometry, liquorrhea in 16.5%, palsy of cranial nerves in 10.8% (facial nerve palsy in 9.4%), bacterial meningitis, stenosis of the external ear canal, and posttraumatic cholesteatoma in 0.7% of the fractures each. Most complications were transient; 8.6% of the patients underwent surgery because of PBF-related complications and 9.4% suffered from severe, irreversible sequelae. Management of PBF in children requires an interdisciplinary approach between pediatric surgeons and pediatric ear, nose, and throat (ENT) specialists. It basically includes daily examination for cranial nerve palsy, liquorrhea, and meningitis during hospitalization as well as routine audiometric examination and antibiotic prophylaxis. Routine vaccination against Streptococcus pneumoniae as a new standard procedure and subtotal petrosectomy after transverse fracture as a new surgical modality are strongly recommended in order to lower the incidence of posttraumatic meningitis. Severe complications such as persistent hearing loss, persistent liquorrhea, cranial nerve palsy, and posttraumatic meningitis require aggressive diagnostic and therapeutic measures in order to minimize further morbidity and irreversible deficits.