Predicting complications of pediatric temporal bone fractures (original) (raw)
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Pediatric temporal bone fractures
The Laryngoscope
Twenty-seven temporal bone fractures in 25 pediatric patients were evaluated over a 6-year period. The diagnosis was confirmed with otoscopy and high-resolution computed tomography scans (HRCT). Three-dimensional reconstruction of high-resolution computed ...
International Journal of Pediatric Otorhinolaryngology, 2018
Introduction: Temporal bone fractures (TBF) are traditionally classified by their angle of fracture relative to the petrous ridge, and more recently by whether or not they violate the otic-capsule. This study compared rates of hearing loss (HL) and signs of otologic dysfunction among fracture types of both classification systems, within the pediatric population. Methods: Pediatric patients were retrospectively characterized from a previously identified cohort of TBF patients, diagnosed from 2000 to 2014. CT scans were reviewed and TBFs were classified first as longitudinal (L), transverse (T) or mixed (M), and then as otic-capsule sparing (OCS) or otic-capsule violating (OCV). Medical records were reviewed, and rates of HL and presenting signs were compared among L, T and M fractures, and OCS and OCV fractures. Results: Forty-three patients with 47 TBFs met the inclusion criteria. Eighteen, 4 and 25 TBFs were classified as L, T and M fractures, respectively. Thirty-three and 9 were classified as OCS, and OCV, respectively. Among 24 cases of HL: 20, 3, and 1 were conductive HL (CHL), sensorineural HL (SNHL) and mixed HL, respectively. Two cases of SNHL were found among OCV fractures, with none in OCS fractures (estimated difference 0.22; 95% confidence interval 0.01-0.60). Similar rates of CHL were found across L, T and M fractures (range 36-50%), and across OCV and OCS fractures (range 42-44%). Hemotympanum was the most common presenting sign, found in 68% of TBFs and 80% of CHL cases. There were no significant differences in the incidence of signs or symptoms between fracture types. Conclusions: In our cohort, both the traditional and otic-capsule radiographic classification systems failed to predict the incidence of CHL and other otologic signs in the pediatric population. Though OCV fractures conferred an increased risk for developing SNHL, we found a lower incidence than anticipated given violation to the bony labyrinth.
Patterns and incidence of temporal bone fractures
IP innovative publication pvt. ltd, 2019
Introduction: Temporal bone has a complex anatomy, divided into five bony divisions, which include squamous part, petrous bone, tympanic part, mastoid process, and styloid process. This contains cranial nerves V, VI, VII, and VIII and vascular structures such as the internal carotid and middle meningeal arteries, the sigmoid sinus, and the jugular bulb. It also harbors the sensorineural and membranous structures of the inner ear. The most common cause of temporal bone fractures is high energy blunt head trauma. For the assessment of temporal fractures, cranial CT is a fundamental and initial diagnostic modality. Complications of temporal bone fractures include facial nerve palsy, cerebrospinal fluid leakage, conductive hearing loss, sensorineural hearing loss, and vertigo. These fractures are divided into longitudinal and transverse based on whether the fracture line is passing parallel to or perpendicular to petrous bone respectively. Materials and Methods: This was a cross-sectional study done at Dr. PSIMS & RF, Gannavaram, Andhra Pradesh. The study period was between January 2015 to December 2018, done on Siemens 16 Slice CT machine with the patients' age ranging from 18 to 70 years who underwent CT brain in view of Road traffic accidents.
Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury
Journal of Trauma and Acute Care Surgery, 2015
Basal skull fractures (BSFs) are caused by blunt force trauma, occurring in the temporal, occipital, sphenoid, and/or ethmoid bones. In pediatric severe traumatic brain injury (sTBI), there is a paucity of data on BSFs. Our goal was to investigate the BSF prevalence, anatomy, and association with short-term outcomes in pediatric sTBI.
Management of complication from temporal bone fractures
European Archives of Oto-Rhino-Laryngology, 2011
The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squamamastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.
Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases
Journal of Clinical Medicine
Temporal bone fractures are a common lesion of the base of the skull. The diagnosis and management of temporal bone fractures require a multidisciplinary approach. Variable clinical presentations may arise from such fractures, ranging from an asymptomatic course to very serious consequences. The aim of this study was to report our experience with a series of patients with temporal bone fractures and to propose a diagnostic/therapeutic algorithm. This study enrolled 141 patients, 96 (68.1%) males and 45 (31.9%) females, ranging in age from 20 to 60 (average age: 39 ± 4.1 years), with temporal bone fractures who were referred to Cardarelli Hospital between 2006 and 2018. The present paper presents a classification of temporal bone fractures and typical clinical sequelae and provides an illustration of their prognosis and treatment.
The American Journal of Emergency Medicine, 1995
The diagnosis and monitoring of patients presenting to an emergency department with blunt temporal bone fracture and complications requiring acute management were reviewed for a four-month period. Of 104 trauma patients with closed head injury, 15 patients were diagnosed with temporal bone fracture, 12 of whom survived their injuries. Four patients developed cerebrospinal fluid (CSF) otorrhea and two patients developed facial nerve paralysis; all patients had resolution of complications with conservative management. Significant shortcomings in the initial evaluation and monitoring of patients with temporal bone fracture were identified. Specific and thorough facial nerve examinations were not initially conducted on temporal bone fracture patients and subsequent inpatient monitoring for facial nerve paralysis and CSF otorrhea was incomplete. The outcome of temporal bone fracture is discussed. This article reminds the emergency physician of the importance of initial diagnosis and documentation of temporal bone fractures. (Am J Emerg Meal 1995;13:211-
Temporal bone fractures: evaluation of 77 patients and a management algorithm
Turkish Journal of Trauma and Emergency Surgery, 2012
Temporal kemik kırığı olan hastalarda etyoloji, otolaringolojik semptom ve bulguların radyolojik değerlendirmeleri, tedavi yaklaşımları ve sonuçlar değerlendirildi. GEREÇ VE YÖNTEM Yetmiş yedi temporal kemik kırığı olgusu, yaş, cinsiyet, kırığın yeri, kırığın etyolojisi ve kanlı otore, timpanik membran perforasyonu, serebrospinal otore, işitme kaybı, hemotimpanum, fasiyal ve diğer kraniyal sinir paralizilerinin varlığı ve bilgisayarlı tomografi sonuçları yönünden geriye dönük olarak değerlendirildi. BULGULAR Olgularda kırıkların %55'i trafik kazası sonucu meydana gelmişti ve çoğunluğu erkekti (%76,6). Otolaringolojik bulgular sıklık sırası ile erken dönem iletim tipi işitme kaybı (%65,8), kanlı otore (%61,2), hemotimpanum (%58,5), timpanik membran perforasyonu (%25,6), fasiyal sinir paralizisi (%12,3), serebrospinal otore (%8,5) ve sensörinöral işitme kaybı (%5,4) idi. Kırıkların çoğu petroz (%65,8) ve uzunlamasına tip (%51,2) idi. SONUÇ Bu araştırmada 77 temporal kemik kırığı hastasında sıklık sırası ile otolaringolojik bulguları ve tedavi yaklaşımımızı literatür bulguları ile karşılaştırıp tartıştık. Temporal kırıklarda sistematik bir değerlendirme ve tedavi için bir algoritma oluşturduk. Anahtar Sözcükler: Kafa travması; maksillofasiyal yaralanma; temporal kemik. BACKGROUND We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures. METHODS Seventy-seven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports. RESULTS Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%). CONCLUSION In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.
A study of temporal bone fractures
Indian Journal of Otolaryngology and Head & Neck Surgery, 2008
Many young adults are now killed and injured in accidents than from another causes. More than 75% of these injuries are to the head, and the ear being the most frequently injured sensory organ of the body. Temporal bone or basilar skull fractures are extremely common in any head injury. Injuries to the temporal bone may be considered in three groups: Those affecting the external auditory meatus (extralabyranthine fractures), those largely affecting middle ear cleft (tympanolabyranthine) and those affecting the internal ear (labyrinthine fractures). Many injuries, however, involve all these structures .The sudden onset of facial paralysis, vertigo and hearing impairment after a head injury is a matter of great concern for the patients and clinicians. Presence of cerebrospinal fl uid leak (CSF Otorrhoea) can be a challenge for both the neurosurgeons and otologists. We hereby present 86 patients of temporal bone fractures who presented in the departments of emergency, Neurosurgery or ENT of Himalayan Institute of Medical Sciences, Dehradun during last 10 years (1996-2006).