236 / 264
3.3.
Associated
fractures
Multiple
fractures
were
observed
to
be
associated
with
temporal
bone
fractures
in
this
study
group.
The most
commonly
encountered
were
parietal
and
sphenoid
bone
fractures.
Other
fractures
included
frontal, mandible, maxillary,
nasal
bones
and
unspecified
facial
bones.
Eight
patients
also
presented
with
lambdoid
suture
diastasis
(see
Fig.
3
).
3.4.
Complications
and
associated
injuries
Complications
included
facial
nerve
injury,
hearing
loss
and
intracranial
injuries.
Only
three
patients
presented
with
facial
asymmetry
on
physical
examination, with
one
patient
having
a
documented
transient
facial
nerve
paresis.
While 12 patients described hearing
loss as a clinical
symptom,
hearing
testing
performed
shortly
following
the
incident
demon-
strated
that
30
patients
actually
had
hearing
loss
of
which
14
presented
with
mild,
10
with
moderate,
1
with
severe
and
2 with
profound
hearing
loss with
audiometry
testing.
The
other
3 patients
failed otoacoustic emissions. Nine patients did not have
documented
audiogram
or
otoacoustic
emission
testing.
In
total,
106
ears were
evaluated
for hearing
impairment:
70
ears
showed
no hearing
loss, 29 were
consistent with a
conductive hearing
loss
(CHL),
5
presented with
a
sensorineural
hearing
loss
(SNHL)
and
2 were mixed.
Follow-up was
not
consistent.
Of
the
information
available, 2 patients
that
failed
the otoacoustic emissions
initially,
passed
at
1
week,
and
3
months
follow
up.
One
patient
with
profound
SNHL
did
not
exhibit
any
change
at
2 week
follow
up.
5 patients with mild
(3 CHL, 2
SNHL)
and one with moderate CHL
recovered
their
hearing
at
1–2 months
follow
up.
2
patients with
moderate
CHL
presented
with mild
CHL
at
1
week,
and
1
year
follow
up.
One
patient with mild
CHL
remained with
the
same
diagnosis
at
3 months
follow
up.
Following
computed
tomography
scanning
of
these
patients,
various
intracranial
complications
were
observed,
of
which
pneumocephalus
was
the
most
common
as
evidenced
in
23
patients.
Parenchymal
contusion
and
intracranial
hemorrhag-
ing were
also
frequently
observed.
Seven patients
presented with
either midline
shift
or
transtentorial
herniation
(
Table
3
).
3.5.
Temporal
bone
fracture
types
Based on the traditional classification of temporal bone fractures,
35.9% of
the
fractures were
longitudinal, 10.6% were
transverse and
53.9% were mixed. Based on
the newer classification established by
Little
et
al.
[7]
,
9
fractures were
otic
capsule
involving.
0
5
10
15
20
25
30
35
40
Number of patients
Fig.
2.
Pediatric
temporal
bone
fractures:
clinical
presentations.
22
10
8
7
7
3
3
2
Parietal
Sphenoid
Frontal
Occipital
Others
Ethmoid
Orbital roof/wall
TMJ
Fig.
3.
Temporal
bone
fractures:
associated
fractures.
Table
3
Computed
tomography
findings
associated with
tem-
poral
bone
fractures
in
the
pediatric
population.
Finding
#
of
patients
Pneumocephalus
23
Parenchymal
contusion
22
Subarachnoid
hemorrhage
13
Subdural
hemorrhage
13
Epidural
hemorrhage
12
Midline
shift
7
Transtentorial
herniation
7
S. Waissbluth
et al.
/
International
Journal
of
Pediatric Otorhinolaryngology
84
(2016)
106–109
215