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Recently,
Kang
et
al.
developed
a
classification
based
on
the
involvement
of
the
four
parts
of
the
temporal
bone
(squamous,
tympanic,
mastoid,
and
petrous)
[8]
.
We
also
evaluated
this
classification
and
found
that
fractures
involving
one
part
represented 37.9%,
involving
two parts
in 25.9%,
involving 3 parts
in
24.1%,
and
involving
all
4
parts
in
12%
of
the
fractures.
Of
the areas compromised,
the most
frequently compromised was
the
mastoid
part
(47%),
followed
by
the
squamous
part
(38%),
the
tympanic
part
(25%)
and
finally,
the
petrous
part
(12%).
4. Discussion
Temporal bone
fractures usually arise
from high
impact
trauma,
and
since
it
is
a
complex
structure
relating
to
important
neurovascular
constituents,
it
is
important
to
evaluate
its
impact
on
the
pediatric
population.
Following
a
review
of
all
the
cases
of
temporal bone
fractures during a 14 year span at a pediatric
tertiary
care
center, we
evaluated 66
temporal bone
fractures. The median
age
of
the
children was
10
years with 74%
being male patients.
The
predominant mechanisms
of
injury were
consistent with
the
literature with 53% of
the cases
resulting
from a MVA
followed
by
falls
[8–10]
.
Interestingly,
in our population, MVA
involving
less
common
vehicle
types
resulted
in
48.2%
of
the
accidents,
and
included ATVs,
scooters, golf carts and
snowmobiles. Two children
died as a result of a MVA. Special precautions should be
takenwhen
children are exposed
to
such vehicles. Also, of
the
traditional MVA,
7
children were hit while
riding a bicycle, and of
these, 5 were not
wearing
helmets.
Educating
children
and
their
parents
in
proper
behavior
and
techniques
for
safe
bicycling
is
also
extremely
important.
Hemotympanum
and
loss
of
consciousness
or
decreased
Glasgow
scale
and
headache were
the most
frequent
findings
at
initial
presentation.
Other
otological
findings were
less
frequent
with
12
patients
referring
decreased
hearing,
9
patients
had
otorrhea,
5
had
tympanic membrane
perforations,
2
had
otalgia
and
1
had
vertigo.
Because
pediatric
temporal
bones
are more
flexible
[11]
and
have decreased mineralization
that may protect
the otic capsule,
it
is
expected
that
the
incidence
of
SNHL
would
be
lower
in
this
population
[12]
.
Our
results
demonstrated
that
only
5
ears
developed
SNHL,
that
29
ears
presented
with
a
CHL
and
two
were mixed.
Also,
it
has
been
previously
described
that
patients
presenting with an otic capsule
involving
fracture were more
likely
to
develop
SNHL,
facial
nerve
injury
and
cerebrospinal
fluid
otorrhea
[7]
. Our
results did not
evidence
such findings,
although,
of
the
5
patients
presenting
with
SNHL,
2
had
otic
capsule
involvement.
Findings
concerning hearing varied
tremendously.
It
is difficult with
this data
to make any strong conclusions
regarding
pediatric
temporal
bone
fractures
and
hearing
loss.
Presentations
varied
from normal hearing
to profound SNHL, and recovery
for
the
patients
that did present some degree of hearing
loss also varied at
different
follow up periods.
It
is
important
to
consider
that not
all
patients
that present hearing
loss
in a hearing
test will report
it as a
clinical
sign. Therefore,
it
is of
importance
for all patients
suffering
a
temporal bone
fracture
to undergo
a
formal hearing
test,
and
to
follow up as
it has been observed
that even mild
losses may not be
recovered.
Three
patients
developed
facial
nerve
paresis.
78%
of
the
patients
had
additional
skull
fractures
of
which
parietal,
sphenoid,
frontal
followed
by
occipital
fractures were
the
most
frequent;
similar
to previously
published
data
[12]
.
Interest-
ingly, 8 patients had
only
the
squamous part
of
the
temporal bone
compromised, however, of
these patients, one developed SNHL and
5 had
intracranial
injuries consisting of parenchymal contusion
(1),
subarachnoid
hemorrhage
(2),
epidural
hemorrhage
(2)
and
subdural
hemorrhage
(1). None
of
these
children
developed
facial
nerve
injury.
Patients
with
isolated
fractures
of
the
squamous
portion
of
the
temporal
bone
are
at
risk
of developing
intracranial
injuries
[5]
.
Intracranial
injuries
were
common
with
pneumocephalus,
parenchymal
contusion
and
intracranial
hemorrhaging
being
the
most
frequently
observed.
Intracranial hemorrhage was
observed
in 62% of
the patients and
included subarachnoid
(21.3%), subdural
(21.3%)
and
epidural
hemorrhage
(19.6%).
Results were
compara-
ble
to
a
previously
published
series
of
pediatric
temporal
bone
fractures
in which 38% of
the patients had a
subdural hemorrhage,
16%
of
patients
had
a
subarachnoid
hematoma
and
13%
had
an
epidural
hemorrhage
[12]
.
5. Conclusion
Considering our
results, pediatric
temporal bone
fractures were
more
common
in males
and
resulted most
frequently
from MVA
and
falls. Associated
skull
fractures
and
intracranial
injuries were
commonly
found
and
the
most
prevalent
clinical
presentation
included hemotympanum, decreased or
loss of
consciousness
and
headache.
Approximately
half
of
the
patients
presented
with
hearing
loss, which
in
the majority, was
conductive.
Facial
nerve
injury was
rare.
Fracture
of
the
squamous
part
of
the
temporal
bone
is
associated
with
intracranial
injury
and
otic
involving
fractures were
infrequent.
Conflict
of
interest
The
authors
declare
that
they
have
no
conflicts
of
interest.
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S. Waissbluth
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Journal
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Pediatric Otorhinolaryngology
84
(2016)
106–109
216