HSC Section 8_April 2017

S. Waissbluth

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 84

(2016)

106–109

most

Recently,

Kang

et

al.

developed

a

classification

based

on

the

frequent;

similar

to previously

published

data

[12] .

Interest-

of

the

four

parts

of

the

temporal

bone

(squamous,

only

the

squamous part

of

the

temporal bone

involvement

ingly, 8 patients had

mastoid,

and

petrous)

[8] .

We

also

evaluated

this part

these patients, one developed SNHL and

tympanic,

compromised, however, of

and

found

that

fractures

involving

one

intracranial

injuries consisting of parenchymal contusion (1),

classification

5 had

involving

two parts

in 25.9%,

involving 3 parts

hemorrhage

(2),

epidural

hemorrhage

(2)

and

represented 37.9%,

subarachnoid

24.1%,

and

involving

all

4

parts

in

12%

of

the

fractures.

Of

hemorrhage

(1). None

of

these

children

developed

facial

in

subdural

the most

frequently compromised was

the the

injury.

Patients temporal

with

isolated

fractures

of

the

squamous intracranial

the areas compromised,

nerve

part

(47%), (25%)

followed

by

the

squamous

part

(38%),

of

the

bone

are

at

risk

of developing

mastoid tympanic

portion injuries

part

and

finally,

the

petrous

part

(12%).

[5] . Intracranial

injuries

were

common

with

pneumocephalus,

4. Discussion

contusion

and

intracranial

hemorrhaging

being

the

parenchymal

frequently

observed.

Intracranial hemorrhage was

observed

most

fractures usually arise

from high

impact

trauma,

the patients and

included subarachnoid

(21.3%), subdural

in 62% of (21.3%)

Temporal bone

since

it

is

a

complex

structure

relating

to

important

and

epidural

hemorrhage

(19.6%).

Results were

compara-

and

constituents,

it

is

important

to

evaluate

its

impact

to

a

previously

published

series

of

pediatric

temporal

bone

neurovascular

ble

the

pediatric

population.

Following

a

review

of

all

the

cases

of

in which 38% of

the patients had a

subdural hemorrhage,

on

fractures

fractures during a 14 year span at a pediatric

tertiary

of

patients

had

a

subarachnoid

hematoma

and

13%

had

an

temporal bone

16%

center, we

evaluated 66

temporal bone

fractures. The median

hemorrhage

[12] .

care

epidural

of

the

children was

10

years with 74%

being male patients.

age

predominant mechanisms

of

injury were

consistent with

The

5. Conclusion

literature with 53% of

the cases

resulting

from a MVA

followed

the

falls

[8–10] .

Interestingly,

in our population, MVA

involving accidents,

less and

by

results, pediatric

temporal bone

fractures were

Considering our

vehicle

types

resulted

in

48.2%

of

the

common

common

in males

and

resulted most

frequently

from MVA

more

scooters, golf carts and

snowmobiles. Two children

included ATVs,

falls. Associated

skull

fractures

and

intracranial

injuries were presentation

and

takenwhen

died as a result of a MVA. Special precautions should be

found

and

the

most

prevalent

clinical

commonly

to

such vehicles. Also, of

the

traditional MVA, these, 5 were not

children are exposed

loss of

consciousness

and

included hemotympanum, decreased or

7 children were hit while

riding a bicycle, and of

Approximately

half

of

the

patients

presented

with

headache.

helmets.

Educating

children

and

their

parents

in

proper

wearing behavior

loss, which

in

the majority, was

conductive.

Facial

nerve

hearing

and

techniques

for

safe

bicycling

is

also

extremely

rare.

Fracture

of

the

squamous

part

of

the

temporal involving

injury was

important.

is

associated

with

intracranial

injury

and

otic

bone

and

loss

of

consciousness

or

decreased

Hemotympanum

infrequent.

fractures were

scale

and

headache were

the most

frequent

findings

at

Glasgow

presentation.

Other

otological

findings were

less

frequent

initial

Conflict

of

interest

12

patients

referring

decreased

hearing,

9

patients

had

with

5

had

tympanic membrane

perforations,

2

had

otalgia

otorrhea,

authors

declare

that

they

have

no

conflicts

of

interest.

The

1

had

vertigo.

and

pediatric

temporal

bones

are more

flexible

[11]

and

Because

that may protect

the otic capsule,

it

have decreased mineralization

References

expected

that [12] .

the

incidence

of

SNHL

would

be

lower

in

this ears two

is

Our that

results

demonstrated

that

only

5

population developed were mixed.

[1]

L.W.

Travis,

R.L.

Stalnaker,

J.W. Melvin,

Impact

trauma

of

the

human

temporal

J.

Trauma

17

(1977)

761–766.

bone,

SNHL,

29

ears

presented

with

a

CHL

and

[2] J.M.Collins,A.K.Krishnamoorthy,W.S.Kubal,M.H.Johnson,C.S. Poon, Multidetector CT of temporal bone fractures, Semin. Ultrasound CT MR 33 (2012) 418–431. [3] M. Sanna, T. Khrais, Temporal Bone: A Manual for Dissection and Surgical Approaches, Thieme, New York, 2006. [4] H.A. Brodie, T.C. Thompson, Management of complications from 820 temporal bone fractures, Am. J. Otol. 18 (1997) 188–197. [5] D. Lee, C. Honrado, G. Har-El, A. Goldsmith, Pediatric temporal bone fractures, Laryngoscope 108 (1998) 816–821. [6] N. Munir, R. Clarke, Ear, Nose and Throat at a Glance, John Wiley & Sons, 2012. [7] S.C. Little, B.W. Kesser, Radiographic classification of temporal bone fractures: clinical predictability using a new system, Arch. Otolaryngol. Head Neck Surg. 132 (2006) 1300–1304. [8] H.M. Kang, M.G. Kim, S.H. Boo, K.H. Kim, E.K. Yeo, S.K. Lee, et al., Comparison of the clinical relevance of traditional and new classification systems of temporal bone fractures, Eur. Arch. Otorhinolaryngol. 269 (2012) 1893–1899. [9] W.T. Williams, B.Y. Ghorayeb, J.W. Yeakley, Pediatric temporal bone fractures, Laryngoscope 102 (1992) 600–603. [10] J. Dunklebarger, B. Branstetter 4th, A. Lincoln, M. Sippey, M. Cohen, B. Gaines, et al., Pediatric temporal bone fractures: current trends and comparison of classification schemes, Laryngoscope 124 (2014) 781–784. [11] H.M. Kang, M.G. Kim, S.M. Hong, Comparison of temporal bone fractures in children and adults, Acta Otolaryngol. 133 (2013) 469–474. [12] S. Ort, K. Beus, J. Isaacson, Pediatric temporal bone fractures in a rural population, Otolaryngol. Head Neck Surg. 131 (2004) 433–437.

Also,

it

has

been

previously involving

described

that

patients

fracture were more

likely

presenting with an otic capsule

develop

SNHL,

facial

nerve

injury

and

cerebrospinal

fluid

to

[7] . Our

results did not

evidence

such findings,

although,

otorrhea

the

5

patients

presenting

with

SNHL,

2

had

otic

capsule

of

Findings

concerning hearing varied

tremendously.

It

involvement. is difficult with

this data

to make any strong conclusions

regarding

temporal

bone

fractures

and

hearing

loss.

Presentations

pediatric

from normal hearing

to profound SNHL, and recovery

for

the

varied

that did present some degree of hearing

loss also varied at

patients different patients

follow up periods. that present hearing

It

is

important

to

consider

that not

all

loss

in a hearing

test will report

it as a

sign. Therefore,

it

is of

importance

for all patients

suffering

clinical

temporal bone

fracture

to undergo

a

formal hearing

test,

and

to

a

it has been observed

that even mild

losses may not be

follow up as recovered.

Three

patients

developed

facial

nerve

paresis.

of

the

patients

had

additional

skull

fractures

of

which

78%

sphenoid,

frontal

followed

by

occipital

fractures were

the

parietal,

216