Pediatric temporal bone fractures.

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 tomography scans were used to aid in the diagnosis. The most common fracture was an oblique fracture which is oriented in an axial or horizontal plane with the temporal bone. Facial nerve paralysis was found in 6 of our patients, which is less than the expected incidence when compared to adults. Hearing loss was found in 24 patients, the most common of which was conductive hearing loss, which had a higher incidence than expected when compared with adults.     

Pediatric all-terrain vehicle related temporal bone fractures

Objectives

To determine the prevalence of helmet use in children involved in all-terrain vehicles (ATV) accidents.

Study design

Retrospective chart review.

Setting

Tertiary Academic Medical Center.

Subjects and methods

Retrospective review was performed using the trauma registry of an academic tertiary medical center identifying ATV injured patients under 13 years of age between 2003-2008. Data regarding age, gender, ethnicity, driver/passenger status, helmet status, length of hospital stay, Glascow Coma Scale, Injury Severity Score, Abbreviated Injury Score, and presence of temporal bone fracture were analyzed.

Results

Seventy-four ATV injured pediatric subjects were identified. Average age was 8.6 years, 62% male, 38 were drivers, 32 were passengers. Helmet use data were available on 47 (64%) subjects, of these 9 (19%) wore helmets, and 38 (81%) were not wearing helmets. There was no observed statistical difference between helmeted and unhelmeted riders when comparing age, gender, ethnicity, driver/passenger status, length of hospital stay, Glascow Coma Scale (GCS), Injury Severity Score, Abbreviated Injury Score, or presence of temporal bone fracture.

Conclusions

This review found that documented helmet use in pediatric ATV injuries to be profoundly low (19%). Within our cohort no protective benefit from helmet use was identified, suggesting the inherent and potentially unalterable dangers of pediatric ATV recreation.     

Unusual complications of temporal bone fractures

Eighty-two temporal bone fractures were diagnosed in 75 patients with high-resolution computed tomographic scanning. Excluding six gunshot injuries, 55 (72%) of the fractures were oblique, 11 (15%) were longitudinal, and ten (13%) were transverse. Facial paresis or paralysis occurred in 45 patients (60%), hemotympanum occurred in 67 (89%), and cerebrospinal fluid otorrhea occurred in 19 (25%). Among 66 patients in whom audiometry was performed, 20 (30%) had conductive hearing loss, nine (14%) had sensorineural loss, and 36 (55%) had mixed hearing loss. Vestibular symptoms were present in 23 patients (30%). Other unusual complications of temporal bone fractures were observed: bilateral abducens paralysis, three patients (4%); unilateral abducens paralysis, two (2.67%); trigeminal paralysis, one (1.33%); and aseptic sigmoid sinus thrombosis, one (1.33%).     

A study of temporal bone fractures

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 fluid 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).     

Management of complication from temporal bone fractures

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 squama-mastoid 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.     

Temporal lobe injury in temporal bone fractures

OBJECTIVE: To determine the incidence of intracranial injury, specifically in the temporal lobe, in patients with longitudinal fractures of the temporal bone. DESIGN: Prospective inception cohort. SETTING: University of Maryland Division of Otolaryngology-Head and Neck Surgery and the Maryland Shock Trauma Center, Baltimore. PATIENTS: Twenty-seven consecutive patients with unilateral or bilateral temporal bone fractures. MAIN OUTCOME MEASURES: Evaluation of temporal bone and intracranial trauma using computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: Of the 27 patients enrolled in the study, 12 had the complete battery of MRI, CT, and physical and audiological examinations. In all 12 patients, MRI demonstrated adjacent middle cranial fossa meningeal enhancement. Results of non-contrast-enhanced CT and MRI demonstrated ipsilateral temporal lobe contusions in 6 of the 13 fractures for an overall incidence of 46%. In addition, MRI demonstrated 4 cerebral contusions not seen in the results of non-contrast-enhanced CT. CONCLUSIONS: While high-resolution CT remains the criterion standard for evaluation of temporal bone fractures, MRI revealed a higher incidence of related temporal lobe injuries. Magnetic resonance imaging data may be valuable in preoperative evaluation of patients who require surgical intervention through a middle cranial fossa approach to document pre-existing injury and potential morbidity before retraction of the middle cranial fossa dura mater and temporal lobe.     

Contralateral labyrinthine concussion in temporal bone fractures

In this case presentation, three cases of labyrinthine concussion in the opposite ears of patients who had unilateral traumatic temporal bone fractures with facial paralysis are reported. The first patient was a 30-year-old male who had a right-sided longitudinal temporal bone fracture and labyrinthine concussion showing pure sensorineural hearing loss with a characteristic notch of 60 dB at 4000 Hz on the left side. The second patient was a 42-year-old male who had a right-sided traumatic facial paralysis owing to a mixed-type temporal bone fracture and labyrinthine concussion, demonstrating pure sensorineural hearing loss reaching its peak of 50 dB at 4000 Hz on the left. The third patient was a 19-year-old male who had a left-sided mixed-type temporal bone fracture and a right labyrinthine concussion exhibiting pure sensorineural hearing loss reaching 60 dB at 4000 Hz. For their facial paralyses, all three patients underwent middle cranial fossa or combined approach operations. The labyrinthine concussion in these patients was managed expectantly. At their 1-year follow-up, it was observed that the hearing loss owing to labyrinthine concussion persisted. Although labyrinthine concussion is not a rare complication of head injuries, it has rarely been reported in the medical literature. The main symptoms of labyrinthine concussion are hearing loss, tinnitus, and dizziness. The diagnosis mainly relies on audiometric tests, which reveal characteristic tracings reminiscent of acoustic trauma.     

Binaural cochlear implantation after bilateral temporal bone fractures

Abstract

In this clinical note we discuss the indications, feasibility, and outcomes of binaural simultaneous cochlear implantation (CI) following bilateral transverse temporal bone (TB) fractures. A 41-year-old male, totally deaf after a bilateral TB fracture, underwent an audiological, electrophysiological, and imaging investigation in order to assess the integrity of the VIIIth cranial nerves. Five months later he received a simultaneous bilateral CI. Speech perception tests were conducted at different time points. A significant advantage by dichotic listening was observed since the beginning of the habilitation program. The patient achieved a 100% word and sentences recognition in quiet at 12 months. His listening skills in noisy conditions were improved by the use of two implants. A CI in TB fractures is feasible if the VIII nerve is intact and the cochlea is spared by the fracture rim. The early timing of the procedure probably contributed to its success by preventing cochlear fibrosis and ossification.

Sumario

En esta nota clínica discutimos las indicaciones, la factibilidad, y los resultados de la implantación coclear (CI) bilateral simultánea posterior a fracturas transversas bilaterales del hueso temporal (TB). Un varón de 41 años de edad, totalmente sordo después de una fractura bilateral del TB, fue sometido a una investigación audiológica, electrofisiológica y por imágenes, para evaluar la integridad de ambos octavos nervios craneales. Cinco meses después, el sujeto recibido IC bilaterales simultáneos. Se realizaron pruebas de percepción de lenguaje en diferentes momentos. Se observó una ventaja significativa en la audición dicótica desde el inicio del programa de habilitación. El paciente logró un 100% de reconocimiento de palabras y frases en silencio a los 12 meses. Sus habilidades para escuchar mejoraron con el uso de dos implantes. Una IC en fracturas del TB es factible si el VIII par está intacto y la cóclea no está involucrada en el trazo de la fractura. La oportuna realización del procedimiento probablemente contribuyó al éxito al prevenir la fibrosis coclear y la osificación.     

儿童颞骨骨折临床特点和治疗策略

目的 探讨儿童颞骨骨折的临床特点及治疗策略.方法 回顾性分析2014年7月～2021年7月首都医科大学附属北京儿童医院确诊的477例18岁以下颞骨骨折患儿的临床资料,包括患儿性别、年龄、受伤原因、影像学、面神经及听力学评估、并发症、治疗及预后.结果 477例颞骨骨折患儿中男358例、女119例,男女比例为3∶1,年龄范...     

正确处理颞骨骨折耳科并发症

人体的位听器官皆位于颞骨内,且周围有诸多重要血管及神经穿行,当发生颞骨骨折时,易出现耳科并发症,诸如听力下降、面神经麻痹、脑脊液耳(鼻)漏、眩晕等。在处理颅脑外伤,特别是合并有颞骨骨折时,应注意识别是否出现了耳科并发症。目前对于颞骨骨折合并耳科并发症的处理原则,取决于损伤的部位和严重程度,结合患者具体情况采用个性化的治疗方案,以期早期干预,改善患者预后及生活质量。     

Histopathology of temporal bone fractures: Implications for cochlear implantation

Temporal bone fractures often cause loss of audiovestibular function. Those patients with bilateral profound sensorineural hearing losses secondary to temporal bone fractures become candidates for cochlear implantation. The authors present the histopathology of five temporal bone fractures in three patients, evaluating specifically the traumatic effects on the neural elements of the inner ear. Transverse fractures of the temporal bone result in severe loss of hair cells, ganglion cells, and other supporting cells in the inner ear. Occasionally labyrinthitis ossificans may occur as a consequence of trauma or infection. While longitudinal fractures do not violate the otic capsule, these same neural elements may be damaged by concussion.     

New aspects of facial nerve pathology in temporal bone fractures

Electron microscopic examination of intratemporal facial nerve segments removed from 12 patients with persisting facial paralysis following temporal bone fractures revealed that traumatic injury at the geniculum induces retrograde degeneration through the labyrinthine and distal meatal segments of the facial nerve. Fibrosis may occur in the traumatized labyrinthine segment and block regenerating motor fibers. The surgical treatment of traumatic facial nerve injuries should be aimed to avoid or eliminate fibrosis within the labyrinthine segment of the Fallopian canal.     

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.