Pediatric temporal bone fractures: A systematic review

Purpose

Pediatric temporal bone fractures, pose significant risks including hearing loss, facial nerve paralysis, and intracranial complications. This study aims to address the knowledge gap in outcomes following these fractures in children.

Methods

A comprehensive literature search across Embase, MEDLINE (PubMed), and Web of Science was conducted following PRISMA guidelines. The primary outcome analyzed was hearing loss, with secondary outcomes including facial nerve injury, and other complications.

Results

This study included 15 articles with outcomes for 1044 patients. The risk of sensorineural hearing loss (SNHL) was higher in otic capsule-violating (OCV) fractures than otic capsule-sparing (OCS) fractures (OR 28.57, p < 0.001). Facial nerve injury was more likely in OCV fractures (OR 4.59, p = 0.0162). Transverse fractures had higher odds of SNHL compared to longitudinal fractures (OR 5.181, p < 0.001). OCV fractures had higher odds of facial nerve injury compared to OCS fractures (OR 4.59, p = 0.0162), and transverse fractures had higher odds of facial nerve injury compared to longitudinal fractures (OR 3.02, p = 0.0146). No significant differences in conductive hearing loss were found between fracture types. Only 57 % of patients had audiometric data available.

Conclusions

This study indicates no single classification system accurately predicts outcomes for all pediatric temporal bone fractures. OCV fractures do carry a higher risk of SNHL than OCS fractures. However, this should not replace a thorough clinical assessment and audiometric testing. Long-term studies are needed to improve patient care due to limited data on long-term effects.