Temporal Bone Fractures and Related Complications in Pediatric and Adult Cranio-Facial Trauma: A Comparison of MDCT Findings in the Acute Emergency Setting

• Published in: Tomography (Ann Arbor) Vol. 10; no. 5; pp. 727 - 737
• Main Authors: Kohler, Romain, Pucci, Marcella, Landis, Basile, Senn, Pascal, Poletti, Pierre-Alexandre, Scolozzi, Paolo, Toso, Seema, Becker, Minerva, Platon, Alexandra
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-05-2024
• Subjects: Accidents; Adolescent; Adult; Adults; Aged; Aged, 80 and over; Child; Child, Preschool; Comparative analysis; cranio-facial trauma; Craniocerebral Trauma - complications; Craniocerebral Trauma - diagnostic imaging; emergency radiology; Emergency Service, Hospital; Facial Injuries - diagnostic imaging; Female; Fractures; Head injuries; Humans; Infant; Male; Middle Aged; Multidetector Computed Tomography - methods; Pediatrics; Prevalence; Retrospective Studies; Skull Fractures - complications; Skull Fractures - diagnostic imaging; Temporal Bone - diagnostic imaging; Temporal Bone - injuries; temporal bone trauma; Tomography, X-Ray Computed - methods; Traffic accidents; Young Adult; CT; temporal bone trauma; cranio-facial trauma; emergency radiology
• ISSN: 2379-139X; 2379-1381; 2379-139X
• DOI: 10.3390/tomography10050056

The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting.
A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard.
CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%);
< 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%),
= 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%).
Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults.