Paediatric petrous temporal bone fractures: A 5-year experience at an Australian paediatric trauma centre

Abstract

Background: Petrous temporal bone (PTB) fractures are often associated with otological and neurological injuries, all of which can have functional, developmental and social implications in the paediatric population. Therefore, appropriate and timely management is required to ensure optimal outcomes. The aims of this study were to investigate the prevalence of PTB fractures in children who presented with a skull fracture and their associated complications, and to provide general recommendations on the early management of PTB fractures in the paediatric population. Methods: A 5-year retrospective cohort study of children with a skull fracture admitted to a tertiary referral paediatric trauma centre (The Royal Children’s Hospital, Melbourne). Results: Five hundred and twenty-eight patients were admitted with a skull fracture between 2013 and 2017. Ninety (17%) patients were diagnosed with a temporal bone fracture, of which 36 (7%) involved the PTB. The most common mechanism of injury was a fall from height (69%). 63% of PTB fractures occurred in males and 78% were associated with an intracranial injury. With regards to complications, 8% had a transient facial nerve palsy (FNP), 8% had a cerebrospinal fluid leak and 19% had persistent hearing loss at 3 months. Conclusions: PTB fractures are uncommon but are frequently associated with intracranial complications and should be managed at a tertiary paediatric trauma centre. FNP and persistent hearing loss are infrequent debilitating complications of PTB fractures. Specific attention to the management of FNP and hearing loss are critical in the care of the child with a PTB fracture.