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Scientific article
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English

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

Published inTomography, vol. 10, no. 5, p. 727-737
Publication date2024-05-10
First online date2024-05-10
Abstract

Purpose: 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. Methods: 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. Results: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 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%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%). Conclusions: 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.

eng
Keywords
  • CT
  • Cranio-facial trauma
  • Emergency radiology
  • Temporal bone trauma
Citation (ISO format)
KOHLER, Romain et al. Temporal Bone Fractures and Related Complications in Pediatric and Adult Cranio-Facial Trauma : A Comparison of MDCT Findings in the Acute Emergency Setting. In: Tomography, 2024, vol. 10, n° 5, p. 727–737. doi: 10.3390/tomography10050056
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ISSN of the journal2379-1381
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