Fracturas de temporal graves en niños: presentación, complicaciones y secuelas observadas en los últimos 11 años / Severe temporal bone fractures in children: Clinical presentation, complications and sequelae observed in the last 11 years

RESUMEN

OBJETIVO: Analizar las características de presentación, complicaciones y secuelas, de las fracturas de temporal ingresadas en UCIP.MATERIAL Y MÉTODOS: Análisis descriptivo retrospectivo de las historias clínicas y TC craneal. RESULTADOS: Veintisiete pacientes ingresados en UCIP presentaron fractura del temporal 13 (48%) sin afectación de peñasco (grupo 1) y 14 (52%) con afectación de peñasco (grupo 2). El grupo 2 presentó mayor estancia en la UCIP 4,5 días (RI 2,75-22,25) vs. 2 (RI 1-3) (p = 0,018), mayor frecuencia de secuelas (p = 0,04) y presencia de fístula del LCR (p < 0,02). Los scores de PRIMS III e índice de traumatismo pediátrico no mostraron diferencias significativas. El 31% presentó hipoacusia, 2 pacientes fallecieron y 4 (15%) presentaron secuelas permanentes. CONCLUSIONES: Las fracturas temporales pueden ser graves, especialmente si incluyen al peñasco, bien por las lesiones asociadas, que marcan el riesgo vital, como por las secuelas (déficit auditivo o fístula LCR). Los autores indican el seguimiento de estos pacientes a largo plazo por Otorrinolaringología

ABSTRACT

OBJECTIVES: To evaluate the clinical presentation, complications and sequelae in patients with temporal bone fracture in the last 11 years. MATERIAL AND METHODS: A total of 27 patient medical records were retrospectively analysed. RESULTS: Of the 27 patients who were admitted for temporal bone fracture from 2001 to 2012, 13 (48%) had no petrous involvement (Group 1), and 14 (52%) with petrous involvement (Group 2). Patients in Group 2 had a longer P-ICU stay median 4.5 days (RI 2.75-22.25 d) vs 2 (RI 1-3 d) (P=.018); more days on mechanical ventilation support median 3 days (RI 1.50-17 d) vs 1 (RI 1-1.25 d). This group also had a higher frequency in sequelae (P=.04 OR = 1.4 (95% CI 1.05-1.95)) and a higher incidence in cerebrospinal fluid (CSF) fistula (P<.02; OR 2.33; 95% CI (1.27-4.27)). Severity scores (PRIMS III and PTI) showed no significant differences. Some degree of hearing loss was observed in 31% of the patients. Traffic accident was the main cause of trauma (33%), followed by falls (27%). There were 2 deaths and 4 (15%) had permanent sequelae. CONCLUSIONS: Isolated temporal bone fractures usually have a good outcome in children, but in some cases they can be fatal or have permanent sequelae. Long term follow up is recommendedby authors