Clinical Characteristics and Management Outcomes of Pediatric Temporal Bone Fractures: A Retrospective Cohort Study

BACKGROUND: Pediatric temporal bone fractures may lead to facial paralysis, hearing loss, and cerebrospinal fluid (CSF) leakage. Understanding their clinical and radiologic characteristics is essential for effective management. METHODS: This retrospective, single-center descriptive study included 50 pediatric patients diagnosed with temporal bone fractures between 2013 and 2020. Demographic data, mechanisms of injury, fracture types, facial nerve function, CSF leakage, and audiological findings were analyzed. Fractures were classified according to the McHugh system (longitudinal, transverse, and mixed) and the Kelly-Tami classification [otic capsule sparing (OCS) versus otic capsule violating (OCV)]. Hearing was evaluated using auditory brainstem response (ABR) in children under 6 years and pure-tone audiometry (PTA) with age-appropriate behavioral techniques in older children. RESULTS: The cohort included 50 patients (mean age: 7.8±3.8 years; 64% boys). Falls were the leading cause of injury, while high-energy traumas such as gunshot and penetrating orbital injuries were rare but associated with complete facial paralysis and total hearing loss. Most fractures were longitudinal and OCS, showing favorable recovery, whereas OCV fractures caused irreversible deficits. CSF leakage occurred in 4 patients, all resolving spontaneously. Surgery was required only for persistent conductive hearing loss, and ossicular reconstruction restored normal hearing. CONCLUSION: Pediatric temporal bone fractures are mostly OCS and longitudinal, typically caused by falls. OCV fractures are uncommon but linked to irreversible facial nerve and cochlear injury.