MANAGEMENT OF PETROUS BONE-FRACTURES IN CHILDREN - ANALYSIS OF 127 CASES

Petrous bone fractures (PBF) in children are relatively frequent. They are mostly diagnosed after collisions and falls. The complications ty pically associated with PBF were different types of hearing disorders in 69.1% of the patients who had audiometry, liquorrhea in 16.5%, pals y of cranial nerves in 10.8% (facial nerve palsy in 9.4%), bacterial m eningitis, stenosis of the external ear canal, and posttraumatic chole steatoma in 0.7% of the fractures each. Most complications were transi ent; 8.6% of the patients underwent surgery because of PBF-related com plications and 9.4% suffered from severe, irreversible sequelae. Manag ement of PBF in children requires an interdisciplinary approach betwee n pediatric surgeons and pediatric ear, nose, and throat (ENT) special ists. It basically includes daily examination for cranial nerve palsy, liquorrhea, and meningitis during hospitalization as well as routine audiometric examination and antibiotic prophylaxis. Routine vaccinatio n against Streptococcus pneumoniae as a new standard procedure and sub total petrosectomy after transverse fracture as a new surgical modalit y are strongly recommended in order to lower the incidence of posttrau matic meningitis. Severe complications such as persistent hearing loss , persistent liquorrhea, cranial nerve palsy, and posttraumatic mening itis require aggressive diagnostic and therapeutic measures in order t o minimize further morbidity and irreversible deficits.