Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report
Abstract Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involving fractures. In the latter, hearing loss, facial nerve paralysis, cerebrospinal fluid leak and meningitis have been reported to occur. The impact of hearing loss can be devastating, especially...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-04053-7 |
| _version_ | 1797831863795974144 |
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| author | Gaelle Vofo Sagit Stern Shavit Ron Eliashar Michal Kaufmann |
| author_facet | Gaelle Vofo Sagit Stern Shavit Ron Eliashar Michal Kaufmann |
| author_sort | Gaelle Vofo |
| collection | DOAJ |
| description | Abstract Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involving fractures. In the latter, hearing loss, facial nerve paralysis, cerebrospinal fluid leak and meningitis have been reported to occur. The impact of hearing loss can be devastating, especially when occurring in children, with significant risk to speech development and sound localization. In the event of hearing loss, early rehabilitation is therefore of paramount importance. Identification of an intra-operative fracture line with available images and the outcome of such cases has not been reported. Case presentation We present the case of a 31-month-old male with an otic capsule involving temporal bone fracture, who presented with ipsilateral profound hearing loss. After all required work-up had been performed, he was admitted for a cochlear implant insertion. Per- operatively, a clear fracture line was seen at the round window niche, but a normal insertion was performed despite the anticipated potential ossification at the fracture line. The dreaded complications of cerebrospinal fluid otorrhea or non-auditory stimulation post-implant did not occur. The peculiarity of this case was its rarity, which was demonstrated by clear images that showed the fracture line on preoperative imaging and intraoperatively. Conclusion Cochlear implantation in the presence of a visible fracture line is feasible and the surgical procedure must not be aborted at its discovery. In these cases, post-operative bacterial meningitis can occur and should be treated aggressively with systemic antibiotics to avoid contralateral ossification of the labyrinth due to labyrinthitis. |
| first_indexed | 2024-04-09T13:58:32Z |
| format | Article |
| id | doaj.art-14ec0c7be12d411883a1e231c0f50feb |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-09T13:58:32Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-14ec0c7be12d411883a1e231c0f50feb2023-05-07T11:24:28ZengBMCBMC Pediatrics1471-24312023-05-012311610.1186/s12887-023-04053-7Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case reportGaelle Vofo0Sagit Stern Shavit1Ron Eliashar2Michal Kaufmann3Department of Otolaryngology- Head and Neck Surgery, Hadassah Hebrew-University Medical Centre, Faculty of Medicine, Hebrew University of JerusalemDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Hebrew-University Medical Centre, Faculty of Medicine, Hebrew University of JerusalemDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Hebrew-University Medical Centre, Faculty of Medicine, Hebrew University of JerusalemDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Hebrew-University Medical Centre, Faculty of Medicine, Hebrew University of JerusalemAbstract Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involving fractures. In the latter, hearing loss, facial nerve paralysis, cerebrospinal fluid leak and meningitis have been reported to occur. The impact of hearing loss can be devastating, especially when occurring in children, with significant risk to speech development and sound localization. In the event of hearing loss, early rehabilitation is therefore of paramount importance. Identification of an intra-operative fracture line with available images and the outcome of such cases has not been reported. Case presentation We present the case of a 31-month-old male with an otic capsule involving temporal bone fracture, who presented with ipsilateral profound hearing loss. After all required work-up had been performed, he was admitted for a cochlear implant insertion. Per- operatively, a clear fracture line was seen at the round window niche, but a normal insertion was performed despite the anticipated potential ossification at the fracture line. The dreaded complications of cerebrospinal fluid otorrhea or non-auditory stimulation post-implant did not occur. The peculiarity of this case was its rarity, which was demonstrated by clear images that showed the fracture line on preoperative imaging and intraoperatively. Conclusion Cochlear implantation in the presence of a visible fracture line is feasible and the surgical procedure must not be aborted at its discovery. In these cases, post-operative bacterial meningitis can occur and should be treated aggressively with systemic antibiotics to avoid contralateral ossification of the labyrinth due to labyrinthitis.https://doi.org/10.1186/s12887-023-04053-7Cochlear implantIntraoperative fracture lineOssificationOtic capsule involving fractureSensorineural hearing lossPaediatric temporal bone trauma |
| spellingShingle | Gaelle Vofo Sagit Stern Shavit Ron Eliashar Michal Kaufmann Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report BMC Pediatrics Cochlear implant Intraoperative fracture line Ossification Otic capsule involving fracture Sensorineural hearing loss Paediatric temporal bone trauma |
| title | Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report |
| title_full | Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report |
| title_fullStr | Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report |
| title_full_unstemmed | Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report |
| title_short | Intra-operative identification of a temporal bone fracture line during cochlear implant surgery: a case report |
| title_sort | intra operative identification of a temporal bone fracture line during cochlear implant surgery a case report |
| topic | Cochlear implant Intraoperative fracture line Ossification Otic capsule involving fracture Sensorineural hearing loss Paediatric temporal bone trauma |
| url | https://doi.org/10.1186/s12887-023-04053-7 |
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