Carotid Canal Injury and High-Resolution Computed Tomography in Pediatric T-Bone Fractures

Abstract

Objective: 1) Review the incidence of carotid canal involvement in pediatric temporal bone fractures. 2) Determine the benefit of temporal bone high-resolution computed tomography (HRCT) in identifying carotid canal fractures (CCF). 3) Evaluate if the mechanism of injury (MOI) predicts the likelihood of CCF.

Method: A retrospective case series was reviewed from 2008 to 2011 in a tertiary children’s hospital. A database including all patients admitted for trauma was searched to identify children with temporal bone fractures and an otolaryngology consultation. Patient age, MOI, and standard head CT and HRCT reports were collected.

Results: A total of 140 temporal bone fractures in 129 pediatric patients were identified. The average age was 9.0 ± 0.4 years. The most common MOI included falls (24%), sports (17%), bicycle (16%), off-road vehicle (12%), motor vehicle (9%), and pedestrian (8%). CCF was identified in 16.2% of the temporal bone fractures. Although nearly half of the CCF were not clearly seen on the CT head, only 9% of all the HRCT ordered identified a previously undetected CCF. A CCF was seen in 60% of pedestrian accidents, while only 3% of falls had an associated CCF (P < .05).

Conclusion: A minority of temporal bone fractures have associated CCF. Although there are other indications for HRCT with temporal bone fractures, routine HRCT infrequently identifies undetected CCF. MOI may help predict temporal bone fractures at higher risk for CCF and suggest when HRCT would help identify CCF and reduce unnecessary HRCT.