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Petrous Bone Fractures Violating Otic Capsule

Magliulo, Giuseppe; Appiani, Mario Ciniglio; Iannella, Giannicola; Artico, Marco

doi: 10.1097/MAO.0b013e31826bf135
Middle Ear And Mastoid Disease

Objective This study presents our experience with a series of patients suffering from petrous bone fractures violating the otic capsule who underwent subtotal petrosectomy combined with eustachian tube, middle ear, and mastoid obliteration, with the goal of preventing cerebrospinal fluid (CSF) leak and meningitis.

Methods This study enrolled 26 patients between 1997 and 2011. The clinical symptoms, otoscopy, and preoperative and postoperative audiometry and facial function, as well as CSF leak or meningitis, were evaluated in each patient. The entire group underwent a subtotal petrosectomy using the technique described in detail by Fisch. In addition, each patient was interviewed using a questionnaire to evaluate the impact on quality of life.

Results Intraoperatively, we found significant CSF leaks in 14 patients (42.5%). No patient reported other episodes of CSF leak or meningitis after the surgery. The patients’ responses of facial nerve function were slightly worse than the House-Brackmann evaluation (50% versus 42.3%; p < 0.05). The vast majority (88.5%) of the patients experienced no social impact.

Conclusion Our findings suggest the importance of not underestimating the risk for CSF leak in the petrous bone fractures violating the otic capsule. Preoperative counseling regarding the various troublesome complications must adequately motivate candidates to undergo surgery by pointing out the positive impact of the proposed treatment.

“Organi di Senso” Department; University “La Sapienza,” Rome, Italy

Address correspondence and reprint requests to Giuseppe Magliulo, M.D., Via Gregorio VII n. 80, 00165 Rome, Italy; E-mail:

The authors disclose no conflicts of interest.

© 2012 Otology & Neurotology, Inc.