A basilar skull fracture is a fracture at the base of the skull. Symptoms may include bruises behind the ears, bruises around the eyes, or blood behind the eardrum. Cerebrospinal fluid leak (CSF) occurs in about 20% of cases and may cause leakage of fluid from the nose or ear. Meningitis is a complication in about 14% of cases. Other complications include cranial nerve or vascular injury.
They usually require significant levels of trauma to occur. Rest at least one of the following bones: temporal bone, occipital bone, sphenoid bone, frontal bone, or ethmoid bone. They are divided into anterior fossa, middle fossa, and fracture of the poterior fossa. Facial fractures are also common. Diagnosis is usually done with a CT scan.
Treatment is generally based on injury to the structures inside the head. Surgery may be performed for CSF leaks that do not stop or injury to blood vessels or nerves. Preventive antibiotics are not used clearly. This occurs in about 12% of people with severe head injury.
Video Basilar skull fracture
Signs and symptoms
- Battle marks - bruises on the mastoid process of temporal bone.
- Raccoon eyes - bruises around the eyes, ie "black eyes"
- Rhinorrhea cerebrospinal fluid
- Cranial nerve palsy
- Bleeding (sometimes many) from the nose and ears
- Hemotympanum
- Conductive or perceptive deafness, nystagmus, vomitus
- In 1-10% of patients, entangled optic nerve occurs. The optic nerve is compressed by the damaged skull bone, causing irregularities in vision.
- Serious cases usually result in death
Maps Basilar skull fracture
Pathophysiology
Basilar skull fractures include a break at the base of the posterior skull or anterior skull base. The first involves the occipital bone, the temporal bone, and part of the sphenoid bone; the latter, the superior part of the sphenoid bone and the ethmoid. Temporal bone fractures are found in 75% of all basilar skull fractures and may be elongated, transverse or mixed, depending on the fracture path associated with the longitudinal axis of the pyramid.
The bone can rupture around the foramen magnum, the hole at the base of the skull where the brain stem comes out and becomes the spinal cord, creating the risk that the blood vessels and nerves coming out of the hole may be damaged.
Because of the proximity of the cranial nerve, such nerve injury may occur. It can cause facial nerve palsy or oculomotor nerve or hearing loss due to cranial nerve damage VIII.
Management
Evidence does not support the use of preventive antibiotics irrespective of cerebrospinal fluid leakage.
Prognosis
Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are highly likely to have meningitis. Unfortunately, the efficacy of prophylactic antibiotics in these cases is uncertain.
Temporal bone fractures
Acute injury to the internal carotid artery (carotid dissection, occlusion, pseudoaneurysid formation) may be asymptomatic or cause life-threatening hemorrhage. They are almost exclusively observed when the carotid ducts are fractured, although only a small fraction of carotid canal fractures produce vascular injury. The involvement of petrous carotid canal segments is associated with a relatively high incidence of carotid.
Society and culture
Basilar skull fractures are a common cause of death in many motorcycle racing accidents. Motorists who have died from basilar skull fractures include Formula One driver Roland Ratzenberger; IndyCar drivers Bill Vukovich Sr., Tony Bettenhausen Sr., Floyd Roberts, and Scott Brayton; NASCAR Driver Dale Earnhardt Sr., Adam Petty, Tony Roper, Kenny Irwin Jr., Neil Bonnett, John Nemechek, J.D. McDuffie, and Richie Evans; CART drivers Jovy Marcelo, Greg Moore, and Gonzalo Rodriguez; and ARCA drivers Blaise Alexander and Slick Johnson.
To prevent this injury, many bodies that impose motor sports require the use of head and neck restraint, such as the HANS device. The HANS device has demonstrated the ability to save lives several times, including Jeff Gordon at Pocono 500 in 2006, Michael McDowell at Texas Motor Speedway in 2008, Robert Kubica at the 2007 Canadian Grand Prix, and Elliott Sadler at Pocono Red Cross 500 in 2010.
References
External links
Source of the article : Wikipedia
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