Basilar Skull Fracture
What makes up a Basilar Skull Fracture?
A basilar skull fracture is a relatively uncommon head injury in the medical community; however, it is seen in traumatic events such as car accidents. When physicians are looking to diagnose a basilar skull fracture, they are looking for fractures at the base of the skull above the jaw and around the nose. These can be fractures in the:
- Temporal bone (most common)
- Sphenoid bone
- Ethmoid bone
- Occipital bone
Some fractures will damage only one of these bones while other fractures could damage all of them. They also vary in size.
What is the mechanism of injury?
There has been a substantial amount of research that has examined how patients sustain a basilar skull fracture. With respect to auto accidents, patient’s heads are free to move around while the body is strapped in. When a car rolls or is t-boned, it is not uncommon for the patient’s jaw to strike the window. Sometimes, the back of the patient’s head will strike the headrest with extreme force when a car is rear-ended. Both of these mechanisms create extreme stress on the base of the skull and can lead to the development of a basilar skull fracture.
What is the approach to treatment?
When deciding on the proper treatment, the physician will first assess the patient’s symptoms. There are specific symptoms that indicate a basilar skull fracture. These include:
- Bleeding from the nose and eyes
- Bruising around the temporal bone (Battle’s sign)
- Bruising around both eyes (Raccoon eyes)
- Blood trapped behind the ear drum
- Leaking of CSF fluid from the nose
- Possible brain damage
The presence or absence of these symptoms, combined with the imaging results, will be used to decide whether or not surgery is required to correct the basilar skull fracture. If surgery is required to repair other structures in the area, the fracture will also be repaired at this time. Many fractures heal without surgery. The long-term damage to the brain is a separate concern.
A Basilar Skull Fracture can Lead to Dangerous Complications
With any skull fracture, there is always concern for brain damage. Due to the location of the fracture, there is an increased concern for damage to cranial nerves that control the motor and sensory functions of the head, including sight and sound. One of the major concerns with a basilar skull fracture is the development of meningitis. When the skull is broken at the base, bacteria from the nose and mouth can move up and into the brain. This can lead to serious brain infections. Meningitis can be deadly.
What other structures are at risk?
When a basilar skull fracture is sustained, there are numerous structures placed at risk that aren’t usually damaged in other fractures to the top of the skull. Examples include:
- Jugular vein
- Carotid artery
- Multiple cranial nerves
- Zygomatic arch
- The bones of the ear and the eardrum
Whether or not these structures are damaged depends on the location of the fracture, the size of the fracture, and whether or not the fracture is displaced. Symptoms and imaging techniques are always used to evaluate these structures.
What is the differential diagnosis?
A basilar skull fracture has unique symptoms that usually clinch the diagnosis; however, this doesn’t mean that other diagnoses aren’t considered, particularly when it comes to a traumatic head injury. Some of these diagnoses include:
- Other types of skull fractures
- Cerebral contusion or concussion
- Intracranial hematoma
A patient could have more than one of these diagnoses depending on the severity of the injury.
What does the prognosis look like?
The prognosis of a basilar skull fracture is actually more dependent on other associated injuries than the fracture itself. Most of these fractures will heal completely; however, if blood vessels or nerves are damaged, this could lead to blood loss that could lead to brain damage. Any nerves that are severed will lead to permanent disabilities that will vary depending on the function of the nerve.
When Might a Patient Require Surgery?
Many basilar skull fractures will heal without surgery. If a fracture is displaced or blood vessels are severed, surgery will be needed to correct these injuries. The physician will use imaging techniques to determine whether or not internal injuries require surgery to correct.
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Catastrophic Injury & Wrongful Death Lawyers
I’m Ed Smith, a Sacramento Catastrophic Injury Lawyer. If you or someone you love has suffered a traumatic brain injury, please call me at (916) 921-6400 or toll-free at (800) 404-5400 for free, friendly advice. I’ve been helping Vallejo families recover compensation for their traumatic injuries and wrongful death claims for more than three decades.
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