Cranial and Facial Fractures

Cranial and facial fractures occur under a number of circumstances. Many people get these fractures secondary to motor vehicle crashes, while others get them from falls, especially from high places, from altercations and from sports-related accidents. Some get just cranial fractures, while others get only facial fractures. Most of the victims of either type of fracture are males.

The signs and symptoms of a skull fracture include nausea, vomiting, decreased level of consciousness, partial paralysis, headache and unequal pupils. These patients often have internal brain injury and many of their symptoms are related to damage to the brain itself and bleeding in the subdural or epidural area. There is often increased pressure on the brain which can cause the brain to herniated through the base of the brain, resulting in loss of ability to maintain breathing, blood pressure and heart rate and imminent death.

The signs and symptoms of a facial fracture depend on where the facial fracture lies. Fractures around the orbit can lead to a sunken orbit and “raccoon’s eyes” or ecchymosis around the eyes. Fractures of the maxilla and/or mandible can lead to an abnormal bite. They need to be treated with the bite in mind so that the teeth are properly aligned. Sometimes the teeth need to be wired shut in order to make sure they heal with the bite in proper alignment.

In some cases, a person is unfortunate enough to sustain both a skull fracture and a facial fracture. In some cases, the fractures are contiguous with one another. Other times there is a separate skull fracture and a separate facial fracture. One research team looked at the characteristic of the people who got these fractures and the relationship between facial fractures and skull fractures over a 100 month period of time.

A total of 882 patients were uncovered with fractures of the facial bones. Eighty five percent of these patients were make and the majority (54 percent) were between the ages of 16 and 30 years old. A total of 64 percent of them were involved in a motor vehicle accident. Seventy percent had midfacial fractures that involved the frontal bone (38 percent), the sphenoid bone (24 percent) or the temporal bone (22 percent). Mandible fractures seemed to carry no relationship with having a cranial fracture but midfacial bones have sutures in common with the cranial bones and there was a relationship between cranial fractures and midfacial fractures. Whenever a patient had a skull fracture associated with a facial fracture, there was no increase in complication than if the patient had a cranial fracture alone.

The treatment of skull fractures is relatively easy. Generally nothing is done except treating the complications unless there is a depressed skull fracture in which the fracture segment that is depressed is lifted and stapled to existing bone. Maxillary fractures are often displaced and need treatment with surgical appliances and other devices in order to put the facial bones back in place, keeping in mind that the bite must be perfect again.

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