Facial and Cranial Fractures

Despite being seat-belted during an auto accident, you can still get facial and cranial fractures from blunt force trauma to the face and/or the top of your head. If you are unbelted, much more severe injuries can occur from being ejected or from being bounced around inside the vehicle.

Facial fractures can cause you to lose teeth or to have misalignment of the teeth, particularly if the mandible or maxillary bone is fractured. Orbital fractures involve the bones around the eye and include a “blow out” fracture, in which the base of the orbit blows the eye itself downward into the maxillary sinus. Few of these are fatal but many can lead to permanent nerve damage or facial disfigurement.

Skull fractures are also called cranial fractures. They can occur in motor vehicle accidents, especially if you are unbelted and are either ejected or pushed up to hit the top of the vehicle. Cranial fractures are broken down into anterior fractures (which are the same as facial fractures), fractures of the top of the head, the sides of the head or the basilar aspect of the skull (the base of the skull or the back).

Any injury that strikes the head enough to break the skull is usually enough to cause brain injury. The individual can get a subdural hematoma, a traumatic brain contusion, an epidural injury or an extra-dural hematoma. Some of these brain injuries require that the patient have immediate decompression of the skull or the brain can herniate into the brainstem, a problem that is often lethal.

There are three types of skull fractures: a linear skull fracture, a comminuted skull fracture, and a depressed skull fracture. Comminuted skull fractures occur when the skull is broken up into several fragments. Some of the fragments can push into the brain underneath and can thus be a depressed skull fracture. Depressed skull fractures are especially dangerous because they can cause contusions of the brain and brain damage. Anytime the fragments push through the skin, the fracture is considered open and septic meningitis can occur.

Common symptoms of a skull fracture include having an obvious deformity to the skull, having deep bruising of the scalp, a palpable depression in the skull, unequal pupils, bruising under the eyes, bruising behind the ears, loss of vision, loss of smell, bleeding from the ear or nose or having clear fluid come from either the ear or the nose.

The prevention of skull fractures depends on wearing appropriate restraining devices in a motor vehicle, wearing helmets in sports, and practicing sports like cheerleading on protective mats until the skill is well learned. Pitchers must use protective face gear when pitching in order to prevent facial injuries.

One study looked at the incidence of both facial and cranial fractures in injured patients. Looking at 882 patients with facial fractures, a total of 4.4 percent of these people also had skull injuries. A total of 85 percent of patients were male between the ages of 16 and 30 and were involved in motor vehicle accidents most of the time. Most patients had midfacial fractures along with frontal skull fractures about 38 percent of the time, sphenoid fractures 24 percent of the time and temporal fractures 22 percent of the time. There was no correlation between mandibular fractures and any kind of skull or cranial fracture.