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Skull Fractures

Some patients are relatively lucky, getting only a basilar skull fracture or a maxillofacial fracture. While these are complex and difficult to treat, they are not as bad as having a combined maxillofacial fracture and basilar skull (skull base) fracture. Having this type of combined fracture requires a team approach of surgeons that can manage cranial injuries, orbital injuries, ENT injuries, and other forms of maxillofacial injuries.

Two studies were done to look at various aspects of basilar skull fractures in children. These are fractures through the inferior part of the brain that are associated with raccoon’s eyes and battle signs, which are areas of bruising around the eyes and behind the ears, respectively. Basilar skull fractures can be seen on CT scan of the brain and skull and often do not include any kind of intracranial injuries. The first study was a retrospective review of charts of patients that were discharged from the emergency room or from the hospital with a diagnosis of basilar skull fracture. Each patient had a clinical sign or x-ray evidence of a basilar skull fracture. There was a subgroup of patients with a normal neurological signs and a Glasgow coma score of 15 that had simple basilar skull fractures.

There were 239 patients in the study. A hundred and fourteen patients or 48 percent had simple basilar skull fractures. This group of simple fractures had vomiting at a rate of 6 percent and a meningitis rate of 1 percent. There were no cases of intracranial hemorrhages and no patients with simple basilar skull fractures needed any kind of surgery. The researchers concluded that some patients with simple skull fractures (basilar) may not need to be hospitalized.

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