Articles Tagged with skull fracture

Head_CT_scan.jpgIn some cases, patients sustaining trauma to the head and neck area will have both closed head injuries and maxillofacial trauma. Of the two, closed head injuries are more severe and need to be managed before the maxillofacial trauma is treated. Patients with closed head injuries can have intracerebral hematomas, subdural hematomas or epidural hematomas. Each of these blood clots can increase in size and can cause excess pressure on the brain. This can lead to semiconscious states or coma and, in severe cases, they can cause herniation of brain tissue through the foramen magnum at the base of the brain. Such a condition is almost uniformly fatal because the patient is unable to breathe on their own and have instability of pulse and blood pressure.

The recommendation of most physicians who suspect an intracranial injury when a maxillofacial injury is noted gives the patient a CT scan of the head and face. This CT scan will determine the presence of bleeding, swelling and blood clots in the brain and will demonstrate any skull fractures or facial fractures. When the brain is stabilized through surgery or other modality, then the maxillofacial fractures, contusions, and lacerations can be managed secondarily.

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.