Skull base fracture

Introduction to skull base fracture Skull base fractures are fractures that occur in several weak areas of the skull base due to a variety of reasons. Most of the skull base fractures are combined fractures of the skull and skull base, and most of them are linear fractures. Skull base fractures are generally closed injuries, and the fracture itself does not require special treatment. It is mainly for serious intracranial and skull base injuries and prevention of infection. The general prognosis is better. A skull base fracture is a type of skull fracture. Injuries of skull fractures do not necessarily involve severe brain injury; those without skull fractures may have severe brain damage. After all, the presence of a skull fracture suggests that the victim is more severely violent and has a higher risk of brain damage. According to the fracture site, the skull fracture is divided into the calvarial and the skull base fracture; according to the fracture morphology, it is divided into linear and concave fractures; according to whether the fracture is connected with the outside, it is divided into open and closed fractures. Open fractures and skull base fractures involving the sinus may be associated with osteomyelitis or intracranial infection. basic knowledge The proportion of illness: 0.003%--0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: deafness cerebrospinal fluid rhinorrhea

Cause of skull base fracture

Most of the fractures of the bottom are combined fractures of the skull and skull base, and most of them are linear fractures. The reason for this:

The calvarial fracture extends (30%):

According to the shape of the fracture, it is classified into: linear fracture, depressed fracture, comminuted fracture, and child growth fracture. A fractured piece of a depressed or comminuted fracture can damage the meninges and brain and damage the cerebral blood vessels and cranial nerves. Skull fractures account for about 15-20% of craniocerebral injury, which can occur in any part of the skull, with the largest amount of parietal bone, followed by the frontal bone, followed by the humerus and occipital bone. Generally, the fracture line does not cross the cranial suture. If the violence is too large, it can also affect the adjacent bone. The positive lateral position of the skull can be diagnosed. Because of the different fracture morphology, the treatment and prognosis are also different.

Head crush injury (20%):

Violence caused the general deformation of the skull. Lighter people generally have a sense of oppression, the eyes are a little out of the way, no vomiting and other reactions. However, it can cause a skull base fracture.

Violence acts on the nearby skull base plane (10%):

Generally not rare.

Individual cases (3%):

When the top of the head hits the head vertically or falls from a height, the buttocks touch the ground. According to its anatomical part, it is divided into: anterior cranial fossa fracture; midcusral fossa fracture; posterior fossa fracture. Skull base fractures are generally closed injuries, and the fracture itself does not require special treatment. It is mainly for serious intracranial and skull base injuries and prevention of infection. The general prognosis is better.

Skull base fracture prevention

First, most of the skull base fractures do not require surgery. The leaks can often heal within one week after the injury, but they should not be negligent due to mild symptoms. If there is any discomfort, please inform the medical staff in time. In short, maintaining a good mood is an early day. An important guarantee for rehabilitation.

1, please enter high calorie, high protein, rich in vitamins, light and easy to digest soft food, should be a small amount of meals, do not overeating.

2, fasting tobacco and alcohol, spicy, cold and other irritating food.

3, do not drink strong tea, coffee, cola and other exciting brain drinks.

4. When the head is raised or the head is sitting, the headache is aggravated. A large amount of boiled water should be added in time, which is greater than 2000ml/day.

Second, discharge health care:

1. The healing of the skull is mostly fibrotic healing. After a linear fracture, the child takes about 1 year, and the adult takes 25 years to achieve bone healing.

2, do not dig ear, nose, do not use force to breathe, cough, nose or sneeze, so as to prevent the air in the sinus or mastoid air chamber from being pressed into or inhaled into the skull, resulting in cranial and infection.

3, please eat celery, soy products, sesame, banana and other crude fiber foods, in order to keep the stool smooth and develop a good habit of regular bowel movements.

4. Please ensure adequate sleep time > 8 hours / day.

5, work and rest, can take a walk, jogging and other sports, so as not to feel headache, dizziness is appropriate.

6, please pay attention to protect your head, to avoid the collision of external forces.

7, if there is severe headache, dizziness, hematemesis and other discomfort, please go to the hospital in time.

8. Please take the medicine according to the doctor's advice. Do not stop the medicine or reduce the amount without authorization.

Complications of skull base fracture Complications, deafness, cerebrospinal fluid, rhinorrhea

1, cranial anterior fossa fracture with cerebrospinal fluid rhinorrhea and olfactory nerve, optic nerve damage.

2, patients with transverse fractures of the cranial fossa may have 5, 6, 7 or 8 damage to the cranial nerve; while longitudinal fractures often cause conductive deafness; both can cause cerebrospinal fluid rhinorrhea and tympanic blood.

Symptoms of skull base fracture Common symptoms Dysphagia, ear leak, nosebleed, hoarseness, cerebrospinal fluid, rhinorrhea, internal carotid artery, traumatic thrombosis, bloody nasal septum or nasal cavity...

1, the anterior cranial fossa fracture: often involving the frontal tarsal plate and ethmoid bone, caused by bleeding before the nose through the nose; or into the sputum, subcutaneous and subcutaneous membrane formation under the membrane, called "panda" eyes When the meningeal ruptures at the fracture site, the cerebrospinal fluid can flow out from the anterior nares through the frontal sinus or ethmoid sinus, and become a cerebrospinal fluid rhinorrhea. The air can also enter the cranial cavity through the retrograde to form intracranial gas. The sieve plate and optic canal fracture can cause sniffing. Nerve and optic nerve damage.

2, middle cranial fossa fracture: often involving the humerus rock, meningeal and periosteal rupture, cerebrospinal fluid through the middle ear through the tympanic membrane hole to form cerebrospinal fluid otorrhea; if the tympanic membrane is intact, cerebrospinal fluid through the eustachian tube to the nasopharynx, often combined VII or VIII cranial nerve injury, such as fracture involving the sphenoid and medial tibia can damage the pituitary gland and the II, III, IV, V and VI cranial nerves, if the internal carotid cavernous sinus segment can form the internal carotid cavernous sinus A pulsatile exophthalmia occurs; if the internal carotid artery ruptures at the ruptured hole or at the internal carotid artery, fatal nosebleeds or ear hemorrhage may occur.

3, posterior fossa fracture: when the fracture involves the posterolateral aspect of the humerus, more than 2 to 3 days after the injury, subcutaneous hemorrhage occurs in the mastoid. When the fracture involves the base of the occipital bone, the occipital swelling and subcutaneous fistula can occur several hours after the injury. Blood; fracture involving the occipital foramen or the posterior margin of the rock bone tip, there may be symptoms of individual or all of the posterior group of cranial nerves (ie IX ~ XII cranial nerve), such as hoarseness, difficulty swallowing.

Examination of skull base fracture

Only 30-50% of the skull X-ray examination can show the fracture line. If necessary, the skull base slice, tomography or CT scan.

1. For patients with simple skull base fracture without combined brain injury, the examination plan is mainly based on basic examination.

2, the injury is heavier, suspected of intracranial hematoma, seizures or brain stem injury should be a CT scan to understand the deep intracranial situation, the head magnetic resonance imaging can more clearly show the brain stem.

3, the skull base X-ray phase diagnosis rate is not high, does not require regular photo, and the position can make the injury worse when the projection, it is not suitable for the acute phase.

Diagnosis and identification of skull base fracture

diagnosis:

(1) Cranial anterior fossa fracture: subcutaneous and ocular combined with subarachnoid hemorrhage, showing "panda" eye signs. Nasal bleeding with cerebrospinal fluid rhinorrhea. It can combine the symptoms of olfactory nerve, optic nerve, pituitary gland, thalamus and frontal lobe brain contusion.

(2) fracture of the middle cranial fossa: external ear canal bleeding and cerebrospinal fluid otorrhea, often accompanied by auditory nerve, facial nerve, trigeminal nerve, abductor nerve and temporal lobe brain injury symptoms. A small number of patients with internal carotid artery - cavernous fistula or traumatic aneurysm.

(3) posterior fossa fracture: subcutaneous hemorrhage, swelling, tenderness, sometimes swelling of the posterior pharyngeal wall, blood stasis or cerebrospinal fluid leakage. Can be combined with glossopharyngeal nerve, vagus nerve, accessory nerve, hypoglossal nerve and cerebellum, brain stem injury symptoms.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.