indidoc1
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Hello friends..
I thought it ll be very useful if we cn all summarise the common clinical features and modes of injury which cause skull fractures.. esp fractures of the base of the skull..
Actually, there ws a Q on the forum which prompted me to start this topic.
Lets build up a collection of all useful facts which is concise enuff to remember.
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| indidoc1
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This is what i hd posted at another place..
About fractures of temporal bone in floor of middle cranial fossa.
Features of lonitudinal fractures.. CSF otorrhea, bleeding frm ear (tympaniic memb rupture) conductive hearing loss.. I don't remember well, but ithink facial nerve palsy association is also less..
Transverse fractures.. No CSF or blood (tymp memb intact), sensorineural hearing loss, Many times subclinical, i think facial nerve is injured more.
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| indidoc1
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new_n_lost wrote:
Yes in Longitudnal Injury there :-The facial paralysis is often delayed in onset, attributed to edema rather than direct interruption of the nerve. Vestibular involvement and sensorineural deficits are relatively uncommon and are attributed to concussive effects rather than direct trauma on the vestibular labyrinth and cochlea.
Where as in Transverse injury :-These fractures often require much greater energy and are more commonly associated with more serious or even fatal head injuries. The facial nerve is involved in 50% of cases. The otic capsule and internal auditory canal are frequently involved as well.
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| new_n_lost
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Ok Skul fractures can be divded into 3 types
1. Linear Fractures :- Most patients with linear skull fractures are asymptomatic and present without loss of consciousness. Swelling occurs at the site of impact, and the skin may or may not be breached. Therefore is of little significance except when it runs through a vascular channel, venous sinus groove, or a suture. In these situations, it may cause epidural hematoma, venous sinus thrombosis and occlusion, and sutural diastasis, respectively.
2. Basilar Fractures :- can be divided into specific anatomical sites
(A) Patients with fractures of the petrous temporal bone present with CSF otorrhea and bruising over the mastoids, ie, Battle sign. Facial Nerve injury is delayed. There again 2 tyes of Temporal Fractures
i) Longitudinal fracture occurs in the temporoparietal region and involves the squamous portion of the temporal bone, the superior wall of the external auditory canal, and the tegmen tympani. These fractures may run either anterior or posterior to the cochlea and labyrinthine capsule, ending in the middle cranial fossa near the foramen spinosum or in the mastoid air cells, respectively.Patients with fractures of the petrous temporal bone present with CSF otorrhea and bruising over the mastoids, ie, Battle sign.
ii) Transverse fractures begin at the foramen magnum and extend through the cochlea and labyrinth, ending in the middle cranial fossa. Transverse temporal bone fractures involve the VIII cranial nerve and the labyrinth, resulting in nystagmus, ataxia, and permanent neural hearing loss.
iii) Presentation with anterior cranial fossa fractures is with CSF rhinorrhea and bruising around the eyes, ie, "raccoon eyes."
B) Occipital condylar fracture results from a high-energy blunt trauma with axial compression, lateral bending, or rotational injury to the alar ligament, again 3 types
Type I:- is secondary to axial compression resulting in comminution of the occipital condyle. This is a stable injury.
Type II fracture results from a direct blow, and, despite being a more extensive basioccipital fracture, type II fracture is classified as stable because of the preserved alar ligament and tectorial membrane.
Type III fracture is an avulsion injury as a result of forced rotation and lateral bending. This is potentially an unstable fracture.
Occipital condylar fracture is a very rare and serious injury (Legros, 1999). Most of the patients with occipital condylar fracture, especially with type III, are in a coma and have other associated cervical spinal injuries. These patients also may present with other lower cranial nerve injuries and hemiplegia or quadriplegia
C) Vernet syndrome or jugular foramen syndrome is involvement of the IX, X, and XI cranial nerves with the fracture. Patients present with difficulty in phonation and aspiration and ipsilateral motor paralysis of the vocal cord, soft palate (curtain sign), superior pharyngeal constrictor, sternocleidomastoid, and trapezius.
D) Fractures of the clivus are described as a result of high-energy impact sustained in motor vehicle accidents. A longitudinal fracture carries the worst prognosis, especially when it involves the vertebrobasilar system. Cranial nerves VI and VII deficits are usually coined with this fracture type
3. Depressed Skull Fractures
Depressed skull fractures result from a high-energy direct blow to a small surface area of the skull with a blunt object such as a baseball bat.Approximately 25% of patients with depressed skull fracture do not report loss of consciousness, and another 25% loose consciousness for less than an hour. The presentation may vary depending on other associated intracranial injuries such as epidural hematoma, dural tears, and seizures.
A depressed fracture may be open or closed. Open fractures, by definition, have either a skin laceration over the fracture or the fracture runs through the paranasal sinuses and the middle ear structures, resulting in communication between the external environment and the cranial cavity. Open fractures may be clean or contaminated/dirty.
Edited by new_n_lost on 03/10/07 - 01:25 PM
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| new_n_lost
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Collet-Sicard syndrome is occipital condylar fracture with IX, X, XI, and XII cranial nerve involvement
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Sicard syndromes (vide supra). Sphenoid bone fracture may affect the III, IV, and VI cranial nerves and also may disrupt the internal carotid artery and potentially result in pseudoaneurysm formation and caroticocavernous fistula (if it involves venous structures). Carotid injury is suspected in cases in which the fracture runs through the carotid canal; in these instances, CT-angiography is recommended.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| indidoc1
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O my gosh!!!
I wish there ws a clapping smily or a genious smily.. i would have fillep this thread wth those...
Gr8 job nnl!! 
Very concise n easy to retain
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| keepgoing
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welldone good work nnl...:thumb up:
here is one more link i got...
http://dentistry.uic.edu/Depts/omfs/gr/2005/01-24...
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| indidoc1
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nice link KG.. thanks.
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