• Skull and Facial Fracture

    (Head Injury; Open Skull Fracture; Closed Skull Fracture; Fracture, Skull and Facial; Maxillary Fracture; Le Fort Fracture; Mandible Fracture; Zygomatic Fracture)

    Definition

    Skull and facial fractures are broken bones of the head and face.
    There are two major types of skull fractures:
    • Open skull fracture—part of the scalp is torn
    • Closed skull fracture—the scalp is intact
    Facial fractures can occur in any of the face’s bones. This includes:
    • Maxillary fracture—upper jaw area
    • Le Fort fracture—fracture of the upper jaw area and other facial structure, like nasal and oral cavities and orbits (classified I-V depending on the specific bones involved)
    • Mandible fracture—lower jaw fracture
    • Zygomatic fracture—cheekbone fracture
    These fractures are potentially life-threatening conditions. They require immediate medical treatment.
    Fractures in the Zygomatic Arch and Orbit
    skull fracture zygo and eye socket
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Skull and/or facial fractures are caused by injuries. Most commonly from:
    • Car accident
    • Sports injury
    • Domestic violence, child or elder abuse
    • Blunt trauma
    • Fall
    • Gunshot

    Risk Factors

    This type of fracture occurs most often in accidents.

    Symptoms

    These will depend on the location and extent of the injury. Your doctor will look for the following:
      Signs of injury to the brain:
      • Leaking cerebrospinal fluid
      • Increased pressure in the brain
      • Blood in the ears
      • Paralysis to the limbs
      Signs of concussion :
      • Dizziness, headache, nausea, feeling faint, changes in vision, grogginess, difficulty concentrating
      Other signs typical of skull and face fracture:
      • Pain
      • Inability to move face or mouth
      • Bruising to eyes and/or face
      • Swelling, tenderness at injury site
      • Headache
      • Hearing loss
    • Facial fractures can affect the airway and the ability to breath

    Diagnosis

    You will most likely be taken to a hospital. A doctor will ask about your symptoms and how your injury occurred. A physical exam will be done. A neurological exam will evaluate your nervous system. Tests may include the following:
      Glasgow coma scale—neurological exam that tests different parts of the nervous system including:
      • Level of consciousness
      • Pupil reaction to light
      • Reflexes
      • Response to stimuli
    • CT scan —type of x-ray that uses a computer to make pictures of any fractures or any other injuries to the head
    • Examination of ears and nose for fluid—cerebrospinal fluid leaks from ears or nose when there is a brain injury
    • Pain assessment

    Treatment

    Treatment will depend on the location and extent of the injury. Call 911 if you have a head injury.
    The first steps will be focused on stabilizing your injury. It may include:
    • Attaching a backboard to stabilize the spine (neck especially, as it is often injured along with the face or skull)
    • Intravenous fluids
    • Oxygen, a breathing tube for a blocked airway
    • Admission to the hospital for monitoring
    Treatment options include the following:

    Surgery

    Surgery for this type of injury will depend on the type of injury. It may include drilling burr holes in the skull to release pressure or fixing the broken bones surgically.
    If the jaw is broken it may need to be wired.
    If there is a collection of blood in the brain, called a hematoma, it may need to be removed. Surgery may take place right away or later once swelling has subsided.

    Medications

    • Medicine may be given to reduce pressure inside the head or brain swelling
    • An antibiotic may be given to prevent infection if there is an opening in the scalp
    • Medication that prevents seizures is sometimes given
    • Pain medicine and sedatives also may be given

    Hospitalization

    People with these fractures usually need to stay in the hospital. Serious injuries may need to be watched in an intensive care unit. Some people with facial or skull fractures need to have help breathing. A tube is inserted and mechanical ventilation is used to protect and assist breathing.

    Prevention

    To help reduce your chance of fracturing your skull or face, take the following steps:
    • Drive safely and always use a seat belt .
    • Do not drive under the influence of alcohol or drugs.
    • Avoid situations that put you at risk of physical harm.
    • Always wear a helmet when riding a bike or motorcycle.
    • Take steps to avoid falls in the home.
    • Buckle children into appropriate child safety seats .

    RESOURCES

    American College of Emergency Physicians. http://www.acep.org/

    Brain Injury Association of America http://www.biausa.org/

    Emergency Medical Services for Children http://www.ems-c.org/

    National Institute of Neurological Disease and Stroke http://www.ninds.nih.gov/index

    CANADIAN RESOURCES

    Canadian Association of Emergency Physicians http://www.caep.ca/

    Trauma Management Group http://www.trauma.ca/

    References

    Aminoff MJ, Greenberg DA, Simon RP. Clinical Neurology. 6th edition. United States:McGraw-Hill;2005: Chapter 1, Disorders of Cognitive Function.

    Day MW. Facial fracture, a formidable challenge to manage. Nursing2007Critical Care . 2007:2(1):26-32.

    Humphries RL. Current Diagnosis& Treatment: Emergency Medicine. 6th edition. United States: McGraw-Hill; 2008: Chapter 20, Head Injuries.

    Martin J, Gwin L. Current Diagnosis & Treatment: Emergency Medicine . 6th edition. United States: McGraw-Hill;2008: Chapter 10, The Multiply Injured Patient.

    Park CH, Lee JH, Hong SM, Lee OJ. Reduction of inferior orbital wall fractures using a Foley catheter and an Endoloop. J Trauma. 2011;70(3):E38-41.

    Ropper AH. Harrison's Principles of Internal Medicine . 17th Edition. United States: McGraw-Hill;2008: Chapter 373, Concussion and Other Head Injuries.

    Skull fracture. Merck Manual website. Available at: http://www.merck.com/mmhe/sec06/ch087/ch087f.html . Accessed October 28, 2008.

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