A skull base fracture or skull base fracture is a life-threatening injury to the head. It is caused by violence and can result in brain damage. A skull base fracture should not be confused with a concussion .
What is a skull base fracture?
The base of the skull forms the so-called brain skull. In the event of a skull base fracture, the brain can therefore also be injured or cerebrospinal fluid can leak: neurological disorders are a possible consequence. See beautyphoon for What is Hypogenitalism.
The breaking edge runs along the bone sutures; these are the places where the individual skull plates initially grow together in infancy by means of connective tissue. The tissue increasingly ossifies over the course of life.
However, the cranial sutures remain thinner than the solid cranial plates and are therefore more prone to fracture. The most common cause of a skull base fracture is a fracture between the ear and the skull base or between the nose and the skull base.
A skull base fracture is the result of physical violence and can occur, for example, in traffic accidents. Predestined for this type of injury are car accidents in which one of the people involved hits the steering wheel or dashboard head-on.
This happens especially when the person is not wearing a seat belt. Another cause of a skull base fracture can be a fall from a height that impacts the head.
Rarely, a fracture of the base of the skull occurs as a result of direct personal violence, i.e. a strong blow to the face. All of these variants can result in a lesion of the orbits, ethmoid, frontal, and sphenoid sinuses.
Symptoms, Ailments & Signs
In the case of a fracture of the base of the skull, the symptoms differ depending on whether the petrous bone is broken longitudinally or transversely. A longitudinal fracture damages different nerves and vessels than a transverse fracture. If the bone is broken lengthwise, a bruise occurs from bleeding around the eyes. It can occur on one side (monocle hematoma) or on both sides (spectacle hematoma).
In addition, the eyelids swell. If the floor of the eye is also fractured, the eyes can sink deeper into the skull. In the case of a longitudinal fracture, the paranasal sinuses are usually also injured. This creates a bony step on the outer ear canal. In addition, the eardrum can rupture and the ossicular chain can be disrupted, leading to hearing impairment.
Olfactory nerves can also be injured. Paralysis of the facial nerve is rare in longitudinal fractures, but more common in transverse fractures. In the case of a transverse fracture, it is primarily the ear that is damaged. Those affected can no longer hear anything and their sense of balance is disturbed. A bruise forms behind the ear.
In exceptional cases, an ascending infection can develop via the auditory canal. With either type of skull base fracture, cerebrospinal fluid may flow out of the nose, ear, or mouth as a clear liquid. There may also be rivulets of blood. In addition to these symptoms, patients suffer from severe headaches and disturbances of consciousness, which can lead to unconsciousness.
Diagnosis & History
A fracture of the base of the skull can cause cerebrospinal fluid and blood to leak out. However, since the skin usually remains intact despite the injury, the fluids do not immediately ooze out of a wound: they make their way through the nose, mouth or ears.
Depending on where exactly the base of the skull breaks, the eyeball may be pushed forward or pulsate. The latter is caused by the ingress of blood from the internal carotid artery when it is damaged.
In addition, hematomas (“bruises”) can develop in the eye sockets, which take on the shape of glasses. This phenomenon can also occur with other fractures in the head area. The fracture itself can be easily detected using imaging techniques.
In addition to these visible changes, a fractured skull base can cause neurological disorders – temporary or permanent. Disorders of consciousness such as loss of consciousness or clouding of consciousness can be immediate consequences.
Secondary damage from a fractured skull base is also possible: if blood from a damaged vein enters the brain, further complications arise; to failure of brain areas and the death of nerve cells.
In most cases, a skull base fracture is not associated with any complications. This is particularly true if no liquor (brain fluid) escapes and the meninges have not been affected. In some patients, however, the effects of the injury are severe, which in turn can have serious consequences and worsen the prognosis.
One of the dreaded consequences of a fractured skull base is the leakage of cerebrospinal fluid. Liquid secretion flows out of the nose. If this is the case, the patient must be given antibiotics, otherwise there is a risk of increasing meningitis. Furthermore, there is a risk of the formation of a brain abscess, which is also the result of liquorrhea.
Another conceivable complication is osteomyelitis, which causes inflammation of the skull bones. Another effect can be the development of a liquor fistula. A passage is formed between the meninges and adjacent body structures in the outer direction. Pathogens such as bacteria can in turn penetrate through this inlet via the nose or ear.
A feared complication of a skull base fracture is the increase in intracranial pressure. The human brain is extremely sensitive to pressure. As a result, there is a risk of convulsions, loss of consciousness or a life-threatening respiratory arrest. Because there is a risk of the affected person suffocating, artificial respiration is necessary. There is always an acute risk of suffocation in the event of a skull base fracture if the patient becomes unconscious.
When should you go to the doctor?
A doctor must be consulted immediately if the skull base is fractured. This disease cannot heal itself, and without treatment, the bones can grow together incorrectly. In order to avoid further complications and damage to the brain, a doctor should always be consulted in the event of a skull base fracture. The doctor should be consulted if the person concerned has a severe bruise on the head and suffers from a very severe headache. Furthermore, swollen eyelids also indicate a fracture of the base of the skull.
Especially after a fall or after another serious injury, these symptoms can indicate a fracture of the base of the skull. In some cases, hearing problems or facial paralysis can indicate this fracture and should be examined by a doctor. It is not uncommon for those affected to lose consciousness or suffer from a disturbed sense of balance. In the case of a skull base fracture, a general practitioner can be consulted in the first place. In the case of very serious symptoms or after an accident, however, an ambulance can also be called or the hospital can be visited.
Treatment & Therapy
Bleeding from a skull base fracture can be prevented or stopped with immediate surgical intervention. The same applies to the release of cerebrospinal fluid.
Vessels may also have to be sutured, for example the internal carotid artery. Since the outer meninges often tear when the skull base fractures, this also has to be sewn up afterwards. The actual fracture is carefully aligned and the fracture points are fixed using various materials so that the skull can grow back together and the bones do not grow together or grow crookedly.
The material used for this is preferably the body’s own (connective) tissue, since there is no risk of the organism repelling it. In addition, the biological fibrin glue can provide valuable services: It acts as a two-component glue. In rarer cases, metal plates have to be inserted into the skull.
If the eyes and/or ears were affected by the fracture of the base of the skull, surgery is also performed here. This is particularly important in order to counteract the expected impairment of the sense of sight or hearing at an early stage.
If the fracture of the base of the skull does not lead to leakage of cerebrospinal fluid or blood and there is no other damage, an operation is not necessary. In particular, fractures between the nose and the base of the skull are relatively mild.
Because a skull base fracture results from violent forces, there is no direct way to prevent it. However, general safety measures such as buckling up when driving can prevent physical violence from occurring in the first place.
A fracture of the base of the skull is in most cases associated with a concussion. It is therefore recommended that those affected take excessive care of themselves during the acute period. This includes doing without unnecessary stress and avoiding sporting activities so that blood pressure does not increase. Likewise, bending the head and long, hot baths should be avoided.
Staying in the sun should also be avoided. Victims should urgently avoid situations that can upset them. A balanced sleeping rhythm is very important. Those affected must get enough sleep after the operation in order to be able to recover as quickly as possible.
If these points of aftercare are observed, not only can healing be accelerated, but also complications. Those affected should refrain from mechanical stress on the body until they have fully recovered. Any sports with head contact may not be practiced. These include martial arts, yoga and soccer.
These sports carry too high a risk of further head injuries. If you ride a bike, you must wear a helmet. In the event of visual disturbances or headaches, those affected should always consult a doctor in order to be able to rule out complications from the operation.
You can do that yourself
The fracture of the base of the skull is a trauma that must first be treated by a doctor. But self-help on the part of the patient is also very important in order not to jeopardize the recovery and to organize it optimally.
As a fracture of the base of the skull is often associated with a concussion, rest during the acute phase is essential. This includes not only physical rest and not doing any sporting activity. It’s also about avoiding activities that raise blood pressure. This includes bending your head as well as taking hot baths or staying in the sun. Excitement should also be avoided in the acute phase. Getting enough sleep is important.
Even after the acute phase, self-help can not only accelerate regeneration, but also avoid complications. The skull base fracture often heals without any problems, but mechanical stress on the skull must be avoided during this time. This includes, for example, avoiding sports that could strain your head. These include martial arts with full contact as well as headstands in yoga or ball sports that can put strain on the skull again with a header in football or the possibility of a head referrer from the ball in handball. When cycling or similar activities, the helmet is mandatory for the phase after the fracture. Headaches or blurred vision are reasons to see a doctor.