Basilar Skull Fracture | Basilar Fracture Treatment

The human body is made up of different bones supporting human movements. When one of your bones breaks, you are said to have a bone fracture. Calcium phosphate is the mineral needed by the bones in order to make them even denser. The denser the bones are the stronger the force it would take to break them. However, a strong impact would be all that it takes for a bone to get fractured. In kids, bone breakage happens because kids are still active and would like to run around. They just seem to be a ball of energy that cannot be easily contained. It is during one of their games that they might meet some accidents like tripping or falling. Fractures in adults occur when they love to play contact sports or when they meet a vehicular accident.

Being that your skull is one of the protective bones in your body that covers your brain, it is still prone to fractures. Basilar skull fracture happens when you break any of the bones at your skull base including the sphenoid bone, temporal bone, occipital bone, and the ethmoid bone. A head injury can just as easily affect any of the aforementioned bones.

Among a hundred people who have severe trauma to the skull brought about by a head injury, only four of them would likely have basal skull fracture, another name for the previously mentioned fracture.

Basilar skull fractures would involve damaging your meninges. These are the membranes that cover your brain. In effect, the cerebrospinal fluid (CSF) will flow from the membranes to the middle ear space. This will then go out to the nasopharynx or the perforated eardrum by passing through the Eustachian tube. The fluid may also come out of the nose with the base skull fracture in the anterior. These are some of the most common basal skull fracture symptoms that would tell if the patient has a fractured skull or not.

Anatomical Analysis of a Basilar Fracture

When your basilar skull is fractured, the break could have happened in the anterior or the posterior skull base. Anterior basal fracture would refer to a breakage in the ethmoid and the sphenoid bones. On the other hand, posterior basal skull fracture would include broken temporal bone, occipital bone, and some parts of the sphenoid bone.

If the depressed skull fracture happens to be at the base of the skull where the spinal cord comes out of, or what is called the foramen magnum, the patient is exposed to the risk of damaged nerves and blood vessels. It is at the same spot where the brain stem starts.

One of the basilar skull fracture symptoms that would show the severity of the fracture’s damage is when the patient goes deaf. Being deaf means that the cranial nerve for hearing has been affected. The oculomotor nerve might be affected as well which can result to facial palsy. This is one of the biggest risks in a basilar skull bone fracture.

Basilar Skull Fracture Signs and Symptoms

There are other visible signs of basilar skull fracture that can tell even without diagnosis that something is really wrong with the skull. It is time to be alarmed after a basilar skull injury when the following signs are observed:

Coming out of CSF in the form of a clear fluid from the nose or ears
Bloody sinuses
Battle sign or bruises behind the ears where the blood is collected
Raccoon eyes or bruises around the eyes
Risk of having meningitis
Basilar Skull Fracture Treatment

There are several types of treatment that can be had for a patient that has basal skull fractures. Consulting a good doctor can help determine the right treatment for basilar fractures. This is quite dangerous because the brain can be easily affected during skull fractures.

A. Medical Therapy

Treatments for adults with linear skull fracture only consist of the patient being examined in the hospital for a few hours but can be sent home after a while. Only when symptoms occur will the patient be asked to go back to the hospital. On the other hand, treatments for infant skull fracture will need to be checked overnight. When the neurological status is stable in patients with linear basilar skull fracture prognosis, treatment is still administered but without antibiotics. This is to assure a certain skull fracture recovery in the infants.

Depressed fractures in infants with neurologically stable status can be treated with seizure basilar skull fracture emedicine. Seizures usually happen 20% more in broken basilar bones than other types of fractures.

B. Surgical Therapy

Open depressed fractures in the skull for both infants and children would need surgery. This procedure needs to be done to bring back up the depressed part of the skull if it is already pushed more than 5mm below the adjacent bone. A surgical procedure has to be done quickly if the patient already experiences hematoma, contamination, or pneumocephalus tearing. When the brain is partly affected that caused it to swell, a procedure called craniectomy is necessary. Occipital condular fracture with unstable neurological status is an urgent case that will be treated with atlantoaxial arthrodesis.

Surgery for a patient showing basilar skull fracture signs can be delayed in certain circumstances. When the patient has ossicular incongruence, delayed surgery can be done as well. Other cases for delayed procedure would be for patients who have grown deaf for more than three months and those with continuous CSF leakage after the comminuted skull fracture. These certain fractures still need careful examination before any surgery should be administered.

Things to Consider Before Operation

Operation on the skull should be done carefully to treat the fractured basilar bone properly. It should not be done just so a surgery can be done. Before surgery, a patient has to be prepped up first.

Intraoperative Information

When the fragments in a skull fracture are separated from each other, they should be put at an elevated position.  Careful examination should be done on the dura in order to inspect it for torn damages. The torn damages on the dura need to be restored as soon as possible. Before reassembly, antibiotic and isotonic sodium chloride solution should be made and put where the fragments have to be placed. This is to make the assembly much easier. On the other hand, the larger fragments have to be pieced together. The reassembled fragments have to be connected by titanium mesh. Fractures in adults with cracked skull injury can be treated by methyl methacrylate but this is not applicable for kids. Instead, plates and crews should be used.

After Operation Information

The patient would face the risks of venous sinus thrombosis and intracranial hematoma. These are even more probable with depressed fractures.

Follow-up

Children and infants with simple linear fractures but have dural tears should be placed under close monitoring. They need close follow up due to the possibility that their fracture might continue to grow bigger. This is only one of the basilar skull fracture complications that have to be kept in mind for those watching over infants with skull fractures.

On the other hand, adults with the same skull defects would not need full time support. If the case of the adults does not involve losing consciousness, follow up is not really necessary in the long term.

There are also depressed fractures that are open and thus, prone to infections. After surgery, they still need to have repeated CT scans within two to three months after the injury. A possible complication would be the formation of abscess. When these complications do happen, they need to be treated as soon as possible before everything would get worse. Other complications would include infections and seizures. Follow ups also are also necessary after the bone fragments are removed.

Skull fractures might have certain complications but patients are not really prone to infection. Thus, antibiotics are not really necessary. Facial palsy and damage to the ossicular nerves are also other complications. These two can be treated by steroids. Neupraxia of the VII cranial nerve is also another complication. When the skull is broken, the surrounding cranial nerves might also get damaged. Even if some nerves would not be directly damaged due to the injury, they might be affected by the tensions on the other nerves. A fracture on the occipital bone would affect the lower cranial nerves. A fracture on the sphenoid bone would damage the III, IV, and VI cranial nerves.

Patients have to wait for quite a long basilar fracture healing time before they can move as they used to.