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A basilar skull fracture typically requires a significant degree of trauma to occur. [1] It is defined as a fracture of one or more of the temporal, occipital, sphenoid, frontal or ethmoid bone. [1] Basilar skull fractures are divided into anterior fossa, middle fossa and posterior fossa fractures. [1] Facial fractures often also occur. [1]
A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull, usually occurring as a result of blunt force trauma.If the force of the impact is excessive, the bone may fracture at or near the site of the impact and cause damage to the underlying structures within the skull such as the membranes, blood vessels, and brain.
Early recognition of this injury is crucial for survival. Infants who have experienced a difficult operative delivery or are suspected to have a SGH require ongoing monitoring including frequent vital signs (minimally every hour), and serial measurements of hematocrits and their occipital frontal circumference, which increases 1 cm with each 40 mL of blood deposited into the subgaleal space.
The Hangman's fracture which is a fracture of the C2 vertebral body or dens of the cervical spine upon which the skull base sits to allow the head to rotate, can also be associated with atlanto-occipital dislocation. Despite its eponym, the fracture is not usually associated with a hanging mechanism of injury. [13]
The calvaria is made up of the superior portions of the frontal bone, occipital bone, and parietal bones. [1] In the human skull, the sutures between the bones normally remain flexible during the first few years of postnatal development, and fontanelles are palpable. Premature complete ossification of these sutures is called craniosynostosis.
Skull x-ray or CT scanning is used if neurological symptoms appear. These measurements are also used if concomitant depressed skull fracture is a possibility. Usual management is mainly observation. Phototherapy may be necessary if blood accumulation is significant leading to jaundice. Rarely, anaemia can develop needing blood transfusion.
CT scans can show brain bleeds, fractures of the skull, fluid build up in the brain that will lead to increased cranial pressure. MRI is able to better detect smaller injuries, detect damage within the brain, diffuse axonal injury, injuries to the brainstem, posterior fossa, and subtemporal and sub frontal regions.
In transcalvarial herniation, the brain squeezes through a fracture or a surgical site in the skull. [7] Also called "external herniation", this type of herniation may occur during craniectomy , surgery in which a flap of skull is removed, the protruding brain region preventing the piece of skull from being replaced during the operation.