A fracture of the base of the skull is one of the most severe traumatic brain injuries. This condition is accompanied by damage to one or even several bones that form the base of the skull. Damaged in this case may be:
- occipital bone;
- temporal bone;
- ethmoid bone;
- sphenoid bone.
A fracture of the base of the skull can occur from a variety of serious physical injuries: car accidents;
- when a person falls from a great height;
- when hitting the face in the area of the lower jaw or base of the nose.
In most patients, the base fracture occurs from the arch. Statistics say that the number of such patients reaches 59%.
Symptoms of a basal skull fracture
A fracture of the base of the skull is an open traumatic brain injury. It is worth noting that injuries accompanied by the release of blood or cerebrospinal fluid from the ear canals or nose are classified as open penetrating head injuries.
Based on location, injuries are divided into fractures:
- middle cranial fossa;
- anterior cranial fossa;
- posterior cranial fossa;
The most common fractures encountered in medical practice are middle cranial fossa fractures. Such fractures can be longitudinal, transverse or oblique. Most often, doctors fix longitudinal fissures in the temporal lobes. In this case, fractures can spread through various holes, crevices and thinning of the skull bones.
Among the main manifestations of fractures:
- bleeding from the ear canal;
- decreased hearing acuity;
- release of cerebrospinal fluid;
- the appearance of bruises in the area of the temporal muscle.
All of the above damage occurs when there is a blow to the occipital region.
It is worth noting that transverse fractures are clinically characterized by the patient being completely deaf. The patient may also exhibit disturbances in vestibular function, loss of taste in the two anterior thirds of the tongue, and may also experience peripheral facial palsy.
How to give first aid
If you witness an accident or a blow to the head, provide first aid for a fracture of the calvarium and base of the skull. A favorable outcome and successful recovery depends on your actions.
Remember! If there is any risk of injury, call a medical team as soon as possible. If you are not confident in your actions, in case of severe injuries, do not attempt first aid. Incorrect first aid can aggravate the victim's condition.
When waiting for an ambulance, take the following steps:
- Lay the victim on his back. Do not use pillows.
- Try not to move your body unnecessarily. To do this, fix the upper part and head.
- If the victim is found unconscious, place him on his back and turn his head to one side. This will prevent choking on vomit.
- Treat the wound on the skull with an antiseptic. Then cover the affected area with a sterile bandage.
- If you have dentures, they need to be removed. Also eliminate jewelry and glasses.
- Unfasten the buttons on your clothing.
- If respiratory function is intact, give the patient pain medication.
- You need to apply cold to your head, be it a bag of meat or a bottle of water.
Consequences of skull base fractures and prognosis
Experts note that the future quality of life of patients directly depends on the quality of rehabilitation after TBI, as well as on the nature of this injury, pathologies and possible infections. In the absence of purulent inflammation, in most cases, doctors give a favorable prognosis.
If there are infectious complications, doctors talk about the possibility of developing complications such as encephalopathy, frequent headaches, uncontrolled increase in blood pressure, etc. in the future. This condition may also be accompanied by recurrent epileptic seizures.
Some traumatic brain injuries can cause excessive bleeding, coma, and even death. With such injuries, the prognosis of doctors is extremely unfavorable.
Bleeding of small volumes, intracerebral hematomas, etc. can form. It is worth noting that in this situation, the patient’s future directly depends on the timeliness and adequacy of the treatment.
Forecast
The prognosis for a basal skull fracture is not always favorable . Fatality is found in approximately 35 percent of cases. This outcome depends on the severity of the injury, the presence of consequences, purulent masses, infection of the body or, in particular, the brain.
With cracks, the patient develops a typical manifestation of a fracture of the base of the skull. In such a situation, fractures without displacement and the development of purulent processes can be eliminated in a few months. The prognosis is generally favorable.
Nuance! When the body becomes infected, nerve cells may be destroyed due to oxygen starvation of the brain. This process disrupts brain functions.
The success of recovery depends on the speed of medical care. Excessive bleeding in the first sixty minutes can lead to coma, as well as disruption of mental activity and vital functions. Subsequently, the patient becomes disabled.
Causes of damage
In order to damage the base of the skull, the injury must be high-energy. A similar factor is:
- traffic accident;
- falling from height;
- hit to the head or face area with a hard object;
- hitting your head on a rock while diving.
After injury, a fracture of the base of the skull bones is accompanied by damage to other bones and organs. Despite the strength of the bones, there are weak spots on the skull that can be damaged. The anatomy of this part of the head will help to better understand the symptoms.
Rehabilitation period
Rehabilitation after injury is required for absolutely all patients. However, the length of this period will depend on the severity of the injury. For a mild, uncomplicated fracture, rehabilitation consists of:
- Compliance with all recommendations of the attending physician,
- Use of prescribed medications,
- Compliance with the prescribed daily routine,
- Observation by specialized specialists: neurologist, ophthalmologist, traumatologist and otolaryngologist.
After a serious injury, rehabilitation is a multi-stage treatment.
The rehabilitation period after a complicated fracture includes:
- Limiting physical activity. That is, excessive loads are excluded,
- Nutrition correction. Meals should be light, small and balanced. Patients with impaired swallowing function require tube feeding with nutritional formulas,
- Physical therapy and massage course,
- Restoration of cognitive functions of the brain. The patient is given classes to develop attention, speech and memory,
- Restoration of coordination and motor functions in the limbs,
- Psychotherapeutic support for patients with mental disorders. In severe cases, treatment in a psychiatric clinic is required,
- Carrying out medical procedures,
- Taking medications of various groups : vitamins, nootropics (improves nutrition and restoration of brain tissue), analgesics,
- Caring for bedridden patients, which includes feeding, hygiene procedures, and anti-decubitus manipulations.
Diagnostics
An accurate diagnosis can be established only after an instrumental examination. However, the clinical picture also helps the doctor to suspect the presence of a fissure. As mentioned above, bleeding occurs. In the area of the crack, reactive inflammation of the soft membrane of the brain can occur, which is defined as meningitis or aseptic traumatic arachnoiditis. If the mucous membranes are torn, bleeding from the mouth, ears and nose occurs. However, such bleeding does not provide good reason to assume that a person has a crack in the skull, since this symptom occurs even with mild head bruises that are not accompanied by brain injury. More pronounced bleeding is of greater importance. Again, it can be seen in skull injuries other than fracture. Two more points can be used when making a diagnosis.
- Leakage of cerebrospinal fluid from the mouth, ear and nose. However, this rarely happens.
- Radiography. It rarely helps identify a skull fracture, so it is rarely used. Moreover, the patient needs rest, and x-rays do not allow this condition to be met.
Since many modern free clinics do not have the opportunity to conduct other tests, sometimes it is best to go to a paid medical center, as it has more gentle and accurate diagnostic methods. This will help make a more accurate diagnosis and prescribe effective treatment.
Subtleties of first aid
Immobilization according to Bashmakov
Immobilization with Elansky splint
In the victim, immediately after its discovery, it is necessary to suspect a fracture of the base of the skull until this assumption is removed by the doctor after an appropriate examination. It is worth remembering: if there is bleeding, then with unnecessary movements it can intensify, reducing the percentage of survival after injury. If there are objective signs of a fracture of the base of the skull, the person urgently needs to be taken to a medical facility.
At the scene of the incident, the head must be immobilized; this can be done using Krammer splints using the Bashmakov method. An Elansky splint, which is often made of plywood, will also help immobilize the head. If such tires are not available, you can use any available means, for example, a piece of plywood placed under the head and upper body. Additionally, a “donut” made of fabric or towel is placed under the head.
Cold is applied to the head, which will help reduce the extent of brain damage. When there is a wound, a sterile bandage is applied to it if possible. The victim must be transported strictly in a horizontal position. The head is turned gently to one side, which allows for the prevention of aspiration of vomit.
Healing procedures
When treating a fracture of the base of the skull, great importance is given to the prevention of purulent complications.
For this purpose antibiotics are used ; the middle ear and nasopharynx are treated by instilling antibiotics into them. The patient is examined by a neurologist, otolaryngologist, and ophthalmologist.
Conservative treatment methods
Conservative treatment methods are used for relatively minor injuries to the skull, middle ear, and paranasal sinuses, when it is possible to hope for the removal of cerebrospinal fluid without surgery.
Treatment begins with bed rest, raising the head above the body line. This helps to reduce the leakage of spinal fluid.
The treatment complex also includes the removal of excess fluid, repeated lumbar punctures every other day with the removal of 30 ml of cerebrospinal fluid, as well as subarachnoid insufflations of 30 ml of air or oxygen.
Among decongestants, preference is given to diacarb, because. it reduces the production of cerebrospinal fluid. In its absence, Lasix or other diuretics are used.
If purulent complications do arise, then the administration of antibacterial agents is combined with endolumbar. For endolumbar administration, kanamycin, chloramphenicol, and monomycin are used.
The best option for selecting a medicine is to study the flora of the spinal fluid or a smear from the nasal mucosa.
Surgery
Surgical treatment of fractures is performed for multi-fragmented injuries of the anterior parts of the skull, the walls of the paranasal sinuses, the base of the anterior fossa, depressed lesions extending to the walls of the parabasal sinuses, and parts of the temple bone.
Surgical methods are also used for compression of the brain under the influence of increasing pneumocephalus, for nasal liquorrhea that is not subject to drug treatment, and for relapses of purulent complications.