Skull and Facial Fracture
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)
- Open skull fracture—part of the scalp is torn
- Closed skull fracture—the scalp is intact
- 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
|Fractures in the Zygomatic Arch and Orbit|
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- Car accident
- Sports injury
- Domestic violence, child or elder abuse
- Blunt trauma
Signs of injury to the brain:
- Leaking cerebrospinal fluid
- Increased pressure in the brain
- Blood in the ears
- Paralysis to the limbs
- Dizziness, headache, nausea, feeling faint, changes in vision, grogginess, difficulty concentrating
Other signs typical of skull and face fracture:
- Inability to move face or mouth
- Bruising to eyes and/or face
- Swelling, tenderness at injury site
- Hearing loss
- Facial fractures can affect the airway and the ability to breath
Glasgow coma scale—neurological exam that tests different parts of the nervous system including:
- Level of consciousness
- Pupil reaction to light
- 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
- 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
- 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
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 Association of Emergency Physicians http://www.caep.ca/
Trauma Management Group http://www.trauma.ca/
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.
- Reviewer: Igor Puzanov, MD
- Review Date: 11/2012 -
- Update Date: 11/26/2012 -