A basilar skull fracture is a break of a bone in the

base of the skull The base of skull, also known as the cranial base or the cranial floor, is the most inferior area of the skull. It is composed of the endocranium and the lower parts of the calvaria. Structure Structures found at the base of the skull are for ...

. Symptoms may include bruising behind the ears, bruising around the eyes, or blood behind the ear drum. A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and may result in fluid leaking from the nose or

ear In vertebrates, an ear is the organ that enables hearing and (in mammals) body balance using the vestibular system. In humans, the ear is described as having three parts: the outer ear, the middle ear and the inner ear. The outer ear co ...

Meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasion ...

occurs in about 14% of cases. Other complications include injuries to the

cranial nerve Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and f ...

s or blood vessels. A basilar skull fracture typically requires a significant degree of trauma to occur. It is defined as a fracture of one or more of the temporal,

occipital The occipital bone () is a cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone lies over the occipital lobes of the cere ...

, sphenoid, frontal or

ethmoid bone The ethmoid bone (; from ) is an unpaired bone in the skull that separates the nasal cavity from the brain. It is located at the roof of the nose, between the two orbits. The cubical (cube-shaped) bone is lightweight due to a spongy constructi ...

. Basilar skull fractures are divided into

anterior fossa The anterior cranial fossa is a depression in the floor of the cranial base which houses the projecting frontal lobes of the brain. It is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and f ...

middle fossa The middle cranial fossa is formed by the sphenoid bones, and the temporal bones. It lodges the temporal lobes, and the pituitary gland. It is deeper than the anterior cranial fossa, is narrow medially and widens laterally to the sides of the skull ...

and posterior fossa fractures.

Facial fractures Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures ...

often also occur. Diagnosis is typically by

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

. Treatment is generally based on the extent and location of the injury to structures inside the head. Surgery may be performed to seal a CSF leak that does not stop, to relieve pressure on a cranial nerve or repair injury to a blood vessel. Prophylactic antibiotics do not provide a clinical benefit in preventing meningitis. A basilar skull fracture occurs in about 12% of people with a severe

head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...

Signs and symptoms

Battle's sign Battle's sign, also known as mastoid ecchymosis, is a late indication of fracture of middle cranial fossa of the skull, appearing as bruising over one or both of the mastoid processes at least one day after the injury. Such fractures can be asso ...

–

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clo ...

of the

mastoid process The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has openings for blood vessels. From its borders, t ...

of the temporal bone. *

Raccoon eyes Raccoon eyes, also known as panda eyes or periorbital ecchymosis, is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Bilateral hemorrhage occurs when damage at the time ...

– bruising around the eyes, i.e. "

black eye A periorbital hematoma, commonly called a black eye or a shiner (associated with boxing or stick sports such as hockey), is bruising around the eye commonly due to an injury to the face rather than to the eye. The name refers to the dark-colo ...

s" *

Cerebrospinal fluid rhinorrhea Cerebrospinal fluid rhinorrhoea (CSF rhinorrhoea) refers to the drainage of cerebrospinal fluid through the nose (rhinorrhoea). It is typically caused by a basilar skull fracture, which presents complications such as infection. It may be diagnosed ...

Cranial nerve Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and f ...

palsy Palsy is a medical term which refers to various types of paralysisDan Agin, ''More Than Genes: What Science Can Tell Us About Toxic Chemicals, Development, and the Risk to Our Children'' (2009), p. 172. or paresis, often accompanied by weakness and ...

* Bleeding (sometimes profuse) from the nose and ears *

Hemotympanum Hemotympanum, or hematotympanum, refers to the presence of blood in the tympanic cavity of the middle ear. Hemotympanum is often the result of basilar skull fracture.. It may also be secondary to fractures of the mandibular condyles. Blueprints ...

* Conductive or perceptive

deafness Deafness has varying definitions in cultural and medical contexts. In medical contexts, the meaning of deafness is hearing loss that precludes a person from understanding spoken language, an audiological condition. In this context it is writte ...

nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) Eye movement (sensory), eye movement. People can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in visual impairment, re ...

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

* In 1–10% of patients,

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

entrapment occurs. The optic nerve is compressed by the broken skull bones, causing irregularities in vision. * Serious cases usually result in

death Death is the end of life; the irreversible cessation of all biological functions that sustain a living organism. Death eventually and inevitably occurs in all organisms. The remains of a former organism normally begin to decompose sh ...

Pathophysiology

Basilar skull fractures include breaks in the posterior

skull base The base of skull, also known as the cranial base or the cranial floor, is the most Anatomical terms of location#Superior and inferior, inferior area of the human skull, skull. It is composed of the endocranium and the lower parts of the Calvaria ...

anterior Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The

temporal bone The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bone ...

fracture is encountered in 75% of all basilar skull fractures and may be longitudinal, transverse or mixed, depending on the course of the fracture line in relation to the longitudinal axis of the

pyramid A pyramid () is a structure whose visible surfaces are triangular in broad outline and converge toward the top, making the appearance roughly a pyramid in the geometric sense. The base of a pyramid can be of any polygon shape, such as trian ...

. While not absolute, three principal types of basilar skull fractures are recognized, based on the direction and location of the impacting force: # Longitudinal fracture: This type divides the base of the skull into two halves (right and left). It may result from blunt impact on the face, forehead, back of the head, or from front-to-back crushing forces. # Transverse fracture: This type divides the base of the skull into a front and rear half. It occurs from impact on either side of the head or from side-to-side compression. The fracture typically runs through the petrous portion of the

temporal bones The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bones ...

and the

sella turcica The sella turcica (Latin for 'Turkish saddle') is a saddle-shaped depression in the body of the sphenoid bone of the human skull and of the skulls of other hominids including chimpanzees, gorillas and orangutans. It serves as a cephalometric la ...

, potentially affecting the

pituitary gland The pituitary gland or hypophysis is an endocrine gland in vertebrates. In humans, the pituitary gland is located at the base of the human brain, brain, protruding off the bottom of the hypothalamus. The pituitary gland and the hypothalamus contr ...

. Blood from both ears often indicates this type of fracture, which is the most common basilar skull fracture. Transverse fractures may extend into the orbital roofs or the ethmoid plate, causing periorbital hemorrhage or extensive nasal bleeding, respectively. A fracture through the sella can lead to profuse blood aspiration. A common mechanism for transverse fractures is a sharp blow to the chin, such as a fall onto a hard surface. The impact energy transfers to the skull base via the mandibular rami and

temporomandibular joints In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the condylar process of mandible below; it is fro ...

. The chin injury may appear minor, often just a small abrasion or laceration. # Ring fracture: This type separates the rim of the

foramen magnum The foramen magnum () is a large, oval-shaped opening in the occipital bone of the skull. It is one of the several oval or circular openings (foramina) in the base of the skull. The spinal cord, an extension of the medulla oblongata, passes thro ...

, the outlet at the base of the skull through which the brain stem exits and becomes the spinal cord, from the rest of the skull base. This may result in injury to the blood vessels and nerves exiting the foramen magnum. This can manifest as loss of

facial nerve The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of ta ...

oculomotor nerve The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements o ...

function, or hearing loss due to damage to

cranial nerve VIII The vestibulocochlear nerve or auditory vestibular nerve, also known as the eighth cranial nerve, cranial nerve VIII, or simply CN VIII, is a cranial nerve that transmits sound and equilibrium (balance) information from the inner ear to the bra ...

. This type of fracture typical results from a fall from height where the victim lands on their feet or buttocks, forcing the skull down onto the vertebral column. In children, fractures may not occur due to suture separation and greater bone flexibility.

Management

Evidence does not support the use of preventive

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

s, regardless of the presence of a

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...

leak.

Prognosis

Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get

meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasion ...

. The efficacy of prophylactic antibiotics in these cases is uncertain.

Temporal bone fractures

Acute injury to the internal

carotid artery Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of ...

(

carotid dissection In anatomy, the left and right common carotid arteries (carotids) () are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries. Structure The common carotid a ...

, occlusion,

pseudoaneurysm A pseudoaneurysm, also known as a false aneurysm, is a locally contained hematoma outside an artery or the heart due to damage to the vessel wall. The injury passes through all three layers of the arterial wall, causing a leak, which is contai ...

formation) may be asymptomatic or result in life-threatening bleeding. They are almost exclusively observed when the

carotid canal The carotid canal is a passage in the petrous part of the temporal bone of the skull through which the internal carotid artery and its internal carotid (nervous) plexus pass from the neck into (the middle cranial fossa of) the cranial cavity. ...

is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.

Motor racing accidents

Basilar skull fractures are a common cause of death in many

motor racing An engine or motor is a machine designed to convert one or more forms of energy into mechanical energy. Available energy sources include potential energy (e.g. energy of the Earth's gravitational field as exploited in hydroelectric power gene ...

accidents. Drivers who have died as a result of basilar skull fractures include

Formula One Formula One (F1) is the highest class of worldwide racing for open-wheel single-seater formula Auto racing, racing cars sanctioned by the Fédération Internationale de l'Automobile (FIA). The FIA Formula One World Championship has been one ...

driver

Roland Ratzenberger Roland Walter Ratzenberger (; 4 July 1960 – 30 April 1994) was an Austrian racing driver, who competed in Formula One at three Grands Prix in . Born and raised in Salzburg, Ratzenberger began his racing career as a protégé of Walter Lechn ...

;

IndyCar IndyCar, LLC (stylized as INDYCAR), is an auto racing sanctioning body for American open-wheel car racing headquartered in Indianapolis, Indiana. The organization sanctions two racing series: the premier IndyCar Series with the Indianapolis ...

drivers

Bill Vukovich William Vukovich (born Vaso Vukovich, December 13, 1918 – May 30, 1955) was an American racing driver. He won the 1953 and 1954 Indianapolis 500s, plus two more American Automobile Association National Championship races, and died while leadin ...

Sr.,

Tony Bettenhausen Melvin Eugene "Tony" Bettenhausen (September 12, 1916 – May 12, 1961) was an American racing driver known primarily for his open-wheel career. He twice won the National Championship, doing so in 1951 and 1958. He also competed in stock cars, wi ...

Sr.,

Floyd Roberts Floyd Marion Roberts (February 12, 1900 – May 30, 1939) was an American racing driver. He won the 1938 Indianapolis 500 with a then-record speed of . He led for 92 laps. The following year, 1939, driving the same car, Roberts was killed in a c ...

, and

Scott Brayton Scott Everts Brayton (February 20, 1959 – May 17, 1996) was an American race car driver on the American open-wheel circuit. He competed in 14 Indianapolis 500s, beginning with the 1981 event. Brayton was killed in practice after qualifying ...

;

NASCAR The National Association for Stock Car Auto Racing, LLC (NASCAR) is an American auto racing sanctioning and operating company that is best known for stock car racing. It is considered to be one of the top ranked motorsports organizations in ...

drivers

Dale Earnhardt Sr. Ralph Dale Earnhardt (; April 29, 1951February 18, 2001) was an American professional stock car driver and racing team owner, who raced from 1975 to 2001 in the former NASCAR Winston Cup Series (now called the NASCAR Cup Series), most notably d ...

Adam Petty Adam Kyler Petty (July 10, 1980 – May 12, 2000) was an American professional stock car racing driver. A member of the Petty racing family, he was the fourth generation from the Petty family to drive in races in the highest division of NASCA ...

, Tony Roper, Kenny Irwin Jr.,

Neil Bonnett Lawrence Neil Bonnett (July 30, 1946 – February 11, 1994) was an American NASCAR driver who compiled 18 victories and 20 poles over his 18-year career. Bonnett was a member of the Alabama Gang, and started his career with the help of Bobby a ...

John Nemechek John Frank Nemechek (March 12, 1970 – March 21, 1997) was an American racing driver who competed in the NASCAR Craftsman Truck Series. Life and racing career The younger brother of four-time NASCAR Cup Series race winner Joe Nemechek, John f ...

, J. D. McDuffie, and

Richie Evans Richard Ernest Evans (July 23, 1941Bourcier, Bones, "61 at 61", ''Speedway Illustrated'' (ISSN 1528-4182), Volume 3, Number 8, August 2002. – October 24, 1985), was an American racing driver who won nine NASCAR National Modified Championships, ...

;

CART A cart or dray (Australia and New Zealand) is a vehicle designed for transport, using two wheels and normally pulled by draught animals such as horses, donkeys, mules and oxen, or even smaller animals such as goats or large dogs. A handcart ...

drivers Jovy Marcelo, Greg Moore, and Gonzalo Rodriguez; and ARCA drivers

Blaise Alexander Blaise Robert Alexander Jr. also known as BR Alexander (March 26, 1976 – October 4, 2001) was an American professional stock car racer from Montoursville, Pennsylvania. He began racing at the age of 12 in go-karts, winning the coveted World Kart ...

and

Slick Johnson Julius David "Slick" Johnson III (February 23, 1948 – February 14, 1990) was an American stock car racing driver. A veteran of short track competition in the Carolinas, he competed in the NASCAR Winston Cup Series during the 1980s; his best fin ...

Ernie Irvan Virgil Earnest Irvan (born January 13, 1959), occasionally referred to as Swervin' Irvan, is an American former professional stock car racing driver. A retired NASCAR competitor, he is perhaps best remembered for his comeback after a serious head ...

is a survivor of a basilar skull fracture sustained at an accident during practice at the

Michigan International Speedway Michigan International Speedway (formerly named as the Michigan Speedway from 1997 to 2000) is a D-shaped oval superspeedway in Brooklyn, Michigan. It has hosted various major auto racing series throughout its existence, including NASCAR, Cham ...

in 1994. Race car drivers Stanley Smith and

Rick Carelli Richard Dean Carelli (born November 9, 1954) is an American former race car driver from Arvada, Colorado. He was nicknamed the "High Plains Drifter". He won multiple times in the No. 6 NASCAR Craftsman Truck Series truck. He is the spotter for Er ...

also survived a basilar skull fracture. To prevent basilar skull fractures, many motorsports sanctioning bodies mandate the use of head and neck restraints, such as the

HANS device A HANS device (head and neck support device) is a type of head restraint and a safety device in motorsports. Head restraints are mandatory when competing with most major motorsports sanctioning bodies. They reduce the likelihood of head or neck ...

. The HANS device has demonstrated its life-saving abilities multiple times, including

Jeff Gordon Jeffery Michael Gordon (born August 4, 1971) is an American stock car racing executive and former professional stock car racing driver who currently serves as the vice chairman of Hendrick Motorsports. He raced full-time from 1993 to 2015, d ...

at the

2006 Pocono 500 The 2006 Pocono 500 was a NASCAR Nextel Cup Series race that was held on June 11, 2006 at Pocono Raceway in Long Pond, Pennsylvania. It was the fourteenth race of the 2006 NASCAR Sprint Cup Series season. Denny Hamlin of Joe Gibbs Racing won the ...

, Michael McDowell at the

Texas Motor Speedway Texas Motor Speedway (formerly known as Texas International Raceway from September to December 1996) is a quad-oval Oval track racing#Intermediate, intermediate speedway in Fort Worth, Texas. It has hosted various major races since its inaugura ...

in 2008,

Robert Kubica Robert Józef Kubica (; born 7 December 1984) is a Polish racing driver, racing and rally driver, who competes in the FIA World Endurance Championship for AF Corse. Kubica competed in Formula One between and , and the World Rally Championship ...

at the

2007 Canadian Grand Prix The 2007 Canadian Grand Prix (formally the Formula 1 Grand Prix du Canada 2007) was a Formula One auto race, motor race held on 10 June 2007 at Circuit Gilles Villeneuve in Montreal, Quebec, Canada. It was the sixth race of the 2007 FIA Formula ...

, and

Elliott Sadler Elliott William Barnes Sadler (born April 30, 1975) is an American former professional stock car racing driver. He last competed part-time in the NASCAR Xfinity Series, driving the No. 10 Chevrolet Camaro for Kaulig Racing. Sadler is one of 36 dr ...

at the 2003 EA Sports 500/

2010 Sunoco Red Cross Pennsylvania 500 The 2010 Sunoco Red Cross Pennsylvania 500 was a NASCAR Sprint Cup Series stock car race held on August 1, 2010 at Pocono Raceway in Long Pond, Pennsylvania. Contested over 200 laps, it was the twenty-first race of the 2010 Sprint Cup Series ...

References

External links

{{DEFAULTSORT:Basilar Skull Fracture Injuries of head Bone fractures Causes of death Wikipedia medicine articles ready to translate