Skull and Facial Fracture

Definition

Skull and facial fractures are broken bones of the head and face. Injury can result in damage to the brain.

Types of skull fractures include:

• Simple—the bone is broken, but skin is intact
• Linear—the break is in a thin, straight line through the depth of the skull bone
• Depressed—the bone of the skull is crushed and pushed in toward the brain
• Comminuted—a complex fracture with bone splintering and tearing of the skin

Facial fractures can occur in any of the face’s bones. They are named for specific areas of the face:

• Maxillary fractures involve the upper jaw. They are classified as Le Fort I-V fractures based on their specific location on the maxillary bone.
• Mandible fractures involve the lower jaw.
• Zygomatic fractures involve the cheekbones.
• Orbital fractures involve the bones around the eyes

Fractures may either be:

• Closed—the fracture does not break the skin
• Open—the fracture breaks through the skin

Both skull and facial fractures may be life-threatening conditions. They require immediate medical treatment.

Fractures in the Zygomatic Arch and Orbit

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Causes

Skull and/or facial fractures are caused by direct trauma to the head. Trauma can be caused by:

• Falls
• Car, motorcycle, or pedestrian accidents
• Blunt force trauma
• Penetrating trauma
• Domestic violence, or child or elder abuse
• Sports injury
• Gunshot

Risk Factors

Factors that may increase the chance of a skull and/or facial fracture include:

• Children up to 4 years old and older adults
• Not wearing a seatbelt
• Not wearing a bike or motorcycle helmet
• Occupations with risk of falls from heights
• Playing sports without proper head protection
• Health conditions that increase the risk of falls

Specific factors that may also increase a child's risk of a skull fracture include:

• Previous head injury
• Wheelchair use
• Car seat related accidents, such as drops, flip-overs, or falls

Symptoms

These will depend on the location, type, and extent of the injury.

A skull or facial fracture may cause:

• Swelling and pain
• Headache
• Bruising
• Visible bleeding (some injuries cause internal bleeding that may not be seen)
• Leaking clear cerebrospinal fluid, which usually occurs through the nose
• Blood in the ears or nose
• Inability to move face or mouth
• Uneven dental bite
• Eye problems, such as double vision or inability to completely move the eyes
• Breathing difficulties due to airway obstruction
• Hearing loss
• Numbness or tingling of the face
• Deformity or facial asymmetry

Some trauma causes bleeding in the brain. A hematoma occurs when a pocket of blood leaks into the spaces between the brain and the skull, increasing intracranial pressure. Signs of injury to the brain or hematoma include:

• Any loss of consciousness
• Worsening headache
• Vomiting
• Confusion
• Seizures
• Unequal pupils
• Increased pressure in the brain
• Paralysis to the limbs

Concussion may cause:

• Lightheadedness, which may lead to fainting
• Nausea with or without vomiting
• Changes in vision
• Sluggishness or grogginess
• Difficulty concentrating

Diagnosis

You will most likely be taken to a hospital. A doctor will ask about your symptoms and how your injury occurred. A physical exam will be done. A neurological exam will evaluate your nervous system. Tests may include the following:

• Pain and airway assessment
• An examination of the ears for blood, and the nose for blood or fluid that may be leaking from the brain
• Glasgow coma scale—neurological exam that tests different parts of the nervous system including:
  • Level of consciousness
  • Pupil reaction to light
  • Reflexes
  • Response to stimuli

Imaging tests may include X-rays and/or a CT scan.

Treatment

If you are in a situation where there is a skull or facial fracture injury, call for medical help right away.

Treatment will depend on the location and extent of the injury.

Stabilizing the Injury

The first steps will be focused on stabilizing the injury. They may include:

• Attaching a backboard to stabilize the head and neck
• A breathing tube for a blocked airway
• IV fluids
• Admission to the hospital for monitoring

Stabilization may also require emergency surgery to protect surrounding tissues and organs.

Initial Care

Some fractures cause pieces of bone to separate. The doctor will need to put these pieces back into their proper place. This may be done:

• Without surgery—anesthesia will decrease pain while the doctor moves the pieces back into place
• With surgery—plates or wires may be needed to reconnect the pieces and hold them in place

Nearly half of skull and facial fractures require surgical repair. Surgery may not be done until the fracture is stabilized and swelling at the injury site goes down.

Hospitalization

People with these fractures usually need to stay in the hospital. Serious injuries may need to be watched in an intensive care unit. Some people with skull or facial fractures need to have help breathing. A tube is inserted and mechanical ventilation is used to protect and assist breathing.

Medications

The following medications may be prescribed:

• Pain medication
• Antiseizure medications
• Medications to reduce pressure inside the head or brain swelling
• Antibiotics if an infection is present or possible

Rest and Recovery

Healing time varies by age and overall health. Children and people in better overall health heal faster. In general, it may take several weeks for a skull or facial fracture to heal.

Activities will need to be adjusted, but complete rest is rarely required. Ice may also be recommended to help with discomfort and swelling.

Physical therapy or rehabilitation may be needed to keep muscles strong.

Prevention

To help reduce your chance of a skull and/or facial fracture:

• Avoid situations that put you at risk of physical harm.
• Always wear a seatbelt when driving or riding in a car.
• Always wear a helmet when riding a bike or motorcycle.
• Do not drive under the influence of alcohol or drugs.
• Wear proper padding and safety equipment when participating in sports or activities.

To help reduce falling hazards at work and home:

• Clean spills and slippery areas right away.
• Remove tripping hazards such as loose cords, rugs, and clutter.
• Use non-slip mats in the bathtub and shower.
• Install grab bars next to the toilet and in the shower or tub.
• Put in handrails on both sides of stairways.
• Walk only in well-lit rooms, stairs, and halls.
• Keep flashlights on hand in case of a power outage.