The main symptoms of fracture of the skull base and treatment methods
A fracture of the skull base in trauma patients is considered to be one of the most severe injuries. What is the reason? This is due to the anatomical structure of this area of the human body.
Features of the skull structure
If we talk about the structure of the skull, it consists of the following elements:
- cons - virtually all of his bone structure that protect the medulla from the top and sides;
- the base, composed of occipital, frontal and temporal bones protect the brain stem.
Directly from the bone medulla are not in contact, as between them is the Dura mater, which performs not only protective but also cushioning function. Fracture of the cranial vault, as well as its Foundation, can lead to traumatic damage of brain tissue. In the end severely affect its function. But the most severe is the injury which causes damage to the Dura mater. In this case violated the integrity of the brain, which ultimately can lead to infectious process, even more compounding the consequences of the resulting physical and physiological disorders.
That leads to traumatic injury?
Injury, namely fractures of the skull base are rare and account for slightly more than 25% of the entire category of such damage. What might be the reason for the formation of this disease?
- Strong direct blow to the nose or temple.
- Falling even from a small height.
- Accident on the road.
In the latter case most often a fracture of the skull can be obtained in emergency at high speed.
Symptoms of a fracture
The clinical manifestations of the considered injuries are quite varied and depend on the localization of the fracture, the direction and location of the crack or fracture and the presence or absence of bone fragments.
In case of damage in the anterior cranial fossa revealed the following clinical symptoms:
- Bleeding from the nose, often profuse.
- In severe injuries of the nasal passages can stand livorna liquid.
- There are typical signs of injury of the skull - "symptom score". It is a dark bluish circles around the eyes. They can be formed in the second or third day from receipt of such injuries. This is the main difference from the classichematomas characteristic of other pathological processes.
- If the damage of ethmoid bone can form subcutaneous emphysema. It is the result of the penetration and free movement of air in the subcutaneous space.
It should be noted that most often, when such injury damages the area of the middle cranial fossa. This usually leads to the destruction of the canal of the facial nerve, the auditory region is suffering a stroke, both internal and secondary. Symptoms characteristic of such localization of traumatic injury:
- The ear is sharply reduced, while the more complex violation almost immediately comes the deafness in one ear.
- It's ear begins to bleed.
- If the eardrum is damaged, the blood starts to stand out livorna liquid.
- In the ear or the temple formed a hematoma.
- Manifested clinical symptoms of damage to the facial nerve. In addition to increasing deafness can be diagnosed dizziness, decreased taste sensitivity of the tongue, increased secretion of saliva.
- If the damage of the posterior fossa, usually diagnosed longitudinal fractures of the skull. They can manifest in the form of hematomas in the left or right ear. In case of personal injury or injury to surrounding nerve branches diagnosed the so-called bulbar clinic. This, for example, paresis, and in more severe cases, paralysis of the muscles of the tongue, throat or soft palate.
What could be broken?
The nature of damage to bone structures of the skull base injuries are divided into the following types:
- A linear fracture is a thin crack in the bone. In this case, an almost total absence of debris, not observed displacement of bone structures. Specified injury related to the category of the least dangerous. It does not require emergency treatment.
- If as a result of injury the bone is crushed into several pieces, then the damage becomes comminuted. It is more complex, with not always predictable results, as due to the resulting mobility of bone structures, the splinter may be damaged not only the hard shell of the brain, but his tissue and blood vessels. In the end, like skull fractures can be the result of hematomas, contusions, and in more severe cases - crush of the nervous tissue. And the trauma region of the occipital bone most often ends in death.
- Case wheninjury to the bone just veneetsia inside of the skull, indicates a depressed damage. Under strong pressure in this case may also suffer the Dura. This damage is considered severe because of the high risk of destruction of brain structures.
- The most complex and often incompatible with life are perforated traumatic brain injury. The main cause of these injuries becomes a gunshot wound. Survival is almost impossible.
The rendering of first aid
In case of detection of injuries that may cause damage to the base of the skull, the detection of the above symptoms, first and foremost, you need to call the victim to the ambulance.
The sooner the patient will be delivered to the relevant Department and he will provide the necessary assistance, the more favorable the prognosis for treatment and the consequences of this injury. Before the arrival of medical workers need to provide first aid. What is it?
- If in the head there is a wound, it is necessary to cleanse it. For this wound surface is rinsed with hydrogen peroxide and, in the absence of regular clean water. Then superimposed aseptic bandage.
- The patient is placed in horizontal position with slight elevation of the head. This is a must, because in such injuries of the locomotor activity of the victim may lead to adverse consequences. If the patient is unconscious, it is placed on the intact side, or just turn my head in that direction. Such first aid will prevent asphyxia the appearance of gag reflexes.
- For the relief of pain to the site of injury you can apply ice. Receive pain medication in this case, it does not make sense. This may complicate diagnosis upon delivery of the victim in the trauma Department.
How to diagnose
Diagnosis of this injury usually simple. The doctor performs the inspection of the received in the emergency Department the patient and asks him if the patient is conscious.
If he is unconscious or similar damage detected in children, talk with accompanying relatives or professionals to deliver their ambulance.
When the history of a trauma of the skull, accompanied by the characteristic symptoms, put the preliminary diagnosis: Fracture of the skull base".
However, to confirm it conducted x-rays in twothe main projections, and in case of special need - MRI.
Specifics of conservative therapy
After diagnosis in the case when the symptoms of fracture of the skull base do not indicate the need for immediate surgical intervention conservative therapy is carried out.
It consists in complete rest and bed rest for the patient. The patient should be treated only in a trauma hospital to conduct a permanent control of the status change.
As the drug therapy are assigned to antimicrobial agents, and anesthetics. Definitely shows a dehydration therapy to prevent swelling of the brain tissue. This uses a lumbar puncture, and with a more severe course of post-traumatic period the treatment is lumbar drainage. Necessary in this case, and drugs that enhance blood circulation of brain tissue, for example, nootropil. It is used during the rehabilitation therapy.
Surgical intervention is indicated only in severe injuries. Typically, this occurs when the diagnosis of depressed fractures of the bony structures of the skull, in the presence of clinical manifestations of damage to the rootlets of the trigeminal nerve or symptoms of damage to the ear drum (for example, in the case of discharge from ears and nasal passages CSF fluid). Other reasons for the purpose of the surgery is haematoma formation immediately after injury and in the course of conservative treatment.
The surgery is performed under General anesthesia. Removed the bone fragments, damaged tissue and clots bleeding. When bleeding use a tampon, and the resulting cavity is cleaned.
What method to treat this injury, only a doctor decides on the basis of all diagnostic data and external manifestations. Important role in the treatment process plays a timely delivery of the patient in the casualty Department of the hospital.