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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)

Definition

Skull and facial fractures are breaks in any of the bones of the head and face.

Fractures in the Zygomatic Arch and Orbit
skull fracture zygo and eye socket

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Causes

Skull and facial fractures are caused by trauma to the head from:

  • Falls
  • A motor vehicle accident
  • A direct blow to the head
  • Gunshot

Risk Factors

Things that may raise your risk are:

  • Playing sports without head protection
  • Having a health problem that may result in falls, such as weak muscles
  • Not wearing a seatbelt

Symptoms

Problems may be: :

  • Swelling and pain
  • Headache
  • Bruising
  • Bleeding
  • Leaking clear fluid through the nose
  • Blood in the ears or nose
  • Problems moving the face or mouth
  • Uneven dental bite
  • Eye problems, such as double vision or problems moving the eyes
  • Breathing problems
  • Problems hearing
  • Numbness or tingling of the face
  • Changes in the way the face looks

Diagnosis

You will be asked about your symptoms and health history. You will also be asked how the injury happened. A physical exam will be done. It will focus on your head.

Images may be taken. This can be done with a CT scan. X-rays may also be taken.

Treatment

It will take several weeks to heal. The goals of treatment are to manage pain and support the bone as it heals. This may include:

  • Medicine to ease pain
  • Devices that help with breathing

Putting Bones Back In Place

Some fractures cause pieces of bone to come apart. These pieces will need to be put back into place. This may be done:

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

Prevention

Most fractures are due to accidents. Wearing a seatbelt and helmet may help prevent some injuries. Healthy bones and muscles may also help prevent falls. This may be done through diet and exercise.

RESOURCES:

American College of Emergency Physicians.
http://www.acep.org

Brain Injury Association of America
http://www.biausa.org

CANADIAN RESOURCES:

Brain Injury Advocates
http://biac-aclc.ca

Canadian Association of Emergency Physicians
http://www.caep.ca

REFERENCES:

Bressan S, Marchetto L, et al. A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Ann Emerg Med. 2017 Nov 23;pii:S0196-0644(17)31797-3.

Facial fractures. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/head-neck/treatments-services/facial-fractures. Updated November 12, 2015. Accessed December 5, 2019.

Maxillofacial injuries. Patient UK website. Available at: http://patient.info/doctor/maxillofacial-injuries. Updated December 19, 2014. Accessed December 5, 2019.

Skull fracture—emergency management. EBSCO DynaMed website. Available at:https://www.dynamed.com/management/skull-fracture-emergency-management. Accessed December 5, 2019.

Last reviewed September 2019 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS  Last Updated: 12/5/2019