These will depend on the location, type, and extent of the injury.
A skull or facial fracture may cause:
Swelling and pain
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
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:
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:
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
Admission to the hospital for monitoring
Stabilization may also require emergency surgery to protect surrounding tissues and organs.
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.
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
is used to protect and assist breathing.
The following medications may be prescribed:
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.
NINDS traumatic brain injury information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Traumatic-Brain-Injury-Information-Page. Accessed September 1, 2017.
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-E41.
Traumatic brain injury and concussion. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/TraumaticBrainInjury/index.html. Updated July 6, 2017. Accessed September 1, 2017.
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