Base of Skull Fractures

Question 1

What bone is involved most commonly in base of skull fractures?

Answer 1

Temporal (75%)

Known as a posterior fossa fracture

Question 2

What are the sx/signs of a posterior fossa fracture?

Answer 2

Battle's sign (bruising over mastoids)
CSF otorrhoea
Bleeding of ear
Conductive deafness (6-8wks)
CN palsies (V, VI & VII)

Question 3

What is the appropriate management of a posterior fossa fracture?

Answer 3

Refer to neurosurgery, often don’t require intervention

Question 4

What proportion of base of skull fractures are anterior fossa?

Answer 4

25%

Question 5

What bones are commonly involved in anterior fossa fractures?

Answer 5

Occipital
Sphenoid
Ethmoid

Question 6

What are the sx/signs of an anterior fossa fracture?

Answer 6

Raccoon eyes
CSF rhinorrhoea
Bleeding from the nose

Question 7

What is the appropriate management of an anterior fossa fracture?

Answer 7

URGENT referral to neurosurgery

Question 8

What are the potential complications of base of skull fractures?

Answer 8

Intracranial infection
Facial nerve palsy
Ossicular chain disruption
Carotid injury

Question 9

How long are prophylactic antibiotics given for after a CSF leak?

Answer 9

7 days after any CSF leak has ceased

Question 10

What is the management of a depressed skull fracture?

Answer 10

Surgical exploration w/i 12hrs

-impossible to know if interruption of dura w/o exploration