Skull pathophys Flashcards
What are the three fossa within the skull
Anterior
middle
posterior
What makes up the hard palate
Maxilla
Palatine bone
What comes through the foramen magnum
Spinal cord and vertebral arteries
What are the types of skull trauma
Basilar
depressed
orbital
scalp lac
What are the layers of the skull (outside to inside)
skin
periosteum
bone
periostea
meninges
What is important to think about with skull fractures
The surrounding structures
TBI
CSF leak
C-spine injury
What is the thinnest bone on the adult skull
temporal
What skull fractures have a higher rate of complications
When the fracture involves high vascular area
What type of fracture has a higher risk of infection
open fracture or fracture involving the sinus
How does a skull fracture present
Hematoma
depression or step off
neurologic findings
periorbital or retroauricular bruising
hemotympanum
What is a linear skull fracture
Fx that goes through the entire calvarium
Where are linear fractures most common
temporal, frontal or occipital
What does a linear skull Fx look like
diastases at suture lines
not typically life threatening
What is a depressed skull Fx
section of skull pushed inward by significant external force
What is often associated with depressed skull fractures
parenchymal injury or intracranial hemorrhage
What are some complications with depressed skull fractures
seizures
infection
high morbidity / mortality
open to dura which increases risk of infection (most are open fx)
What is a basilar skull fx
base of the skull gets fractured
What bones are broken in a basilar skull fx
cribriform plate
orbital plate
petrous aspect of temporal bone
sphenoid
occipital bone
What is the presentation of an anterior basilar skull fx
raccoon eyes
evidence of CSF leak
change in vision / smell
change in EOM
What is the presentation of a middle basilar skull fx
loss of hearing/balance
carotid artery injury
battle sign
What is a “battle sign”
Bruising behind the ear
What is the presentation for a posterior basilar skull fx
vertebral artery injury
c-spine injury
What bones make up the orbit
sphenoid bone
lacrimal bone
Palentine bone
maxilla
zygomatic
ethmoid
frontal
What is the most common orbital fracture
orbital zygomatic
What is a potential complication of a fx of the nasoethmoid bone
entrapment of the medial cantal ligament, lacrimal duct or medial rectus
What are the complications of an orbital floor fx
inferior rector muscle may become entrapped causing decreased EOM
Infraorbital nerve entrapment
What is the biggest concern with orbital roof fx and who are they seen in most commonly
Children
concern for intracranial injury
What is the biggest concern with a zygomatic fracture
facial nerve palsy from injury to infraorbital nerve or zygomaticotemporal nerve
What is the purpose of a fontanel
allow for brain growth
What is craniosynostosis
premature closure of cranial sutures
When do the skull sutures typically seal
18-20 months
What suture closes prematurely most often
Sagittal
What are some things that commonly are associated with craniosynostosis
abnormal dural attachment sites
intrinsic abnormality with increased osteoblastic activity
hyperthyroidism
medication in utero
What is positional plagiocephaly
Flat spot from being on their back too long
What may be done to correct craniosynostosis
A surgical spacer may be placed
What may cause mastoiditis
untreated otitis media
How does otitis media cause mastoiditis
the area becomes blocked and unable to drain
What pathogen is associated with mastoiditis
s. pneumoniae
streptococcus pyogenes
p. Aeruginosa
What are the common symptoms of mastoiditis
typical otitis media findings plus…
pain
erythema
swelling
all around the mastoid
