Therapy of the skull base fracture
introduction
The therapy of a Skull base fracture mainly depends on that Extent of damage surrounding structures due to the break. It is not necessary to operate immediately for every fracture of the base of the skull. However, there are some situations where a immediate action is necessary. This is especially important to mention here open traumatic brain injurywhich is mostly caused by accidents. Also one Involvement of cranial nerves is an absolute indication for surgery, e.g. if the Ocular nerve (second cranial nerve) is affected by entrapment and a Blindness threatens or even if the seventh cranial nerve is damaged, which is responsible for the facial muscles and if it fails, it becomes one Facial paralysis comes (Facial palsy). Another rush situation is with one massive loss of nerve water (Liquor) and blood or if the head is impaled with a foreign body.
Conservative therapy
If no displacement of the fracture ends is present, you can also wait and see, with regular checks for bleeding and inflammation, conservative therapy attempt start. If the above-mentioned situations do not occur, this can often be sufficient. Even at Eardrum defects or accumulation of blood in the middle ear, healing is often achieved by waiting. Kick Nerve fluid from the ear out (otogenic liquorrhea), it is replaced by a Administration of antibiotics treated to prevent bacteria from entering and causing inflammation.
One then treats symptomatic e.g. With Antivertiginosa against dizziness or one Pain medication. It is debated whether a prophylactic administration of antibiotics to avoid a dangerous Meningitis (meningitis) or also Encephalitis (Encephalitis) makes sense. Opinions differ here; it certainly makes sense to discuss this topic with the treating doctor in each individual case, depending on the severity of the injuries.
surgery
On the other hand, it looks different if one of the situations mentioned above occurs, or it turns out to be one Nerve fluid leaks from the nose comes (rhinogenic liquorrhea). Here is one surgery displayed. The surgical procedure usually consists of removing the tissue that has been damaged by the trauma or fracture, to take the pressure off and so irreversible damage caused by the discharge to prevent. In addition, the ends of the fracture must be brought back into the correct anatomical position so that healing and, above all, Stability of the bones can be guaranteed. Because unstable fractures or a growing together of the bones in the anatomically incorrect position can also be secondary Pressure damage to nerves or vessels lead in the brain and / or facial skull area.
So there must be both Injuries to the hard meninges (Dura mater) again sewn as well as the Bone defects with filling material covered become. For this purpose, in the best case, one uses the body's own tissue, such as so-called Fascia (= Connective tissue that envelops muscle groups, for example) or also Fibrin glue (= Two-component adhesive that connects tissue to one another). With these substances is the dangerthat it becomes a Rejection reaction of the body is essential less than with synthetically manufactured products.
If there are larger defects, so can Metal plates or pins are used to stabilize the fracture ends again in such a way that they can grow together and thus restore the necessary stability. The use of these metallic parts is rather rare. If the skull has been dented by the fracture, it is raised again during the operation.
Does it come through a Participation of vessels to a profuse bleeding, the injured vessel must be restored using a Vascular suture be locked. The is often affected internal carotid artery (Internal carotid artery), because its course at the base of the skull is endangered by fractures of the same. Do you have to use the Open skull, this usually falls within the remit of the Neurosurgeons.
However, if the facial skull is broken, the Oral and maxillofacial surgeon are used. Should the eyes be damaged by injury to the second cranial nerve (Optic nerve) or hearing through involvement of the eighth cranial nerve (Vestibulocochlear nerve) may be affected, the Ophthalmologist or ENT specialist participate in the treatment.
Complications
Regarding the possible complications, especially the Wound healing disorders by Infections or to name repeated irritation. In rare cases, if the blood vessels are damaged, it can also lead to a Rebleeding come, which must then be stopped in a second treatment / operation. Did cranial nerves become involved in the course of the fracture of the base of the skull and the associated ones neurological failuresso it is likely that nerve recovery will take a long time. However, it can too permanent nerve damage come if the decompression of the nerves has taken too long, or if the damage to the nerve itself is simply too great. The brain itself can of course be affected and it can too irreparable brain damage come. These can vary from mild symptoms such as Concentration and memory disorders or personality changes can range up to very serious damage. The worst complication here is certainly the so-called apallic syndrome (Vegetative state), in which the entire function of the cerebrum is lost, whereas the function of the cerebellum, diencephalon, brain stem and spinal cord is retained. The patients appear awake to the observer, but can no longer interact with their environment.
So you should with existing neurological deficits or persistent symptoms after fracture of the skull base early at one Possibility of rehabilitation To take care of. This significantly improves the patient's outcome. In the case of severe brain damage, the Admission to special clinics possible, in which an attempt is made to restore the patient's suitability for everyday use through intensive care and support.
