The document discusses various types of skull and facial fractures, their causes and symptoms. It describes linear, depressed, open and basal skull fractures, as well as fractures of the cranial vault, skull base and facial bones. Facial fractures include nasal, orbital and mid-face fractures. Symptoms vary depending on the location of the fracture but may include headache, blurred vision, swelling and bruising. Causes are typically high-impact injuries from accidents or assaults.

2. Presenters:
Muhammad Arslan Yasin
Muhammad Usman
Muhammad Maaz
Akash Bashir
Hizqail Jafri
DPT-3rd
Semester

3. Learning Objectives
We will learn:
A)Skull Fracturs
o Types of skull Fractures
o Causes
o Symptoms
B)Cranial Fossa Fracturs
C)Facial Fractures
o Types of Facial Fractures
o Causes
o Symptoms

4. skull fracture
A skull fracture is a break in one or more of the eight bones
that form the cranial portion of the skull, usually occurring as a
result of blunt force trauma. A partial or complete break in
skull bone

5. Types of Fractures
Closedfracture
With a closed fracture, also called a simple fracture, the skin that covers the fracture
area isn’t broken or cut.
Openfracture
Also known as a compound fracture, an open fracture occurs when the skin is broken
and the bone emerges.
Depressedfacture
This refers to a fracture that causes the skull to indent or extend into the brain cavity.
Basalfracture
A basal fracture occurs in the floor of the skull: the areas around the eyes, ears, nose, or
at the top of the neck, near the spine.
Othertypes
In addition to the above types, fractures can also classify as:
linear (in a straight line)
comminuted (broken into three or more sections)

7. Types of Fractures

8. Overview
Vault:
The cranial vault is the space in the skull within
the neurocranium, occupied by the brain.

9. Overview
The term “skull base” refers to the bottom of the skull, or
the plate of bone upon which the brain sits. The skull
base is an important area since it separates the brain
from the remainder of the anatomic structures in the head,
including the sinuses, eyes and ears. The skull
base contains many openings.

10. Types of Fractures
Linear fracture
Linear skull fractures are breaks in the bone that
transverse the full thickness of the skull from the outer
to inner table. They are usually fairly straight with no
bone displacement.

11. Types of Fractures
Depressed skull fractures
result in the bone of the skull vault being folded
(depressed) inward into the cerebral parenchyma. It
is usually the result of a high energy impact to
the skull.

12. Types of Fractures
Ping‐pong fracture occurs in newborn and young
infants, when the skull is relatively very soft and
resilient and is able to indent without a break in
the bone. It is so called due to its similarity to
indentation produced on a ping‐pong ball.
Ping‐pong fracture

13. Types of Fractures
Open fractures communicate with the skin through a
wound, a sinus, the ear, or the oropharynx.
Open fractures

14. Causes
Causes of skull fractures:
A skull fracture occurs when
• A force that’s strong enough to break the bone hits the skull
• Any type of impact to the head can cause a skull fracture
• Hit with an object,
• Falling and hitting the ground
• Injuring the head in a car accident
• Any other type of trauma.

15. o headache
o nausea
o vomiting
o blurred vision
o restlessness
o irritability
o loss of balance
o stiff neck
o pupils not reacting to light
o confusion
o excessive drowsiness
o fainting
Symptoms of skull
fractures

16. Temporal bone fracture
Temporal bone fracture is usually a sequela of
significant blunt head injury. In addition to
potentially damage to hearing and the facial
nerve, associated intracranial injuries, such as
extra-axial haemorrhage, diffuse axonal injury
and cerebral contusions are common.
Temporal bone fracture

17. Temporal bone fracture

18. Sphenoidbone
Fracture
Fractures of the sphenoid bone occur following
injury to the orbit and base of the skull. Such
fractures are important since they can cause loss of
vision and damage to various neural and muscular
tissues.
Fractures of the sphenoid bone

19. Orbitomeatal Plane
In anatomical position, cranium is
oriented so that inferior margin of
orbit and superior margin of
external acoustic meatus (ear) lie
in same horizontal line.

20. Cranial Fossas

21. Anterior Cranial Fossa
Fracture of anterior cranial fossa may cause
bleeding and discharge of cerebrospinal fluid
through nose. It may also cause a condition
called Black eye.

22. Epistaxis Injuries of the mucosa in the cranial base
region can result in brief loss of blood from the
nose.
Anterior Cranial Fossa

23. Middle Cranial Fossa
Fracture of anterior cranial fossa may cause
bleeding and discharge of cerebrospinal fluid
through ear.

24. A temporal bone fracture may cause facial
paralysis, hearing loss, bruising behind the
ear, and bleeding from the ear.
Middle Cranial Fossa

25. Posterior Cranial Fossa
Fracture of posterior cranial fossa may cause
bruising over the mastoid region.

26. Battle's sign
Battle's sign, also known as mastoid ecchymosis, is an indication of
fracture of middle cranial fossa of the skull.

27. These fractures may be associated with underlying
brain trauma. Battle's sign consists of bruising over
the mastoid process as a result of extravasation of
blood along the path of the posterior auricular
artery.
Battle's sign

28. Pneumocephalus
Def.
Pneumocephalus is the intracranial presence
of air. Increased pressure in the nose and
paranasal sinuses .
Causes
air to leak through the defect in the bony skull
base resulting in epidural,
subdural/subarachnoidal, or intracerebral
presence of air.

29. Seiferth Sign
The Seiferth sign is a submucosal hematoma visible on
the roof of the pharynx that can occur with fractures
involving the sphenoid sinus or posterior ethmoid.
Flexible endoscopy is used for evaluation.

30. Raccoon eyes (panda eyes) or periorbital ecchymosis is a sign
of basal skull fracture or subgaleal hematoma, a craniotomy
that ruptured the meninges, or (rarely) certain cancers.
Raccoon Eye

31. Bilateral hemorrhage occurs when damage at the time of a
facial fracture tears the meninges and causes the venous
sinuses to bleed into the arachnoid villi and the cranial
sinuses.( blood from skull fracture seeps into the soft
tissue around the eyes.)
Raccoon Eye

32. Hem tympanum
Hem tympanum or hematotympanum, refers to the presence
of blood in the tympanic cavity of the middle ear. Hem
tympanum is often the result of basilar skull fracture.
Causes
Basal skull fracture A basal skull fracture is a fracture in one of
the bones at the base of your skull. This is almost always
caused by something hitting your head, a hard fall, or a car
accident.

33. Symptoms
pain sense of fullness in the ear hearing loss
Keep reading to learn about additional
symptoms you may have, depending on the
cause.
Hem tympanum

34. Treacher Collins syndrome
(TCS)
Def.
Treacher Collins syndrome (TCS) is a genetic disorder characterized by
deformities of the ears, eyes, cheekbones, and chin.
Causes
Genetic
Symptoms
• underdevelopment of the lower jaw
• underdevelopment of the zygomatic bone

35. Treatment
• Reconstructive surgery
• Hearing aids
• Speech therapy
• tongue being retracted
• The small mandible can result in a poor
occlusion of the teeth
• trouble breathing or swallowing
Treacher Collins
syndrome (TCS)

36. Clinical Importance
The mandible is commonly fractured at the canine
socket where it is weak. Involvement of the inferior
alveolar nerve in the callus may cause neuralgic
pain, which may be referred to the areas of
distribution of the buccal and auriculotemporal
nerves. If the nerve is paralysed, the area supplied
by the mental nerve becomes insensitive.
The mandible

37. Clinical Importance
In a suspected case of murder, fracture of the
hyoid bone strongly indicates throttling or
strangulation.
Hyoid bone

38. Clinical Importance
A blunt blow to the external ear can cause bruising between
the cartilage and the layer of connective tissue around it
(perichondrium). When blood collects in this area, the external
ear becomes swollen and purple. The collected blood
(hematoma) can cut off the blood supply to the cartilage,
allowing that portion of the cartilage to die, leading in time to a
deformed ear. This deformity, called a cauliflower ear, is
common among wrestlers, boxers, and rugby players.
Ear

39. facial fractures
A) Nasal bones (broken nose)—Nasal bone fractures
b) Frontal bone (forehead) fractures—The frontal bone is the main
bone in the forehead area. A high-impact injury to the head can
cause a fracture of the frontal bone and floor of the sinuses.

40. Facial fractures
c) Zygomaticomaxillary fractures (broken cheekbone/upper
jaw)—The zygomas (cheekbones) are attached at several
points to the upper jaw (maxilla) and bones of the skull.

41. d) Orbital fractures (eye socket)—There are three main types of
orbital fractures.
• Orbital rim fracture—The outer rim is the thickest part
of the eye socket. It requires a lot of force to break the bone.
Many other injuries may accompany an orbital rim fracture,
such as damage to the optic nerve.
• Blowout fractures—The orbital rim remains intact in this
case, but a crack forms in the thin bone at the lower part of the
eye socket. The eye muscles and other structures can become
entrapped in the break and prevent the eyeball from moving
normally.
• Direct orbital floor fracture—This is a rim fracture that
extends into the lower socket.

42. e) Mid-face (Le Fort fractures)--Blunt force trauma tends to cause fractures
along three lines of weakness in the mid-face. One characteristic of all
types of Le Fort fractures is the fracture of the pterygoid processes, part o
the sphenoid bone. There are three main types of Le Fort fractures, but
there may be individual variations.
• Le Fort I. The fracture extends above the upper jaw (maxilla).
• Le Fort II. The fracture extends from the lower part of one cheek,
below the eye, across the bridge of the nose, and to the lower part of the
other cheek.
• Le Fort III. The fracture extends across the bridge of the nose and
the bones surrounding the eyes.
Facial fractures

43. f) Mandible (lower jaw) Fractures of the lower jaw affect the
sections of the lower jaw that supports teeth (called the body),
the part where the jaw curves upwards into the neck (the
angle) or the knob-shaped joint at the top of the jaw bone (the
condyle) or the point where the two sides of the lower jaw are
joined (the symphysis). Fractures of the mandible may be
accompanied by broken or loose teeth.
Facial fractures

44. • High-impact accidents, such as motor vehicle
collisions
• Sports injuries
• Workplace accidents
• Falls
• Interpersonal trauma or domestic violence
Cauese of facial fractures
Causes

45. Symptoms
Symptoms of a fracture to the face may include pain as well as
bruising, swelling, or tenderness.
Symptoms of a nose fracture may include
• Purplish patch on skin caused by leakage of blood from ruptured
blood vessels (bruising or ecchymosis)
• Discoloration under the eyes
• Blockage of one or both nostrils or a deviated septum
• Twisted or crooked nose or indented bridge
• Nosebleed
Symptoms of facial
fractures

46. Symptoms of facial
fractures
Symptoms of an orbital fracture may include
• Blurry, decreased or double vision (diplopia)
• Difficulty in moving eyes left, right, up or down
• Swollen forehead or cheek or swelling under the
eyes
• Flatness of the cheeks
• Sunken or bulging eyeballs
• Facial numbness near the injury
• Blood or discoloration in the white part of the eye

47. Symptoms of facial
fractures
Symptoms of upper or lower jaw fractures
• Trouble with chewing, eating, or speaking
• Loose, broken or missing teeth
• Teeth not fitting together properly
• Cheek pain when opening the mouth

48. A
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