(Head Injury; Open Skull Fracture; Closed Skull Fracture; Fracture, Skull and Facial; Maxillary Fracture; Le Fort Fracture; Mandible Fracture; Zygomatic Fracture)
- Simple—the bone is broken, but skin is intact
- Linear—the break is in a thin, straight line through the depth of the skull bone
- Depressed—the bone of the skull is crushed and pushed in toward the brain
- Comminuted—a complex fracture with bone splintering and tearing of the skin
- Maxillary fractures involve the upper jaw. They are classified as Le Fort I-V fractures based on their specific location on the maxillary bone.
- Mandible fractures involve the lower jaw.
- Zygomatic fractures involve the cheekbones.
- Orbital fractures involve the bones around the eyes
- Closed—the fracture does not break the skin
- Open—the fracture breaks through the skin
|Fractures in the Zygomatic Arch and Orbit|
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- Car, motorcycle, or pedestrian accidents
- Blunt force trauma
- Penetrating trauma
- Domestic violence, or child or elder abuse
- Sports injury
- Children up to 4 years old and advancing age
- Not wearing a seatbelt
- Not wearing a bike or motorcycle helmet
- Occupations with risk of falls from heights
- Playing sports without proper head protection
- Health conditions that increase the risk of falls
- Previous head injury
- Wheelchair use
- Car seat related accidents, such as drops, flip-overs, or falls
- 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
- Hearing loss
- Numbness or tingling of the face
- Deformity or facial asymmetry
- Any loss of consciousness
- Worsening headache
- Unequal pupils
- Increased pressure in the brain
- Paralysis to the limbs
- Lightheadedness, which may lead to fainting
- Nausea with or without vomiting
- Changes in vision
- Sluggishness or grogginess
- Difficulty concentrating
- 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:
- Level of consciousness
- Pupil reaction to light
- Response to stimuli
Stabilizing the Injury
- Attaching a backboard to stabilize the head and neck
- A breathing tube for a blocked airway
- IV fluids
- Admission to the hospital for monitoring
- 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
- Pain medication
- Antiseizure medications
- Medications to reduce pressure inside your head or brain swelling
- Antibiotics if an infection is present or possible
Rest and Recovery
- Avoid situations that put you at risk of physical harm.
- Always wear a seatbelt when driving or riding in a car.
- Always wear a helmet when riding a bike or motorcycle.
- Do not drive under the influence of alcohol or drugs.
- Wear proper padding and safety equipment when participating in sports or activities.
- Clean spills and slippery areas right away.
- Remove tripping hazards such as loose cords, rugs, and clutter.
- Use non-slip mats in the bathtub and shower.
- Install grab bars next to the toilet and in the shower or tub.
- Put in handrails on both sides of stairways.
- Walk only in well-lit rooms, stairs, and halls.
- Keep flashlights on hand in case of a power outage.
American College of Emergency Physicians. http://www.acep.org
Brain Injury Association of America http://www.biausa.org
Canadian Association of Emergency Physicians http://www.caep.ca
The Brain Injury Association of Canada http://biac-aclc.ca
Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 29, 2015. Accessed August 10, 2015.
Facial fractures. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/head-neck/treatments-services/facial-fractures. Accessed August 10, 2015.
Maxillofacial injuries. Patient UK website. Available at: http://patient.info/doctor/maxillofacial-injuries. Updated December 20, 2010. Accessed August 10, 2015.
Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 20, 2015. Accessed August 10, 2015.
NINDS traumatic brain injury information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/tbi/tbi.htm. Updated July 17, 2015. Accessed August 10, 2015.
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.
Skull fracture—emergency management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Accessed August 10, 2015.
Subdural hematoma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15. 2014. Accessed September 29, 2014.
Traumatic brain injury. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/TraumaticBrainInjury/index.html. Updated March 27, 2015. Accessed August 10, 2015.
- Reviewer: Michael Woods, MD
- Review Date: 08/2015 -
- Update Date: 09/30/2013 -