Basilar skull fractures and facial nerve injury

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1. Basilar skull fractures are caused by either direct impact to the occiput, mastoid prominence, or supraorbital area, the thin basilar skull is particularly susceptible to remote effects of trauma
   1. vulnerable areas of the skull base are the sphenoid sinus, foramen magnum, petrous temporal ridge, and inner parts of the sphenoid wing
   2. low-velocity crushing injuries of the skull which produce crushing or avulsion of the petrous bone, causing stretch injuries of CN 5 and 6
   3. CN 7 and 8 can be injured by transverse fractures of the petrous bone
      1. CN 7 exits out of brainstem into the internal auditory meatus and then exits the skull through the stylomastoid foramen
      2. CSF leaks from the ear (otorrhea) usually resolve spontaneously and don’t require surgical correction
2. Treatment of depressed skull fractures
   1. treatment of depressed skull fractures is based on correcting a cosmetic deformity as well as preventing infection; treatment may be based on:
      1. cosmetic deformity
      2. scalp laceration
      3. dural laceration
      4. extension of the fracture over a venous or paranasal sinus
      5. existence of other underlying lesions (e.g. subdural, epidural)