A basilar skull fracture is a break in one of the many bones at the bottom of a person's skull, including the occipital bone at the back of the head, the temporal bone at the bottom of the skull above the jaw, the sphenoid bone above the cheek, or the ethmoid bone behind the eye. Fractures at the base of the skull are less common than cracks in other areas of the skull. A severe blow to the back or bottom of the head is usually responsible for these types of fractures, though force from trauma to other areas of the skull can transfer and result in a crack in one of the bones near the base.
It can be difficult to diagnose a basilar skull fracture with traditional imaging studies such as x-rays, since it is difficult to see the underside of the skull on an image. Doctors often diagnose this type of skull fracture by looking for other signs and symptoms commonly associated with an injury to the floor of the skull. Patients with a bone fracture at the bottom of the skull often have swollen black eyes, bruising behind the ear, balance problems, facial muscle weakness, vision problems, or nasal problems or leakage.
The most common complication following a basilar skull fracture is leakage of cerebral spinal fluid. Doctors can order laboratory tests of nasal fluid to determine if cerebral spinal fluid is present. If there is a leak of fluid, the patient's head is kept elevated and liquids are restricted to inhibit the flow of the fluid. Doctors can drain the fluid from the head through the neck if the leak is severe, and they may order intravenous or oral antibiotics to reduce the risk of infection.
A basilar skull fracture that occurs around the opening in the base of the skull where the spinal cord attaches to the brain can cause damage to the surrounding nerves and blood vessels. Damage to these nerves or other nerves in the face can result in temporary or permanent paralysis of facial muscles and the muscles around the eyes.
Most basilar skull fractures heal on their own with limited medical treatment, though a doctor should always diagnose any problems following a head injury. Patients with skull injuries are usually monitored for at least 24 to 48 hours to ensure there are no serious complications or additional injuries. In some cases, surgery may be required to repair the broken bones, though this is usually only necessary if the break is severe or spans multiple bones.