The human skull is divided into two parts: the neurocranium, a hard shell of bone that protects the brain, and the viscerocranium, the bones of the face and jaw. At birth, the human skull is not yet fully developed; different bones in the neurocranium fuse and harden as a child grows.
The skull protects some of the most vital and delicate tissue in the human body: the brain. While it’s well adapted to protecting the neurological tissue within, the hard bones of the neurocranium can still fracture under sufficient force. Skull fractures may happen when the head slams into a hard object like a steering wheel, dashboard, or pavement; they can also occur when a heavy object is dropped on the head or swung at the head. An object with a point or edge may penetrate the skull when it breaks through the bone.
In many cases, a skull fracture may also involve an injury to the brain or the brain’s blood supply. Fractures to the neurocranium need to be treated quickly to ensure that the brain does not sustain permanent damage.
What are the different types of skull fracture?
In a closed fracture, the bones of the skull are broken, but the skin covering those bones is not cut or broken.
A fracture is said to be open or compound when the skin is broken and the bone is emerging through the skin.
A basal fracture is a break in the bone in the floor of the skull: the portion around the ears, nose, eyes, and the start of the spinal column.
When a fracture is depressed, the skull has been pushed inwards into the cavity that holds the brain. This type of fracture can be extremely dangerous.
How can skull fractures be treated?
In some cases, particularly those involving basal skull fractures, surgery may not be necessary. The bones of the skull can heal themselves over time if the break is not too severe. In these cases, a doctor will focus on pain management while the skull heals. Infants with skull fractures may need different treatment and a longer period of medical observation than adults.
Surgery may be necessary for certain types of skull fractures, especially if the fracture is severe. Leakage of cerebrospinal fluid (the fluid that protects the delicate nerve tissue of the brain) from the nose and ears may indicate that surgery is necessary. Depressed skull fractures are highly likely to need surgery if the depressed area is putting pressure on the brain or causing fluid leakage.
The treatment of skull fractures is often complicated by damage to the nearby soft tissues. If an accident involves enough force to fracture the skull, it may also tear the thin skin over it. Traumatic brain injuries may also be seen after an accident that causes a skull fracture; in severe cases, surgery may be required to cut through the skull to relieve pressure on the brain or stop bleeding in the area.
What are the symptoms of skull fractures?
If you suspect that you have a fractured skull, see a doctor immediately. Symptoms may include:
- Torn skin near the area of the fracture
- Changes in the size of the pupils (the sizes are not equal or do not react to light)
- Bleeding from the nose, ears, or around the eyes
- Bleeding or swelling at the site of the wound
- Confusion, drowsiness, loss of consciousness
- Bruising beneath the eyes or behind the ears
- Slurred speech
- Nausea or vomiting
- Headache or stiffness in the neck
- Visual disturbances
- Irritability or restlessness