Skull and Facial Fracture

Skull and facial fractures are broken bones of the head and face. Injury can result in damage to the brain. Types of skull fractures include: Facial fractures can occur in any of the face’s bones. They are named for specific areas of the face: Fractures may either be: Both skull and facial fractures may be life-threatening conditions. They require immediate medical treatment.

  • Causes

    Skull and/or facial fractures are caused by direct trauma to your head. Trauma can be caused by:

    • Falls
    • Car, motorcycle, or pedestrian accident

    • Blunt force
      trauma
    • Penetrating trauma
    • Domestic violence, child or elder abuse
    • Sports injury
    • Gunshot

  • Definition

    Skull and facial fractures are broken bones of the head and face. Injury can result in damage to the brain.

    Types of skull fractures include:

    • 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

    Facial fractures can occur in any of the face’s bones. They are named for specific areas of the face:

    • 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.

    Fractures may either be:

    • Closed—the fracture does not break the skin
    • Open—the fracture breaks through the skin

    Both skull and facial fractures may be life-threatening conditions. They require immediate medical treatment.

    Fractures in the Zygomatic Arch and Orbit
    skull fracture zygo and eye socket
    © Nucleus Medical Media, Inc.

  • Diagnosis

    You will most likely be taken to a hospital. A doctor will ask about your symptoms and how your injury occurred. A physical exam will be done. A neurological exam will evaluate your nervous system. Tests may include the following:

    • 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
      • Reflexes
      • Response to stimuli


    Imaging tests may include
    X-rays
    and/or a
    CT scan.

  • Prevention

    To help reduce your chance of a skull and/or facial fracture, take these steps:

    • 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

    To help reduce falling hazards at work and home, take these steps:

    • 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

  • Risk Factors

    Factors that may increase the chance of a skull and/or facial fracture include:

    • 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

    Specific factors that may also increase a child's risk of a skull fracture include:

    • Previous head injury
    • Wheelchair use
    • Car seat related accidents, such as drops, flip-overs, or falls

  • Symptoms

    These will depend on the location, type, and extent of the injury.

    A skull or facial fracture may cause:

    • Swelling and pain
    • Headache
    • Bumps and bruises
    • Visible bleeding (some injuries cause internal bleeding that may not be seen)
    • Leaking 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

    Some trauma causes bleeding in the brain. A hematoma occurs when a pocket of blood leaks into the spaces between the brain and the skull, increasing intracranial pressure.
    Signs of injury to the brain or hematoma include:

    • Any loss of consciousness
    • Worsening headache
    • Vomiting
    • Confusion
    • Seizures
    • Unequal pupils
    • Increased pressure in the brain
    • Paralysis to the limbs

    Concussion
    may cause:

    • Lightheadedness, which may lead to fainting
    • Nausea with or without vomiting
    • Changes in vision
    • Sluggishness or grogginess
    • Difficulty concentrating

  • Treatment

    If you are in a situation where there is a skull or facial fracture injury, call for medical help right away.

    Treatment will depend on the location and extent of the injury.