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Otology & Neurotology : Official... Dec 2020Only a handful of case reports exist describing posttraumatic sutural diastasis in the calvarium and none report concurrent temporal bone involvement. We aim to describe...
OBJECTIVE
Only a handful of case reports exist describing posttraumatic sutural diastasis in the calvarium and none report concurrent temporal bone involvement. We aim to describe diastasis along the temporal bone suture lines in the setting of temporal bone trauma and to identify clinical sequelae.
STUDY DESIGN
Retrospective case review.
SETTING
Tertiary Level 1 trauma center.
PATIENTS
Forty-four patients aged 18 and younger who suffered a temporal bone fracture from 2013 to 2018 were identified. Diastasis and diastasis with displacement at the occipitomastoid, lambdoid, sphenosquamosal and petro-occipital sutures, and synchondroses were determined.
MAIN OUTCOME MEASURES
The presence of temporal bone suture and synchondrosal diastasis following temporal bone trauma. Diastasis was defined as sutural separation of a distance greater than 1 mm in comparison to the contralateral side.
RESULTS
Using our diastasis diagnostic criteria, diastasis occurred in 41.5% of temporal bone fractures. Transverse fracture types were significantly associated with diastasis (p ≤ 0.001). Lower Glasgow Coma Scale (GCS) and loss of consciousness (LOC) were associated with the presence of diastasis with displacement and diastasis (p = 0.034 and p = 0.042, respectively). Otic capsule violation was more common in fractures with diastasis but did not reach statistical significance. There were two cases of cerebrospinal fluid otorrhea and three deaths in cases that featured diastasis.
CONCLUSION
Our findings indicate that diastasis is a positive predictor for higher disruptive force injuries and more severe outcomes and complications. Posttraumatic temporal bone suture diastasis may represent a separate clinico-pathologic entity in addition to the usual temporal bone fracture classification types.
Topics: Adolescent; Child; Cranial Sutures; Fractures, Bone; Humans; Retrospective Studies; Skull Fractures; Sutures; Temporal Bone
PubMed: 32810023
DOI: 10.1097/MAO.0000000000002804 -
The American Journal of Forensic... Dec 2003Several controversies exist regarding ultimately lethal head injuries in small children. Death from short falls, timing of head injury, lucid intervals, presence of... (Review)
Review
Several controversies exist regarding ultimately lethal head injuries in small children. Death from short falls, timing of head injury, lucid intervals, presence of diffuse axonal injury (DAI), and subdural hematoma (SDH) as marker of DAI are the most recent controversial topics of debate in this evolving field of study. In this area of debate, we present a case of delayed death from a witnessed fall backwards off a bed in a 9-month-old black male child who struck his head on a concrete floor and was independently witnessed as "healthy" postfall for 72 hours until he was discovered dead in bed. Grandmother, babysitter, and mother all independently corroborated under police investigation that the child "acted and behaved normally" after the fall until death. Autopsy showed a linear nondisplaced parietal skull fracture, diastasis of adjacent occipital suture, subgaleal hemorrhage with evidence of aging, small posterior clotting SDH, marked cerebral edema, and a small tear of the midsuperior body of the corpus callosum consistent with focal axonal injury (FAI). No DAI was seen, and there were no retinal hemorrhages. All other causes of death were excluded upon thorough police and medical examiner investigation. Although this seems to be a rare phenomenon, a delayed, seemingly symptom-free interval can occur between a clinically apparent mild head injury and accidental death in a young child.
Topics: Accidental Falls; Brain Edema; Corpus Callosum; Death, Sudden; Humans; Infant; Intracranial Hemorrhage, Traumatic; Male; Occipital Bone; Parietal Bone; Skull Fractures; Time Factors
PubMed: 14634479
DOI: 10.1097/01.paf.0000097851.18478.16 -
British Journal of Neurosurgery 1989Twenty patients with an epidural haematoma of the posterior fossa (EPIPF) among a total number of 359 patients with an epidural haematoma are reported (5.6%). Nine... (Review)
Review
Twenty patients with an epidural haematoma of the posterior fossa (EPIPF) among a total number of 359 patients with an epidural haematoma are reported (5.6%). Nine patients obtained a good outcome, four patients had a moderate disability and seven patients died (mortality 35%). Mortality of the acute cases was 50%, of the subacute cases 20%. In general, the clinical features were uncertain. Sixteen cases showed an occipital skull fracture or diastasis of the lambdoid suture respectively. A total number of 127 cases with EPIPF from the literature since 1961 was studied. The mortality in the CT-diagnosed group ran to 21.7% and to 25.9% in the group without CT. None of the patients showing a subacute course died when the diagnosis was made by CT, in the group without CT, however, four patients out of 11 subacute cases died. Head injured patients with an occipital trauma should therefore undergo CT scanning to detect a surgically significant lesion before clinical deterioration occurs.
Topics: Adolescent; Adult; Brain Injuries; Child; Child, Preschool; Female; Hematoma, Epidural, Cranial; Humans; Infant; Male; Middle Aged; Radiography
PubMed: 2679686
DOI: 10.3109/02688698909002792 -
Acta Clinica Croatica Mar 2009Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this...
Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this lesion in craniocerebral injuries make the establishment of a diagnosis more difficult. The aim of the paper is to point to the advantages of early diagnosis. During the 1982-2008 period, 18 patients with EHPCF were operated on at University Department of Neurosurgery, Clinical Center of Montenegro in Podgorica. The clinical picture, neuroradiological examination findings and outcome of operated patients were retrospectively analyzed. In our patient series, EHPCF accounted for 0.11% of craniocerebral injuries or 7.9% of epidural hematomas recorded. In 11 cases, the injury was inflicted in traffic accidents and in 7 patients it was caused by fall. Linear fracture of the occipital bone was detected by radiographic investigation in 12, isolated diastasis fracture of lambdoid suture in four, and linear fracture of the occipital bone with diastasis fracture of lambdoid suture in two patients. Glasgow Coma Scale of 8 and less was present in three, 9-12 in seven, and 13-15 in eight patients. The majority of cases (90%) were detected within 24 hours. In all cases, the diagnosis was made by computed tomography. Mortality rate was 11.11%. Early computed tomography of the head in combination with clinical picture and timely surgical intervention could reduce the mortality and morbidity in these lesions.
Topics: Adolescent; Adult; Child; Child, Preschool; Cranial Fossa, Posterior; Female; Hematoma, Epidural, Cranial; Humans; Male; Middle Aged; Young Adult
PubMed: 19623868
DOI: No ID Found -
Child's Nervous System : ChNS :... Apr 2015This study aimed to consider an appropriate treatment for large subgaleal hematoma with skull fracture and epidural hematoma (EDH).
PURPOSE
This study aimed to consider an appropriate treatment for large subgaleal hematoma with skull fracture and epidural hematoma (EDH).
CASE REPORT
A 6-year-old boy presented at our hospital with head trauma, and computed tomography (CT) showed a thin EDH in the right temporo-occipital area and cranial diastasis in the right lambdoidal suture. However, no neurological deficits were identified in the patient. One week after trauma, he visited our hospital again with a massive fluctuant watery mass extending from the forehead to the right temporoparietal areas, and laboratory data revealed that he was anemic. CT showed a massive subgaleal hematoma with extremely high density around the cranial diastasis. Damage of the transverse sinus was suspected, and emergent sinus repair surgery was performed. The surgery disclosed that bleeding from the transverse sinus was flowing out extracranially through the cranial diastasis. The subgaleal and epidural hematomas were removed, and bleeding from the sinus was stopped by dural tacking sutures along the transverse sinus. Postoperative CT demonstrated complete disappearance of epidural and subgaleal hematomas. The patient recovered from general fatigue without blood transfusion and was discharged 9 days after surgery.
CONCLUSIONS
The therapeutic strategy for massive subgaleal hematoma is individualized. However, treatment for massive subgaleal hematoma with skull fracture should not be considered the same as for hematoma without skull fracture. Emergent surgery is recommended before neurological deterioration is recognized in the patient if damage to the dural sinus is suspected.
Topics: Child; Cranial Sutures; Epidural Space; Humans; Male; Skull Fractures; Subarachnoid Hemorrhage, Traumatic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25142690
DOI: 10.1007/s00381-014-2531-3 -
Traffic Injury Prevention 2022This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify...
This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify multiplanar loads. Pretest radiographs of pre-screened five human cadaver head-neck complexes were obtained. Cranium contents and sectioned the structure rostral to skull base. The caudal end was embedded, and cervical-thoracic disc was unconstrained condition. The loading was applied as a torque about the occipital condyle joint. The head and T1 were angulated 30 degrees and 25 degrees. Peak forces and moments at the occipital condyles were recorded using a six-axis load cell. After testing, x-rays and CT images were obtained. Injuries were scored using the Abbreviated Injury Scale, AIS 2015 version. The mean age, stature, total body mass, body mass index of the five subjects were as follows: 63 years, 1.7 m, 78.0 kg, and 28.1 kg/m. The mean peak axial force and coronal, sagittal, and axial bending moments were: 754 N, and 36.8 Nm, 14.8 Nm, and 9.5 Nm. All but one specimen sustained injury. Injuries were scored at the AIS 2 level. Two specimens sustained left anterior inferior lateral mass fractures of the atlas. While the transverse atlantal ligament was intact, some capsular ligament involvement was observed. In the other two specimens, although the same injury was noted, joint diastasis of the atlas-axis joint was identified. Using a PMHS model, the present study described the biomechanics of the initially head rotated head-neck complex under lateral bending in terms of injuries, injury mechanisms, quantification of the multiplanar loads at the occipital condyles, and underscored potential injury scoring issues for occupant protection. The issue of diastasis is not addressed in the AIS 2015 version. While this may not always result in immediate instability and require surgical intervention, it may be necessary to revisit this issue. Upper cervical fractures with diastasis and or transverse atlantal ligament involvement may be potential injury scoring factors for AIS consideration.
Topics: Humans; Middle Aged; Accidents, Traffic; Neck; Neck Injuries; Spinal Injuries; Fractures, Bone; Biomechanical Phenomena; Cervical Vertebrae; Posture; Cadaver
PubMed: 36215262
DOI: 10.1080/15389588.2022.2124811 -
The Medical Journal of Australia Aug 1977A case of traumatic basal subarachnoid haemorrhage and fractured mandible following a blow to the neck is described. The characteristic findings exhibited were diastasis...
A case of traumatic basal subarachnoid haemorrhage and fractured mandible following a blow to the neck is described. The characteristic findings exhibited were diastasis of the atlanto-occipital joint with subluxation of the right side of the first cervical vertebra, in the absence of a demonstrable abnormality of the cerebral circulation.
Topics: Adult; Female; Forensic Medicine; Humans; Mandibular Fractures; Neck Injuries; Subarachnoid Hemorrhage; Wounds, Nonpenetrating
PubMed: 909485
DOI: 10.5694/j.1326-5377.1977.tb99141.x -
Singapore Medical Journal Mar 1998While posterior fossa extradural haematomas (PFEDH) may lead to rapid neurological deterioration and death because of brainstem compression, prompt treatment often leads...
OBJECTIVES
While posterior fossa extradural haematomas (PFEDH) may lead to rapid neurological deterioration and death because of brainstem compression, prompt treatment often leads to a good outcome. The non-specific clinical signs and the rarity of this lesion in craniocerebral trauma adds to the difficulty in diagnosis. The aim of this study was to identify features which could lead to an early diagnosis.
METHODS
Seventeen patients with posterior fossa extradural haematomas were operated on over 4 1/2 years, accounting for 7.5% of the 226 surgically operated extradural haematomas in the Department of Neurosurgery, Tan Tock Seng Hospital, Singapore. Four patients were excluded from this study due to non-availability of the case records. The remaining 13 patients formed the study group in this retrospective analysis.
RESULTS
The majority of cases (77%) presented acutely within 24 hours. The mechanism of injury varied from a fall in 7 cases, a road traffic accident in 4 cases and assault in 2. Nine patients had evidence of external injury to the occiput, 8 patients had skull fractures, and diastasis of the lambdoid suture was seen in 2 cases. Presence of aerocele was noted in the CT scan of 4 cases. All 9 cases admitted with a high GCS score of more than 8 had a very good outcome.
CONCLUSION
An early CT scan head is recommended if a combination of the following features is present: occipital soft tissue injury, drowsiness, occipital fracture or diastasis of the lambdoid suture.
Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Air; Brain Stem; Child; Child, Preschool; Cranial Fossa, Posterior; Cranial Sutures; Female; Glasgow Coma Scale; Hematoma, Epidural, Cranial; Humans; Male; Occipital Bone; Parietal Bone; Retrospective Studies; Skull Fractures; Sleep Stages; Tomography, X-Ray Computed; Treatment Outcome; Violence
PubMed: 9632968
DOI: No ID Found -
World Neurosurgery Apr 2024Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and...
BACKGROUND
Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience.
METHODS
We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
RESULTS
We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
CONCLUSIONS
Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
Topics: Humans; Aged; Odontoid Process; Spinal Fractures; Bone Screws; Fractures, Bone; Fracture Fixation; Neck Injuries; Fracture Fixation, Internal
PubMed: 38266989
DOI: 10.1016/j.wneu.2024.01.094 -
Journal of Engineering and Science in... Aug 2024Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The...
Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The objective of this study was to determine the lateral bending tolerance of the head-cervical spine with initial head rotation posture using loads at the occipital condyles and lower neck and describe injuries. Using a custom loading device, head-cervical spine complexes from human cadavers were prepared with load cells at the ends. Lateral bending loads were applied to prerotated specimens at 1.5 m/s. At the occipital condyles, peak axial and antero-posterior and medial-lateral shear forces were: 316-954 N, 176-254 N, and 327-508 N, and coronal, sagittal, and axial moments were: 27-38 N·m, 21-38 N·m, and 9.7-19.8 N·m, respectively. At the lower neck, peak axial and shear forces were: 677-1004 N, 115-227 N, and 178-350 N, and coronal, sagittal, and axial moments were: 30-39 N·m, 7.6-21.3 N·m, and 5.7-13.4 N·m, respectively. Ipsilateral atlas lateral mass fractures occurred in four out of five specimens with varying joint diastasis and capsular ligament involvements. Acknowledging that the study used a small sample size, initial tolerances at the occipital condyles and lower neck were estimated using survival analysis. Injury patterns with posture variations are discussed.
PubMed: 38059268
DOI: 10.1115/1.4063648