title: Bilateral occipital condyle fractures leading to retropharyngeal haematoma and acute respiratory distress.
abstract: Injuries to the occipito-cervical junction are rare and not easily diagnosed on conventional radiographs. The authors report such a case where the diagnosis was delayed. The patient developed a significant retrophyarngeal haematoma resulting in acute respiratory distress and required emergency endotracheal intubation. The patient remained intubated for five days and received a tapered dose of intravenous dexamethazone to reduce swelling in the proximity of the airway. At six weeks the patient had developed a left hypoglossal nerve palsy that persisted at 12 months. Occipital condyle fractures and the difficulties of diagnosis are discussed. The importance of measuring pre-vertebral soft tissue swelling on lateral radiographs is emphasized. Computed tomography of the C0-C2 region should be performed to identify base of skull and upper cervical fractures.
authors.affiliation: The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK. brian.freeman@mail.qmcuh-tr.trent.nhs.uk
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
authors.forename: Hannes
authors.initials: H
authors.lastname: Behensky
mesh_terms: D000059:Accidents; D000208:Acute Disease; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000209:etiology; D008297:Male; D009049:Motorcycles; D009777:Occipital Bone / Q000293:injuries*; D010614:Pharynx; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome