title: Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?
abstract: The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P<0.001) than for predominantly anterior force (12.0%). Fractures were significantly more likely to propagate into the posterior fossa with a lateral vector of impact compared to an anterior vector (P=0.049). This difference in energy transfer across the skull base may, in part, be explained by the local anatomy. The more delicate central ACF acts as a 'crumple zone' in order to absorb force. Conversely, no collapsible interface exists in the lateral aspect of the ACF, thus the lateral ACF behaves like a 'buttress', resulting in increased energy transfer.
authors.affiliation: The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, UK. Electronic address: jonny08@hotmail.co.uk.
authors.forename: J R
authors.initials: JR
authors.lastname: Stephens
authors.affiliation: The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Department of Oral and Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Holmes
authors.affiliation: The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Department of Oral and Maxillofacial Surgery, University Hospital Southampton, Southampton, UK.
authors.forename: B T
authors.initials: BT
authors.lastname: Evans
mesh_terms: D059925:Anatomic Landmarks; D035262:Cranial Fossa, Anterior / Q000033:anatomy & histology* / Q000293:injuries; D004739:England / Q000453:epidemiology; D006801:Humans; D012189:Retrospective Studies; D012887:Skull Fractures / Q000453:epidemiology*
keywords: anterior cranial fossa; applied anatomy; craniofacial trauma; fracture pattern; skull base fracture; skull base trauma