title: The effect of direction of force to the craniofacial skeleton on the severity of brain injury in patients with a fronto-basal fracture.
abstract: The skull base is uniquely positioned to absorb force imparted to the craniofacial skeleton, thereby reducing brain injury. Less well understood is the effect of the direction of force imparted to the craniofacial skeleton on the severity of brain injury. Eighty-one patients from two UK major trauma centres who sustained a fronto-basal fracture were divided into two groups: those struck with predominantly anterior force and those by predominantly lateral force. The first recorded Glasgow Coma Score (GCS), requirement for intubation, and requirement for decompressive craniectomy were used as markers of the severity of brain injury. An average GCS of 5 was found in the lateral group and 14 in the anterior group; this difference was statistically significant (P<0.001). There was an increased need for both intubation and decompressive craniectomy in the lateral group compared to the anterior group (absolute risk difference 46.6% and 15.8%, respectively). These results suggest that the skeletal anatomy of the fronto-basal region influences the severity of head injury. The delicate lattice-like structure in the central anterior cranial fossa can act as a crumple zone, absorbing force. Conversely in the lateral aspect of the anterior cranial fossa, there is a lack of collapsible interface, resulting in an increased energy transfer to the brain.
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: Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bulters
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: D000328:Adult; D001696:Biomechanical Phenomena; D001930:Brain Injuries / Q000209:etiology*; D035262:Cranial Fossa, Anterior; D056424:Decompressive Craniectomy; D005260:Female; D005624:Frontal Bone / Q000293:injuries* / Q000601:surgery; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019291:Skull Base / Q000293:injuries* / Q000601:surgery; D020205:Skull Fracture, Basilar / Q000209:etiology / Q000601:surgery; D012887:Skull Fractures / Q000209:etiology* / Q000601:surgery; D006113:United Kingdom; D055815:Young Adult
keywords: anterior cranial fossa; craniofacial trauma; skull base fracture; skull base trauma; traumatic brain injury