Traumatic brain injury fracture of the temporal bone. Fractures of the temporal bone

The study of large statistical data and our own observations give reason to believe that severe ear lesions are more common with fractures of the base of the skull and are a consequence of the involvement of the pyramid of the temporal bone. It depends on the fracture line of the pyramid which elements of the ear suffer, what are the symptoms of the lesion and its consequences. In this regard, attempts to classify fractures of the temporal bone according to the direction and location of the cracks are understandable. There are longitudinal, transverse and combined fractures of the pyramid, but these three groups do not fit all the types of fractures encountered. In connection with this, an atypical form is singled out.

Rice. 37. Transverse fracture of the skull and longitudinal fracture of the labyrinth (a); longitudinal fracture of the skull and transverse fracture of the labyrinth (b).

At longitudinal fracture(Fig. 37, a) the crack runs along the roof of the tympanic cavity and the upper wall of the bony auditory canal and divides the pyramid into anterior and posterior parts. In the anterior - part of the auditory canal and the tympanic cavity is included, in the posterior - the entire labyrinth and canal of the facial nerve.

At transverse fracture(Fig. 37, b) pyramid fissure passes through the array of the inner ear, vestibule, cochlea, semicircular canals, as well as the canal of the facial nerve.

At combined(Fig. 38) fracture the fracture line runs from the posterior surface of the mastoid process or pyramid to the posterior lacerated foramen. The scope of the fracture usually includes the posterior wall of the external auditory canal, the roof of the tympanic cavity, the facial nerve canal, and the inner ear. An oblique fracture occurs mainly with a blow in the occipital region.

Rice. 38. Combined fracture of the labyrinth.

Schematically, it is possible to outline the usual clinical symptomatology for each group. For a longitudinal fracture, bleeding from the ear, rupture of the eardrum and a slight decrease in hearing are characteristic. Occasionally there are other symptoms - liquorrhea, paresis of the facial nerve, usually transient and deafness.

Hearing loss is associated with changes in the middle ear and has a sound-conducting character, but sound perception is often disturbed. The cause is labyrinth compression, which is possible with any type of fracture. Similarly, hemorrhage in the inner ear cannot be ruled out. These points are of great importance in the pathogenesis of damage to the functions of the labyrinth, as evidenced by the convincing data of Ulrich (1926), who found unilateral complete deafness in 17% of patients, and a significant decrease in hearing in 28%.

The most severe damage to the inner ear occurs when transverse fracture pyramids. Typical for this type of injury are unilateral complete deafness, loss of vestibular function and paralysis of the facial nerve. It should, however, be pointed out that such a lesion occurs with a total fracture of the labyrinth; often there are only partial fractures, cracks in the bone capsule of the labyrinth, leading to a limited decrease in function - loss or decrease in the perception of individual tops. With a transverse fracture of the pyramid, the tympanic membrane remains intact, in the middle ear there is only sometimes a small hemorrhage when the fracture line passes through the inner wall of the middle ear. With a longitudinal fracture, significant changes occur in the tympanic cavity - rupture of the tympanic membrane, tendons, muscles, fracture of the auditory ossicles. One of the frequent signs is a hematotympanum - an accumulation of blood that has poured out from vessels damaged by a fracture of the roof and the inner wall of the tympanic cavity. The membrane is intact and takes on a dark blue or pink color and appears somewhat protruding.

According to the observations of B. S. Preobrazhensky, in one patient, 2 weeks after a longitudinal fracture of the pyramid, the tympanic membrane took on an almost black color. The literature describes liquor tympanum - an accumulation of cerebrospinal fluid in the tympanic cavity, which penetrates through a crack in the meninges and in the roof of the cavity (Foss).

With an oblique fracture of the pyramid, cracks can pass in such a way that they capture different parts of the ear and therefore it is difficult to isolate the characteristic symptoms. This is even more true for atypical fractures.

In the diagnosis of pyramidal fractures, radiography is of great importance; with its help, it is possible to recognize the fracture lines in detail. However, there is a peculiar pyramidal fracture, microscopic, which is rarely seen on radiographs. Such fractures were found during histological examination of the temporal bone. They pass either through the entire pyramid, or only through the bone capsule of the labyrinth. In the latter case, due to the peculiarities of the anatomical structure of the capsule, regeneration does not occur and the fracture does not heal. The presence of communication between the tympanic cavity and the inner ear is of particular danger in inflammatory disease of the middle ear.

Assessing the role of head trauma in the etiology of deafness and hearing loss, we can assume that the greatest threat to ear function is posed by transverse fractures of the pyramid of the temporal bone, and then oblique ones. Longitudinal fractures are important mainly because of the possibility of developing purulent inflammation in the middle ear.

Purulent diseases of the middle ear that develop in connection with a fracture of the base of the skull have their own characteristics that affect the symptomatology and clinical course. The most important of these is the presence of cracks in the inner bone plate and the associated risk of infection spreading into the skull. Severe otitis media have with deep damage to the mucous membrane, the presence of bone sequesters.

Temporal bone is one of the bones that make up the base of the skull covers the temporal(lateral) region of the brain. It is a steam room: there are left and right parts. Fractures of the bones of the base of the skull occur in 4% of all, of which 75% are fractures specifically of the temporal bone.

Photo 1. Head injuries are one of the most dangerous because of the possibility of brain damage. Source: Flickr (Dion Hinchcliffe).

The structure of the temporal bone

The temporal bone is formed as a result of the fusion of 3 bones: squamous, tympanic and pyramidal (stony), the fusion sites are indicated by furrows. Complete fusion of the bones occurs by the end of the first year of life and closes the external auditory canal.

The temporal bone has several processes that are involved in the formation of the auditory canal, jaw joint, as well as the muscle-ligamentous apparatus. Also, the bone is pierced by 9 channels through which nerves (facial, vagus, trigeminal) and blood vessels (tympanic vessel, aqueduct vein, internal carotid artery) pass.

Note! Injuries to the temporal bone are very dangerous for human health and life, as they can lead to neurological disorders of varying severity, complications such as meningitis, hearing loss, severe hemorrhage when the carotid artery is ruptured.

Causes of fractures

Fracture of the temporal bone occurs due to impact with a hard object on the temporal region of the skull(a strong blow to the temple in a fight, hitting the corner of furniture when falling, etc.). This bone is quite thin, so local pressure on it very often ends in a fracture.

Fractures of the temporal bone in children

In children under one year old, the fusion of the constituent parts of the temporal bone has not yet been completed, in preschool years joints still pretty weak. For this reason, and also due to increased physical activity in children, temple fractures are quite common.

It is important! It should be borne in mind that the bone density in a child is quite low, and the nervous system is still imperfect, so head injuries can have the most serious consequences.

Types of fractures of the temporal bone

Depending on the location of the impact, a fracture can occur in any part of the temporal bone: tympanic, squamous, pyramidal, various processes, splitting of the sutures can occur.

Fractures of the tympanic labyrinth

With such fractures, opening of the tympanic cavity, which is accompanied by bleeding from the ear (sometimes not blood is released, but cerebrospinal fluid). In some situations, blood cannot leave the ear and a bruise forms behind the pinna (Battle sign).

Fracture of the scales of the temporal bone

This type of fracture is one of the most common injuries although in this case, displacement of fragments is often observed. Usually the injury is accompanied by hearing loss. Outwardly, it can be manifested by bleeding from the ear or nose; periorbital ecchymosis is rarely manifested.

Fractures of the pyramidal bone

Pyramidal bone fractures are the most difficult in terms of treatment and prognosis. With such injuries, patients often lose consciousness (for up to several days) and may even fall into a coma.

Fractures of the pyramidal part of the temporal bone are one of the most common causes of death in traumatic brain injuries. There are 3 types of fractures:

transverse. With such an injury, the patient loses consciousness (the duration of the unconscious state depends on the severity of the injury), hemorrhage from the nose and ears, the Battle symptom, periocular ecchymosis, horizontal nystagmus, and CSF effusion are possible. Complications include hearing impairment (rarely vision), paralysis of the facial nerves, loss of vestibular function, neurological autonomic disorders, and other symptoms of TBI. Depending on the severity of the injury, the consequences can be either reversible or irreversible. In especially severe cases, the development of a vegetative state and even death is possible.
Longitudinal. Such a fracture may develop as a result of a blow to the parieto-occipital region. Usually such an injury does not affect the labyrinths of the capsule, but can seriously damage the facial nerves and blood vessels. For this reason, the symptoms of a longitudinal fracture of the temporal bone are very pronounced: rupture of the tympanic membrane or hemorrhage into it, outflow of blood or cerebrospinal fluid from the ear, loss of consciousness, nausea and vomiting, paresis of the facial nerves, and so on.
Atypical. This injury captures the smallest and thinnest parts of the temporal bone, including the capsules of the labyrinth. The patient shows hearing loss, however, maintains a sense of balance. There is also dizziness with sudden movements of the head. The presence of bleeding from the ears is extremely rare.

Signs of a fracture of the temporal bone

Depending on the location of the injury and its severity, the symptoms will vary slightly. However, there are a number of indicative symptoms by which a fracture of the temporal bone can be suspected:

gaping wound at the site of injury (),
damage to the soft tissues of the temporal region of the skull without violating the integrity of the bone,
dizziness and nausea of the victim,
loss of consciousness, coma,
paresis and paralysis of the facial nerves,
hearing impairment or loss
ear bleeding,
battle symptom,
leakage of cerebral fluid from the ears or nose,
nose bleed,
horizontal nystagmus,
visual impairment,
periocular ecchymosis (bruising around the eyes),
may happen seizure.

If the above symptoms appear, it is necessary to transport the victim to the emergency room or neurological department. If the person is unconscious, call an ambulance.

First aid for a fracture of the temporal bone

With a closed fracture of the temporal lobe, provide the victim with maximum comfort and, if possible, deliver his to a medical institution. You can apply a cool, damp towel to your head.

It is important! In no case, if the temporal bone is injured, do not warm up the ear and do not bury anything in it!

In the case of an open fracture, do not wash the wound, because this action can contribute to infection and subsequent complications. If possible, you can impose on the wound and take the victim to the hospital. If the patient is unconscious, you need to call an ambulance to transport him.

Fracture diagnosis

According to external symptoms, a fracture of the temporal bone is similar to a concussion. A distinctive feature is bleeding from the ear. However, injuries to other bones that make up the base of the skull have similar symptoms. This requires a differential diagnosis.

The most informative method for diagnosing bone fractures is radiography. Due to the peculiarities of the structure of the temporal bone, for accurate diagnosis, it is necessary to perform fluoroscopy in 3-4 projections. It is also possible to conduct an MRI, laboratory tests of blood and outflowing cerebrospinal fluid are prescribed.

Treatment of fracture of the temporal bone

In most cases, this injury is indicated conservative treatment. The operation is performed only in case of an open or displaced fracture. You may also need mastoidectomy(dissection of the mastoid process) and tympanic membrane drainage.

Conservative treatment mainly consists of anti-infective therapy, since in other moments (for example, bone fusion), recovery occurs spontaneously.

It is important! Fracture of the temporal bone is extremely rare is actually a fracture. In many cases, there is a concussion or contusion of the brain, and sometimes damage to the brain substance. Therefore, with this injury, treatment from the point of view of neurology is very often necessary.

Without proper neurological care, the patient is threatened with numerous complications that can significantly reduce his quality of life.

Complications of trauma to the temporal bone

The consequences of a fracture for a person depend on several factors: the location of the injury, its severity, the general health of the person and his medical history, the timeliness of first aid, the correct choice and responsible treatment. The most common consequences, which can be both reversible and irreversible:

spontaneous healing with minimal residual effects (recurrent headaches, slight hearing loss);
hearing loss or loss;
chronic otitis;
facial nerve injury: violation of the innervation of the muscles of the face, paresis and paralysis, pain syndrome;
visual impairment;
purulent meningitis (the risk of its development persists throughout life);
neurological disorders characteristic of TBI: ataxia and impaired coordination of movements, headaches, speech apraxia, memory loss and other mental disorders.

Rehabilitation after fracture of the temporal bone

Usually, in case of bone fractures, procedures during the rehabilitation period are aimed at restoring the motor function of the injured limb, but the consequences of trauma to the temporal bone are more similar to TBI and are more neurological in nature. Rehabilitation of a fracture of the temporal bone consists in:

(drugs that improve the supply of tissues with oxygen, vitamins, neuroprotectors, diuretics, sedatives, antibiotics in case of infection);
massage of the head and collar zone;
Exercise therapy for violations of the motor functions of the body;
work with a speech therapist for hearing and speech disorders.

The rehabilitation period takes 4 weeks to 6 months since the injury. Over the next 1.5-2 years there is still room to correct some residual effects. After this period, we can talk about established changes.

Prevention of fractures

Photo 2. Simple precautions will help to avoid serious consequences.

A fracture of the temporal bone in a child or adult can have serious consequences, as important vessels and nerves pass through it. Injuries can lead to imbalance, hearing loss, and facial paralysis. Bleeding and pain, and sometimes leakage of cerebral fluid, accompanies the injury.

The structure and functions of the temporal bone

The temporal bone anatomically consists of three parts: squamous, stony, tympanic, which are separated from each other by cracks. Scales have two surfaces: brain and outer. It carries the meningeal nerves. The tympanic part contains the external auditory meatus. In the stony part, the densest, forming the base of the skull, is the vestibulocochlear nerve, the organ of hearing and balance.

Learn about the varying degrees of severity.

The fracture is accompanied by an increase or decrease in intracranial pressure. When the patient feels nausea, vomiting occurs. At the same time, vomiting does not bring relief, since it has a central origin, it occurs due to irritation of sensitive receptors in the hypothalamus. This can also occur with damage to the vagus nerve.

If the patient is unconscious, then vomit can enter the respiratory tract and cause further inflammation in the trachea, bronchi, and lungs.

Damage to the brain tissue by bone fragments from a strong blow causes a change in the reaction of one of the pupils to light, which becomes asymmetric. The defeat of the vagus nerve causes malfunctions of the heart. This nerve inhibits myocardial contraction, and if damaged, tachycardia may occur.

Read about: symptoms, diagnosis and first aid.

What symptoms occur during: clinical manifestations, treatment.

Find out how it turns out and what not to do with TBI.

The trigeminal nerve, the trunk of which runs in the pyramid of the temporal bone, provides sensitive innervation of the face. If damaged, his face may become numb. With a strong blow, the facial nerve, which is responsible for the motor innervation of the face, can break. The consequence of this is facial paralysis, its asymmetry.

The main formations are the vestibulocochlear nerve, which transmits signals from the vestibular apparatus, as well as the organ of hearing. When the temporal bone is fractured, the tympanic membrane often ruptures, the consequences of which are serious, as the patient develops lifelong deafness.

Damage to the nerve plexuses of the organ of hearing entails sensorineural hearing loss. Violation of the integrity of the vestibular apparatus leads to a loss of balance both at rest and in motion. The patient feels very dizzy. Microcracks and microfractures of the bony labyrinth of the temporal bone are dangerous.

Diagnosis of fracture of the temporal bone

The first examination that must be done if a fracture of the temporal bone is suspected is a computed tomography of the brain. X-rays are taken later. An examination by a neurologist is required for the possible detection of paresis of the facial muscles.

Provided to patients:

audiometry;

checking the functions of the vestibular apparatus;

Rinne and Weber tuning fork tests to determine the nature of hearing loss: conductive or neurosensory.

Treatment

First aid - immobilizing a sterile bandage on the head to ensure the immobility of bone fragments. To prevent aspiration of vomit into the respiratory tract, it is necessary to put the head on the uninjured side so that the contents of the stomach do not fall into the larynx, but pour out.

It is urgent to deliver the victim to the first-aid post for a complete examination and treatment. When a clear fluid flows out of the ear and nose, infection from the external environment should be avoided.

Important! Rinse and bury in the ear when providing first aid is impossible to avoid infection of the central nervous system.

With paralysis of the face on the side of the fracture, the function of the facial nerve is restored. If it is torn, it is stitched end to end. To reduce the intensity of inflammation of the facial nerve, ear candles with hormonal agents are used.

Damage to the eardrum requires surgery to repair. Fracture of the bones of the hearing aid (hammer, stapes and anvil) also requires surgical intervention.

Antibacterial drugs are used to prevent infectious complications in liquorrhea. In case of suppuration, a revision is made. With cerebral edema, dehydration therapy is performed - the introduction of diuretic drugs (Furosemide).

Conclusion

The consequence of a fracture of the temporal bone can be sensorineural and conductive hearing loss, dysfunction of the vestibular apparatus, impaired facial sensitivity. Some injuries are cured by surgery or go away on their own.

Pyramids of the temporal bone fractures - often observed in TBI. Pyramid cracks are divided into longitudinal and transverse.

Longitudinal cracks account for 3/4 of all such fractures. They occur with trauma to the lateral parts of the skull (parietotemporal). A crack from the cranial vault descends to the base, passes through the upper or posterior-upper sections of the external auditory canal, the middle ear and the musculo-tubal canal. Damage is mainly to the middle ear, to a lesser extent - the inner ear and the canal of the facial nerve. Clinical longitudinal fractures of the pyramid of the temporal bone are manifested by bleeding from the external auditory canal due to rupture of the tympanic membrane. Hearing in this ear is reduced mainly by the conductive type due to trauma to the eardrum, bleeding into the middle ear, and dislocation of the auditory ossicles. Decreased taste in the anterior 2/3 of the tongue in the acute period. Prognostically, longitudinal fractures of the pyramid are more favorable than transverse ones, since hearing and taste are restored in most patients, peripheral paralysis of the VII nerve is rare, and there is less possibility of infection of the cranial cavity.

Transverse fractures are 1/4, run perpendicular to the axis of the pyramid. They occur when struck in the occipital region. Transverse fractures pass through the internal auditory meatus, the inner ear (cochlea, semicircular canals), the facial nerve canal. Transverse fractures of the pyramid lead to damage to the labyrinth with irreversible deafness and loss of vestibular function, taste in the anterior 2/3 of the tongue, often there is insufficiency of the VII nerve on the affected side. There is no bleeding from the ear if the tympanic membrane is preserved, but often it is reddish-cyanotic, and later dark gray, because blood that has poured into the middle ear shines through it. Initially, after an injury, spontaneous destruction nystagmus appears, directed towards the healthy side, and later, multiple spontaneous stem nystagmus usually occurs as a result of edema, dysgemic disorders in the brain stem. Despite the acute shutdown of the labyrinth function, dizziness in the acute stage of the disease is often not observed, because the patients are in an unconscious state, and when consciousness returns to them, the vestibular attack has already passed. Transverse fractures are more dangerous, with more frequent intracranial complications, irreversible loss of hearing, vestibular function, facial nerve and taste in the anterior 2/3 of the tongue.

Since, with pyramidal fissures, the cranial cavity communicates with the cavities of the middle ear, and through the auditory tube - with the nasopharynx, these injuries should be considered open.

If a fracture of the pyramid is suspected, the auricle should be treated with alcohol, an aseptic bandage should be applied to the ear and immediately begin to give massive doses of antibiotics and sulfonamides, since the risk of infection of the cranial cavity is very high. Usually, fissures of the pyramid of the temporal bone are successfully treated conservatively. Gunshot injuries to the temporal bone require surgery.

Traumatic brain injury (TBI) is a mechanical damage to the skull and intracranial structures (brain, blood vessels, nerves, meninges).

The manifestations of traumatic brain injury in children differ significantly from the symptoms characteristic of adults, and they are due to the characteristics of the child's body, namely:

the process of ossification of the baby's skull is still incomplete, the bones of the skull are plastic, flexible, their connection to each other is loose;
the brain tissue is immature, saturated with water, the differentiation of the structures of the nerve centers and the circulatory system of the brain is not completed. Thus, on the one hand, the brain tissue has great compensatory capabilities and the so-called margin of safety (soft bones of the skull and more fluid in the brain than in adults can absorb a blow). On the other hand, since it is the immature brain tissue that is exposed to trauma, which can lead to a disruption in the development of its structures and provoke further limitation of mental development, emotional disorders, etc.

According to one of the classifications, traumatic brain injuries are divided into:

The baby lies on the changing table or on the couch, the mother turns away for a few moments, and the baby falls on the pop.
The baby is left unattended in a high chair. He kicks off the table with his feet and, together with the chair, falls on his back.
The baby is trying to get up in the crib. Something on the floor interested him, and he is hung over the side and falls.
The baby was left to sit in the stroller, not assuming that he would try to get up in it and, not finding support, would fall down.

Since the relative weight of the baby's head is much greater than the weight of the body, when it falls, it first of all hits the head and more often the parietal region. Very rarely, the frontal and occipital regions of the head are injured.

After a fall, the child develops redness in the impact zone, the baby feels pain. If a pronounced rapidly growing edema does not appear in this place for several minutes, but only a slight swelling is noted, then as a rule, this indicates a bruise of the soft tissues of the head (which does not apply to TBI).

Something cold must be applied to the sore spot (a bubble with ice, a towel moistened with cold water - do not forget to re-moisten it periodically, etc.). A cold compress is applied for at least 5-15 minutes (or at least for as long as the baby allows, - often this procedure causes an active protest).

A cold compress will reduce tissue swelling that interferes with the normal functioning of the organ, narrow the blood vessels, which is the prevention of bleeding and will become an important factor in the favorable outcome of the injury in the future.

The benefits of this procedure are more significant than the mythical possibility of hypothermia in such a short period of time. And most importantly, stay calm and try to calm the child.

Fractures of the temporal and parietal zone are often diagnosed in children. The causes of such an injury can be different: from a birth injury to a blow with a heavy object.

As a result of damage to the parietal region, the child has an indentation of the bone inside. Since there is no bone in the parietal zone in newborns, such an injury can occur very easily.

The consequences for the child are very severe.

As a result of trauma in the parietal zone in children, a hematoma, edema and abrasions form. There may also be tissue rupture and profuse blood loss. In more serious traumatic brain injuries, children may experience bleeding from the ears, throat, and nose. Even with a light hit of the child's head on something, it is recommended to consult a specialist.

The first step is to bring the victim to a motionless position, putting a soft object (a piece of cloth, a pillow, a folded blanket) under the head.

IMPORTANT: it is necessary to lay it on the opposite side of the injury site.

The next action, in addition to an urgent call for an ambulance, is to monitor all life-supporting functions - pulse rate, breathing.

In cases where, with a complex injury, cerebral fluid leaked out, there are signs of an open fracture of the skull bones, it is necessary to apply a sterile bandage. This should be done especially carefully, without making any effort, without squeezing the head of the victim.

If the victim is conscious, then he should be reassured and not allowed to move. There may also be bouts of vomiting and convulsions - this should be remembered and be prepared for this.

In the process of rehabilitation, a detailed examination is carried out, affecting many specialists. The patient's condition is being monitored.

A special diet, drugs and procedures are prescribed. One of the folk remedies for restoring bones is eating eggshells. As you know, it contains a lot of calcium, which is involved in the formation of bone tissue. However, a balanced course of vitamin preparations eliminates the use of shells in the diet.

Rehabilitation does not guarantee a complete restoration of human health. And the person himself is also able to have a positive effect on his treatment, if he gives up bad habits and follows all the recommendations of the attending physician.

Fracture of the temporal bone is distinguished by the nature and area of damage. There are four main types: linear, open (closed), comminuted or depressed.

A linear fracture is dangerous because the injury leads to damage to the vessels of the brain, as a result of which a hematoma forms inside the brain. The linear type of skull damage is often diagnosed when a child's head is injured.

Comminuted and depressed skull fractures damage the hard shell of the skull, as a result of which a hematoma is formed in the brain area.

A depressed fracture can lead to crushing of the brain. Victims with such trauma survive very rarely. Even in the case of saving life, brain activity is severely impaired. The person remains disabled.

dislocations

The temporal part of the skull is associated with the jaw composition. Subluxation and dislocation of the temporomandibular joint is often the result of trauma to the temporal lobe.

In some cases, subluxation is observed with a strong blow to the parietal zone. The pressure exerted on the region of the parietal zone affects the jaw composition, which leads to its subluxation (dislocation).

Traumatic brain injury, which is characterized as subluxation of the temporomandibular joint, is diagnosed more often in adults than in children. Subluxation is not always amenable to complete recovery, since the complete deviation of the jaw head from the cavity is very rarely inserted into its original place.

After trauma to the skull, a person may lose his memory - completely or partially. A facial surgeon deals with the treatment of skull fractures. An x-ray is taken first to check for bone abnormalities.

Head injuries can be both fractures and severe bruises, causing concussions and hematomas. This is no less dangerous to health than a broken bone.

The main thing you need to know is that a head injury is associated with the brain, so there can be any violations associated with impaired brain functions - in addition to memory loss, paralysis of the limbs, impaired functioning of the organ of hearing, speech, and also the psyche can occur.

spontaneous healing with minimal residual effects (recurrent headaches, slight hearing loss);
hearing loss or loss;
chronic otitis;
damage to the facial nerves: impaired innervation of the muscles of the face, paresis and paralysis, pain syndrome;
visual impairment;
purulent meningitis (the risk of its development persists throughout life);
neurological disorders characteristic of TBI: ataxia and impaired coordination of movements, headaches, speech apraxia, memory loss and other mental disorders.

Comprehensive rehabilitation of patients with post-traumatic sensorineural hearing loss, subjective tinnitus, hyperacusis and vestibular disorders is based on a combination of pharmacotherapy, physiotherapy, psychotherapy, reflexology, intravascular detoxification therapy.

Classification

Fractures vary:

According to the damaged bones of the same name;

Along the cranial fossae of the inner surface of the skull: anterior, middle and posterior;

In relation to the external environment;

By the presence or absence of bone displacement.

The occipital and sphenoid bones are part of the brain region of the skull. The temporal bones form the vault of the skull and contain the organs of hearing: in the pyramid of the temporal bone is the tympanic cavity and the inner ear.

The anterior fossa is formed by the frontal bone, a plate of the ethmoid bone, separated from the middle one by the edges of the sphenoid bone. The middle fossa is formed by the sphenoid and temporal bones.

The posterior fossa is formed by the occipital bone, the posterior part of the sphenoid bone.

According to the clinical classification, the following types of temporal bone fractures may occur:

fracture of the scales of the temporal bone;
fracture of the pyramid of the temporal bone;
linear fracture of bone tissue;
longitudinal fracture;
depressed fracture.

ICD 10 injury code

According to the medical classification of diseases, ICD code 10: S02 Fracture of the skull and facial bones. This violation of the integrity of the bone tissue is not usually classified as open or closed, since it is closed in all clinical situations.

In order to subdivide fractures of the bones of the face according to anatomical features and the degree of displacement of their parts, it is necessary to know the structure of the cranium.

Head injuries can be both fractures and severe bruises, causing concussions and hematomas. This is no less dangerous to health than a broken bone.

Due to the peculiarities of the structure of bone tissue, the skull is able to have a certain degree of strength and withstand a significant load without damaging the bones. However, brain damage often occurs in this case.

The localization, direction and severity of the injury are due precisely to the unequal elasticity, the presence of nerve, venous and air holes and, associated with this, the thickness of the bone in various departments.

Like other bone injuries, skull fractures can be open or closed.

Fracture of the vault - a violation of the integrity of the brain department. It can be direct when the localization of the injury is limited to the place where the force is applied. At the fracture site, in this case, the bones bend inward. With an indirect fracture, when the cracks extend to the entire skull and the bone bends outward.
When the base is fractured, the membranes of the brain, the spinal cord are often damaged, and the nerves responsible for vision, hearing and facial expressions are pinched. The fracture can be both independent and accompany the fracture of the arch. Cracks extend to the bones of the nose and orbit, as well as the ear canal area. Depending on the location of the lesion, the anterior, middle, or posterior cranial fossa may be affected.

1. Comminuted - are the most common type of fracture and its treatment is often complicated by the location of the injury, the shape and number of bone fragments. Such injuries can lead to bruises, the formation of intracerebral hematomas, and crushing of the brain.

2. Linear fractures can be local and distant.

In the first case, a linear fracture is a crack that starts at the point of impact and propagates to the sides. Distant linear fractures differ from local ones in that the crack begins at some distance from the impact site and propagates towards this site and in the opposite direction from it.

3. Depressed fractures can be impression (when bone fragments are not separated from whole areas) and depression (bones are separated from the skull).

The type of depressed fracture is determined by the following factors: the area and shape of the damaging object and its ratio with the area of the skull, the force and intensity of the blow, the degree of elasticity of the bones of the skull and skin.

4. Perforated fractures are usually the result of gunshot wounds and are often fatal.

With this type of injury, the fracture line runs along the thinnest sections of the bones of the base of the skull, microfractures and very small cracks in the bone capsule of the labyrinth can also be observed.

The reasons

The most common cause of damage to the temporal bone is the application of direct mechanical impact (for example, a strong blow with a blunt object or a fall).

Such a fracture, as a rule, appears as a result of an impact with an object with a large area. Usually there are traces of mechanical impact (abrasion, edema) over the fracture site.

Skull fractures can be: direct, indirect. With direct impact, the bone is deformed directly at the site of impact, with indirect impact, the impact is transmitted from other damaged bones. Unlike fractures of the base of the skull, fractures of the vault in most cases are straight.

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Despite the fact that the lower jaw is the strongest in the cranium, most of the injuries of the facial bones occur precisely in it (more than 60%). The reason for this is its mobility and placement on the internal skeleton.

Injuries to the upper jaw and nasal cavity occur an order of magnitude less often, although they are also recorded quite often. The arch of the cheekbones is even less injured.

Most often, patients in trauma departments are people who have received bruises as a result of alcohol intoxication, who are involved in power disassembly or who have been in an accident. The risk group also includes active people professionally involved in any kind of sport.

From this it follows that the causes of fractures can be intentional assassination attempts or accidental injuries.

The main causes of pathologies are:

injury to the head area with any object;
falling from a high point of support;
falling from a moving or stationary vehicle;
emergency situation on the road;
injury resulting from active motor functions;
anatomic pathology.

The main causes of the fracture are the impact of a blunt massive object, falling from a standing position, a blow to the head (sports injuries), as well as zeal with an additional acceleration given to the body.

Moreover, the condition of the victim before the incident, the state of his metabolism and the presence of diseases that increase bone fragility, has a significant impact on the type and severity of the fracture.

Depending on the type of damage, the signs of a fracture may be different, but the common ones for a skull fracture are:

sharp pains, aggravated by slight movement,
loss of consciousness in most cases,
cerebral edema,
change in the shape of the skull
respiratory failure.

Linear fractures, as a rule, are accompanied by the appearance of hematomas in the region of the orbit and mastoid process. Hemorrhage occurs in the middle ear. The presence of these symptoms is very helpful in making a diagnosis when lesions are not identified on an x-ray.

A fracture of the anterior cranial fossa is accompanied by bleeding from the nose, as well as the appearance of bruising in the area of the upper and lower eyelids. Sometimes there may be subcutaneous emphysema caused by cracked air sinuses.

With a fracture of the middle cranial fossa, damage to the temporal bone is often observed. Such fractures are manifested by bleeding from the ear, as they cause a rupture of the eardrum. The facial nerves are also affected.

Fractures of the posterior cranial fossa include damage to the region of the occipital bone, when cranial nerves are affected and vital organs are disturbed. Another obvious symptom of a fracture is the leakage of cerebrospinal fluid from the nose or ear.

With severe damage to the frontal bone, severe headaches indicate a concussion. The symptom of a fracture in this case is pronounced hematomas in the frontal bone, a change in the shape of the skull, dizziness, nausea, vomiting, loss of vision, loss of consciousness.

There may be bleeding from the nose, and swelling in the area of impact.

If the fracture is comminuted, then soft tissue damage, as well as complete or partial loss of sensitivity, are added to the general symptoms. In this case, part of the fragment may appear at the fracture site.

Disturbances of consciousness as a result of a fracture depend on the severity of the injury and can be both short-term and long-term, when the victim falls into a coma.

In children, symptoms may not appear immediately and may be completely absent for some time. Subsequently, the child begins to lose consciousness due to sudden pressure surges.

The effects of trauma become more noticeable at the age of 16, when the frontal lobes complete their formation. Any head injury requires a thorough examination and timely medical attention.

Often victims of skull fractures are people under the influence of alcohol or drugs, which can make it difficult to identify symptoms.

Therefore, in such cases, bruises, wounds and hematomas of the head and other objective evidence of damage may serve as a reason for going to the hospital for examination.

The main etiological factor in damage to the temporal part of the skull is the direct impact of force (for example, a blow with a heavy blunt object).

A fracture of the temporal bone occurs as a result of a blow with a hard object to the temporal region of the skull (a strong blow to the temple in a fight, a blow to the corner of furniture when falling, etc.). This bone is quite thin, so local pressure on it very often ends in a fracture.

Fractures of the temporal bone in children

In children under one year old, the fusion of the constituent parts of the temporal bone has not yet been completed; in the preschool years, the articulations are still rather weak. For this reason, and also due to increased physical activity in children, temple fractures are quite common.

It is important! It should be borne in mind that the bone density in a child is quite low, and the nervous system is still imperfect, so head injuries can have the most serious consequences.

First aid

The main task of first aid is to ensure complete rest for the victim, as well as to prevent infection from entering the site of possible damage.

To do this, when bleeding from the ear opening, it is first necessary to make a tamponade with sterile cotton wool or apply a clean and sterile bandage.

Any movement of the victim, including to the hospital, should be carried out in a supine position with complete immobility.

In the hospital itself, if increased intracranial pressure is detected, a lumbar puncture can be done.

If you suspect a fracture, you should immediately call an ambulance. If the condition of the victim is satisfactory and he is conscious, then he should be laid on his back (without a pillow), immobilize and fix the head and upper body, apply an antiseptic bandage to the wound.

If hospitalization is delayed, dry ice may be applied to the head. If there are no breathing problems, you can give the victim Diphenhydramine or Analgin.

In an unconscious state, the victim should be laid on his back in a half-turn position and slightly turn his head to the side in order to avoid aspiration in case of vomiting, unfasten tight clothes, remove existing glasses, dentures, jewelry. To fix the body under one side of the body, put a roller of clothes or a blanket.

In acute respiratory disorders, artificial respiration is done through a mask. Cardiovascular drugs (sulfocamphocaine, cordiamine), glucose solution, lasix are introduced.

With heavy bleeding and a sharp drop in pressure, Lasix is replaced by intravenous administration of polyglucin or gelatinol. With motor excitation, a solution of suprastin is injected intramuscularly.

Painkillers should be used with caution, as this can complicate bleeding. The use of narcotic painkillers is contraindicated, they exacerbate respiratory disorders.

We strongly advise parents whose children have suffered a head injury: even if, in your opinion, the baby is not bothered by anything, he fell from an insignificant height, stopped crying, etc. immediately seek help from the following doctors: a pediatric neurologist, a traumatologist, a neurosurgeon.

To do this, you need to call an ambulance team at home and you and your child will be taken to a specialized hospital. Or, on your own, contact the emergency surgical department of any major children's hospital, where the indicated specialists will advise the child.

If they do not confirm the pathology, it will be possible to safely return home.

Timely and correct provision of first aid is the key to successful treatment. As a rule, in case of damage to the (right or left) temporal bone, it consists of applying a sterile bandage to the auricle and immediately hospitalizing the victim in a hospital with a neurosurgery department.

Before the arrival of the ambulance, the patient must be laid on a flat surface and completely immobilized. It is not necessary to give the victim analgesic drugs on their own, since their appointment may hide the true clinical picture of the disease.

In order to help the victim, you must:

Lay the victim down on a hard surface. Please note that you do not need to put a pillow or a homemade roller under your head. Do everything as carefully as possible so as not to harm the patient even more. He must be absolutely motionless in order to exclude the worsening of the situation and the increase in injury;
With an open fracture, bleeding must be stopped. To do this, it is necessary to make a tamponade of the ear canal using cotton wool for this. Then you should apply an antiseptic bandage to this place;
If the fracture is closed, then gently apply ice or something cold to the injury. For example, you can simply dampen a cloth in cold water;
If the victim is unconscious, carefully lay him on his side. Then possible vomit will not enter the respiratory tract and the victim will not suffocate;
Call an ambulance as soon as possible. Or take the patient to the doctor on your own. However, please note that the victim is transported lying on his back, while his body must be completely motionless. If you cannot provide such transportation, it is better to wait for the ambulance to arrive.

Please note that when providing first aid, it is forbidden to try to wash an open wound, to bury any medicines and painkillers in the victim's ear. Timely and quickly rendered first aid will help to minimize the negative consequences of the injury.

The consequences of such a fracture include headaches, partial or complete hearing loss, frequent dizziness.

After the victim is taken to the hospital, his condition is stabilized. After that, the operation will be done.

During the entire period of treatment and after it, any bruises of the head and concussions should be avoided. Not infrequently, the situation is complicated by infection in an open wound.

Therefore, it is so important to call an ambulance as soon as possible and start providing first aid.

First aid for a fracture of the base of the skull should be provided within 10 minutes. If a person is conscious and able to contact others, he must be placed on a stretcher on his back so that his head is on the same plane as the body.

If possible, apply an antiseptic dressing to the victim.

If the person has lost consciousness, put him on a stretcher so that the body is half a turn to one side. In order to fix the torso, place a fabric folded several times under the back of the victim.

Also turn your head to the side so that in an attack of vomiting a person does not suffocate (the airways do not clog).

Try to loosen clothing that may restrict the injured person's movements or interfere with free breathing. Take off his glasses and dentures (tooth).

Providing first aid for skull fractures is a very important component of all subsequent treatment. While waiting for the arrival of an ambulance, the victim must be laid on his back, if he is conscious. In case of loss of consciousness, the patient is laid in a half-turn.

First aid consists of applying a sterile bandage to the head and transporting to the nearest medical facility.

In a hospital, surgical treatment is performed only in the presence of an open craniocerebral injury or hematoma in the cranial cavity. Primary surgical treatment of the wound, reposition of bone fragments, removal of tissue detritus and foreign bodies are performed. If necessary, an autopsy and pumping out of intracranial hematomas are performed.

Damage to the structures of the middle ear and the tympanic membrane is eliminated after the relief of life-threatening conditions. In the case of a long period without therapeutic measures, a decrease and loss of hearing is possible. When there are no indications for surgery, patients are prescribed drug therapy, which consists of:

Fighting cerebral edema with osmotic diuretics;
Relief of neurological symptoms, neuroprotection. It is carried out by the introduction of B vitamins, nootropics, neuroprotectors;
Analgesic therapy with the use of narcotic and non-narcotic painkillers;
Symptomatic elimination of nausea and vomiting with antiemetics of the central type of action;
In case of inadequacy or violent behavior on the part of the patient, sedatives are used in the form of benzodiazepine tranquilizers or the latest generation of hypnotics.

Later, after discharge from the hospital, the patient is registered with a neurologist, symptomatic therapy is carried out in case of chronic headaches, disorders of the nervous system or damage to the cranial nerves.

If the victim has a pronounced cosmetic defect, then during the first 3-6 months after the injury, the highest quality surgical restoration of the correct forms of the temporal region is possible.

Postponing plastic correction will lead to the formation of rough scars and bone outgrowths that make subsequent cosmetic interventions difficult.

With a closed fracture of the temporal lobe, it is necessary to provide the victim with maximum peace and, if possible, deliver him to a medical institution. You can apply a cool, damp towel to your head.

It is important! In no case, if the temporal bone is injured, do not warm up the ear and do not bury anything in it!

In the case of an open fracture, do not wash the wound, because this action can contribute to infection and subsequent complications. If possible, you can apply a sterile dressing to the wound and take the victim to the hospital. If the patient is unconscious, you need to call an ambulance to transport him.

Diagnostics

An important examination for head trauma in infants is neurosonography - a study of the structure of the brain using an ultrasound machine through the large fontanel of the child (such a study is possible until the large fontanel closes, up to 1 - 1.5 years).

This method is easy to use, does not have a negative effect on the body, provides enough information to determine the tactics of treating the patient. With its help, you can first of all exclude or determine the presence of intracranial hemorrhages (the most life-threatening).

The only limitation of its use may be the lack of an ultrasound machine in the hospital or a specialist who can work on it (for example, not all hospitals in the country with ultrasound machines can perform emergency neurosonography at night, since the specialist works during the day).

By the presence of blood cells in the cerebrospinal fluid, the presence of intracranial hemorrhage is judged.

In addition, there are more sophisticated methods for examining a child's head: computed tomography (CT) and magnetic resonance imaging (MRI).

Computed tomography (CT) (from the Greek tomos - a segment, a layer of the Greek.

grapho - write, depict) - a research method in which images of a certain layer (slice) of the human body (for example, the head) are obtained using x-rays. With CT, the rays fall on a special device that transmits information to a computer that processes the received data on the absorption of x-rays by the human body and displays the image on the monitor screen.

Thus, the smallest changes in the absorption of rays are recorded, which, in turn, allows you to see what is not visible on a conventional x-ray. It should be noted that the radiation exposure with CT is much lower than with conventional X-ray examination.

Magnetic resonance imaging (MRI) is a diagnostic method (not associated with X-rays) that allows you to get a layered image of organs in different planes, to build a three-dimensional reconstruction of the area under study.

It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and radiate it after the cessation of exposure to the radio frequency pulse.

For MRI, various pulse sequences have been developed to image the structures under study to obtain the optimal contrast between normal and altered tissues. This is one of the most informative and harmless diagnostic methods.

But the widespread use of CT and MRI even in early childhood is difficult due to the need to conduct this examination in children in a state of immobility (under anesthesia), since an important condition for the successful implementation of the technique is the immobility of the patient, which cannot be achieved from an infant.

After an injury to the temporal region, it is necessary to make a clinical diagnosis in a timely and correct manner. To do this, a specialist needs to see a complete x-ray picture (CT - a study that uses x-rays) of the state of bone structures.

The use of an x-ray diagnostic method in this situation is inappropriate, since this study does not allow the doctor to see the area and line of fracture of the temporal bone pyramid and assess the severity of the disease itself.

In this situation, computed tomography is necessary. It is this method that is based on layer-by-layer visualization of bone structures using X-rays.

With a traumatic lesion of the base of the skull, it is necessary to make a diagnosis as soon as possible and begin symptomatic treatment. MRI, on the contrary, is prescribed for a visual assessment of the state of soft structures (cerebral hemispheres, brain stem, cerebellum, etc.).

To make a diagnosis, the method of craniography is used (X-ray examination of the skull without the use of a contrast agent). In some cases, cracks may extend through several bones.

When examining images, special attention should be paid to the intersection of the vascular furrows with a fissure, since this may damage the intracranial vessels and meningeal arteries, which causes the formation of epidural hematomas.

Sometimes the edges of the hematoma can be compacted and raised, which creates the impression of a depressed fracture on palpation.

Sometimes in medical practice there are errors when the shadow of the vascular sulcus is taken for an incomplete fracture (crack). Therefore, it is necessary to take into account the location of the arterial grooves and the specifics of their branching. They always branch in a certain direction, their shadows are not as sharp as the fracture lines.

A linear fracture on an x-ray has the following distinguishing features:

Fracture line in black;

The fracture line is straight, narrow, without branching;

The vascular sulcus is gray in color, wider than the fracture line, tortuous, with branching;

The cranial sutures are gray in color and of considerable width, with a standard course.

8-10 days after TBI, fractures in the bones are more clearly defined than immediately after the injury.

The first examination that must be done if a fracture of the temporal bone is suspected is a computed tomography of the brain. X-rays are taken later. An examination by a neurologist is required for the possible detection of paresis of the facial muscles.

Provided to patients:

audiometry;
checking the functions of the vestibular apparatus;
Rinne and Weber tuning fork tests to determine the nature of hearing loss: conductive or neurosensory.

The exact diagnosis of "fracture of the temporal bone" and the type of damage are established after a thorough radiography of the temporal region in at least three projections. In particularly difficult cases, one has to resort to computed tomography.

Having acquired such a fracture, it is necessary to be treated only in a hospital, under the continuous supervision of doctors. For the treatment of a longitudinal fracture, therapy is most often sufficient in three directions:

bleeding or liquorrhea;

The ear is cleaned “dry”, using a cotton holder or a suction device. After cleaning, a sterile dressing is put on, which can not be removed day or night. In the normal course of recovery, the discharge stops in a few days.

Basically, conservative therapy is indicated, and the operation is carried out only in the most severe cases and only after the symptoms of concussion or brain contusion have been eliminated. In the process of treatment, it is important to exclude the development of secondary complications, so the patient is often prescribed antibiotic therapy, which will help eliminate cerebral edema.

It is important to understand that the treatment of a temporal bone fracture is determined by the doctor individually for each patient, based on the severity of the disease.

The diagnosis of "fracture of the temporal bone" is made by a doctor on the basis of an anamnesis, examination, and the results of instrumental studies. In order to get a clear picture of the disease, the doctor prescribes an X-ray examination, as well as magnetic resonance imaging or computed tomography.

The results of the diagnosis will determine the degree of damage, make a therapeutic therapy.

Upon receipt of such an injury as a fracture of the skull in the temple or other zone, it is necessary to provide the victim with first aid and call an ambulance. After the patient is taken to a medical facility, treatment will begin.

First of all, a person with a skull fracture is examined and all necessary actions are taken to restore his condition. After the condition of the victim stabilizes, he is sent for diagnosis.

In emergency cases, diagnosis is carried out while the patient is being prepared for surgery.

Diagnostics includes a number of laboratory and hardware studies:

general analyses;
x-ray;

To establish a complete clinical picture, it may be necessary to consult several doctors of different specialties. Only after the general picture of the pathology is established is the method of its elimination determined.

Treatment Methods

Depending on the area of injury, as well as the complexity of the fracture, treatment can be carried out by different methods. Head trauma is a serious pathology, therefore, in most cases, fractures require surgical intervention.

Such an operation is dangerous for children and adults. An elderly person with a traumatic brain injury does not undergo surgery because of the high risk.

In some cases, conservative treatment is allowed. It is used mainly if subluxation of the temporomandibular composition is diagnosed.

Treatment of a temporal lobe fracture

In case of a fracture of the temporal bone, it is very important that the victim receive first aid, which will consist of applying a sterile bandage to the ear, as well as urgent transportation to the hospital, or rather to the intensive care or neurosurgical department.

It is important to understand that after an injury, it is strictly forbidden to rinse the auricle or instill any drops. After admission to the hospital, treatment can be carried out conservatively or surgically.

Basically, conservative therapy is indicated, and the operation is carried out only in the most severe cases and only after the symptoms of concussion or brain contusion have been eliminated.

In the process of treatment, it is important to exclude the development of secondary complications, so the patient is often prescribed antibiotic therapy, which will help eliminate cerebral edema.

It is important to understand that the treatment of a temporal bone fracture is determined by the doctor individually for each patient, based on the severity of the disease.

The diagnosis "Fracture of the temporal bone" is made on the basis of the anamnesis, an objective examination of the patient and the X-ray picture. The fracture line of the temporal bone is not always visible on x-rays.

In this case, it is necessary to take pictures of the bone in other additional projections - lateral, medial and oblique. In some cases, to clarify the diagnosis, it is necessary to consult a neurologist, an ENT doctor and conduct a computed tomography.

When examining a patient, the attending physician must conduct a differential diagnosis between the symptoms of infectious or non-infectious (reactive) meningitis. Even a small subarachnoid hemorrhage can cause symptoms of reactive meningitis.

In this case, when obtaining the results of the analysis of the cerebrospinal fluid, you can see an admixture of "old blood" or "leached" erythrocytes, which indicate a hemorrhage in the brain structures.

The most informative method for diagnosing bone fractures is radiography. Due to the peculiarities of the structure of the temporal bone, for accurate diagnosis, it is necessary to perform fluoroscopy in 3-4 projections. It is also possible to conduct an MRI, laboratory tests of blood and outflowing cerebrospinal fluid are prescribed.

Features of treatment

After a fracture of the temporal bone is detected, the patient is usually prescribed conservative treatment. However, if a concomitant concussion or brain injury, an infectious complication is detected, the following methods can be performed:

conducting antibiotic therapy;
dehydration therapy;
surgical intervention to eliminate mechanical damage in case of a fracture of the pyramid of the temporal bone;
Schwarze operation or extended mastoidotomy (trepanation of the mastoid process to remove damaged bone tissue).

Treatment tactics are based on the patient's individual complaints and a complete picture of bone structures obtained after computed tomography.

Surgical treatment

Surgical treatment is carried out with the ineffectiveness of the use of conservative therapy. In most situations, an extended matoidotomy or Schwartze operation is used.

When performing this operation, local anesthesia is used to control the patient's condition during the cutting of the bridge, since paralysis of the facial muscles may develop due to damage to the facial nerve.

The Schwarze operation is indicated for patients with a typical clinical picture of matoiditis. The main purpose of this surgical intervention is to eliminate the purulent-destructive process in the area of the mastoid process and parallel drainage of the tympanic cavity.

Where is TBI treated?

According to existing rules (standards), all children with traumatic brain injury must be hospitalized. Children with a concussion (a mild traumatic brain injury) can be treated in the neurological and neurosurgical departments.

Patients with more severe forms of injury should be treated in a neurosurgical department (if available in a particular region).

Carrying out reasonable targeted treatment requires a comprehensive examination of the child, which is possible only in a hospital.

This examination includes thorough examinations of the nervous system, vestibular apparatus, organs of vision, hearing, and other studies.

In the admission department, the child is examined, signs are identified that indicate damage to the bones of the skull or brain injury, parents are asked about the condition of the child after a fall, etc.

TBI treatment tactics

After the examination and clarification of the diagnosis, the tactics of treatment are determined. Drug treatment is prescribed (therapy aimed at eliminating cerebral edema, lowering intracranial pressure, correcting metabolism and blood flow in the brain, etc.).

Surgical treatment is used (and necessary) primarily to eliminate compression of the brain. It is prescribed for children with depressed skull fractures and intracranial hemorrhages.

Parents need to realize that only a comprehensive, adequate examination of the child allows you to correctly and timely treat a brain injury, achieve recovery and avoid disability.

How to reduce the likelihood of TBI

Injuries in children happen most often in the presence of adults, and this once again indicates our inattention or frivolity and carelessness, as well as the fact that we have a poor idea of the motor skills of the baby. Parents should provide for the emergence of new motor skills in the child and take safety measures.

So, a month-old baby, lying on his stomach, can push off with his feet from the side of the changing table, from the back of the sofa, bed and fall. Every next skill or movement of the baby (attempts to sit, crawl, stand) can also lead to "unexpected" injuries.

A child, trying to get up, may fall out of the stroller, out of the child's chair, especially if they forgot to fasten it.

If you need to move away, do not leave the child alone lying on any high (and not very) surface, put the baby in a crib, playpen, or even on the floor.

Secure your child in the highchair and stroller.

If your home has stairs, put up a safety rail to prevent your baby from falling down or climbing high and then falling.

“Walkers” can also be unsafe: children, being in them, can strongly push off, hit something, roll over, and also fall down the stairs. It is better to refuse to use such a vehicle.

"Jumpers" are dangerous because of the unpredictability of the trajectory of movement: for example, a child in them may collide with a wall.

The most important role in reducing child injuries is given to prevention, and the main thing in it is the attentive attitude of adults to children and their safety.

Orest Gayevy, Neurosurgeon, Associate Professor, Department of Pediatric Neurosurgery, RMAPE