For treatment of basic fractures, see [p. 116].
Fracture of the Base of the Skull: Summary of Symptoms
| Anterior Fossa. | Middle Fossa. | Posterior Fossa. |
|---|---|---|
| Hæmorrhages. | Hæmorrhages. | Hæmorrhages. |
| Subconjunctival. Palpebral. Peripalpebral. Orbital. Retinal. From the nose. From the mouth. | Into the temporal region. From the mouth. From the nose. From the ear. | Into the nuchal region. Into the occipital region. Into the post-auricular region. |
| Cerebro-spinal fluid. | Cerebro-spinal fluid. | Cerebro-spinal fluid. |
| From the nose. From the mouth. | From the nose. From the mouth. From the ear. | None. |
| Brain-matter. | Brain-matter. | Brain-matter. |
| From the nose. | From the ear. | None. |
| Air-escape. | Air-escape. | Air-escape. |
| From the frontal sinus. From the ethmoidal cells. | From the mastoid antrum. | From the mastoid antrum. |
| Nerve-involvement. | Nerve-involvement. | Nerve-involvement. |
| Olfactory. Optic. Third. Fourth. Fifth (first division). Sixth. | Fifth (second and third divisions). Sixth. Seventh. Eighth. | Seventh. Eighth. Ninth. Tenth. Eleventh. Twelfth (?). |
FRACTURE OF THE MASTOID PORTION OF THE TEMPORAL BONE
Fractures limited to this region are of rare occurrence. Our knowledge of the condition is obtained from the researches of Lèon Boullet, who first described the fracture in 1876, reporting at the same time 26 cases.
The fracture usually results from sharp blows delivered along the posterior border of the mastoid process, the force acting obliquely from above downwards and forwards. More rarely, the process is detached as the result of a blow delivered immediately above the ear, that organ sharing in the displacement. In either case the detachment is usually of an incomplete nature, mainly on account of the muscular and pericranial attachments in the region involved.
According to Boullet, the following symptoms result:—
Surgical emphysema and pneumatocele.
Air escapes from the mastoid cells and antrum into the overlying tissues, either spreading widely through the subaponeurotic space of the scalp and cellular tissues of the neck (surgical emphysema), or remaining localized and forming a tumour of inconsiderable size (pneumatocele). In either case palpation reveals that peculiar crepitation which is pathognomonic of tumours of this nature.