The treatment of fractures . mpairment of the senseof smell may exist if the olfactory nerves become involved in thefracture. Blood may trickle from a fracture of the base into thepharynx, be swallowed, and later vomited. Epistaxis, of course,may be due to a blow upon the face without fracture of the base. 28 FRACTURES OF THE SKULL If inspection discloses a broken nose or ecchymosis of the face orthe skin of the forehead, it is very probable that the minor acci-dent has occurred. Most fractures of the base involve the middlefossa. If the petrous portion of the temporal bone is fractured, sever
The treatment of fractures . mpairment of the senseof smell may exist if the olfactory nerves become involved in thefracture. Blood may trickle from a fracture of the base into thepharynx, be swallowed, and later vomited. Epistaxis, of course,may be due to a blow upon the face without fracture of the base. 28 FRACTURES OF THE SKULL If inspection discloses a broken nose or ecchymosis of the face orthe skin of the forehead, it is very probable that the minor acci-dent has occurred. Most fractures of the base involve the middlefossa. If the petrous portion of the temporal bone is fractured, severalimportant signs appear (see Fig. 19). If the tympanum is torn,hemorrhage from the external auditory meatus is sure to this hemorrhage is continuous, it is significant; if it is triflingand temporary, it is probably unimportant. Cerebral tissuemay escape from the nose, thus establishing the seat of thelesion. Cerebrospinal fluid may likewise escape from theear. Cerebral tissue may also appear at the external audi-. Fig. 19.—Fracture of the base of the skull, involving the middle and posterior fossse on theleft (Warren Museum, 5106). tory meatus. Any of these signs is conclusive evidencethat the base of the skull is fractured and that there is alesion of the brain. Lesions of the facial (seventh) andauditory (eighth) nerves lying within the bones occur. Lesionsare likewise reported of the fifth nerve, because of its lyingupon the petrous portion of the temporal bone. Subconjunc-tival hemorrhage may appear, owing to the blood working itsway forward and through the sphenoidal fissure and the opticforamen. A primary profuse watery discharge from the noseor the ear is probably cerebrospinal fluid. A watery dischargeappearing late after such an injury is likely to be serum froma blood-clot. The optic nerve may be involved, and completeloss of vision result. CERTAIN CAUSES OF UNCONSCIOUSNESS 29
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