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Węgiel A, Zielinska N, Głowacka M, Olewnik Ł. Hypoglossal Nerve Neuropathies-Analysis of Causes and Anatomical Background. Biomedicines 2024; 12:864. [PMID: 38672218 PMCID: PMC11048189 DOI: 10.3390/biomedicines12040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The hypoglossal nerve is the last, and often neglected, cranial nerve. It is mainly responsible for motor innervation of the tongue and therefore the process of chewing and articulation. However, tumors, aneurysms, dissections, trauma, and various iatrogenic factors such as complications after surgeries, radiotherapy, or airway management can result in dysfunction. Correct differential diagnosis and suitable treatment require a thorough knowledge of the anatomical background of the region. This review presents the broad spectrum of hypoglossal neuropathies, paying particular attention to these with a compressive background. As many of these etiologies are not common and can be easily overlooked without prior preparation, it is important to have a comprehensive understanding of the special relations and characteristic traits of these medical conditions, as well as the most common concomitant disorders and morphological traits, influencing the clinical image. Due to the diverse etiology of hypoglossal neuropathies, specialists from many different medical branches might expect to encounter patients presenting such symptoms.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Mariola Głowacka
- Nursing Department, Masovian Academy in Płock, 09-402 Płock, Poland;
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland
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Morcos MM, Liu DS, Farid AR, See P, Hogue GD. Occipital condyle fracture in the pediatric population: A management algorithm and systematic review. J Child Orthop 2024; 18:216-228. [PMID: 38567039 PMCID: PMC10984159 DOI: 10.1177/18632521241229301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
Purpose This study aims to develop an accessible stepwise management algorithm for pediatric presentations of occipital condyle fractures (OCFs) based on a systematic review of the published literature regarding diagnostic evaluation, treatment, and outcomes. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric OCFs. Data extraction of clinical presentation, management strategies, imaging, and treatment outcome was performed. Results A total of 15 studies reporting on 38 patients aged 18 years and younger presenting with OCFs were identified. Loss of consciousness (LOC), depressed level of consciousness, neck pain, decreased neck range of motion (ROM), and cranial nerve injury were the most common presenting symptoms. Diagnostic imaging included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and functional radiographs to assess cervical stability. Treatment options varied and included soft collar, hard collar, and halo vest. All studies resulted in a complete healing of the OCF, with resolution of associated pain. Conclusion The proposed treatment algorithm suggests a framework for the management of pediatric OCFs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a stepwise approach should be utilized in the management of isolated pediatric OCFs.
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Affiliation(s)
- Mary M Morcos
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | - David S Liu
- Harvard Medical School, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | | | - Pokmeng See
- Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, USA
| | - Grant D Hogue
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
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Aguilera-Pena MP, Castiblanco MA, Osejo-Arcos V, Aponte-Caballero R, Gutierrez-Gomez S, Abaunza-Camacho JF, Guevara-Moriones N, Benavides-Burbano CA, Riveros-Castillo WM, Saavedra JM. Collet-Sicard syndrome: a scoping review. Neurosurg Rev 2023; 46:244. [PMID: 37707587 DOI: 10.1007/s10143-023-02145-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
Collet-Sicard syndrome (CSS) is the unilateral palsy of the cranial nerves (CN) IX, X, XI, and XII. To our knowledge, no review describes the characteristics of patients diagnosed with CSS. Therefore, this review aims to collect and describe all cases in the literature labeled as CSS. We performed a scoping review of the literature and conducted a database search in Embase and PubMed. We included articles and abstracts with case reports or case series of patients with CSS diagnosis. We classified the cases into two groups: "CSS", referring to patients presenting exclusively with IX-XII nerve involvement, and "CSS-plus", which corresponds to cases with CSS and other neurological impairments. We included 135 patients from 126 articles, of which 84 (67.7%) were male. The most common clinical manifestations reported were dysphagia and dysphonia. The most common etiology was tumoral in 53 cases (39.6%) and vascular in 37 cases (27.6%). The majority of patients showed partial or total improvement, with just over half receiving conservative treatment. The most frequent anatomic space was the jugular foramen (44.4%) and the parapharyngeal retrostyloid space (28.9%). Approximately 21% of the patients had other CN impairments, with the seventh and eighth CN most frequently compromised. We conclude that although there is a need for greater rigor in CSS reporting, the syndrome has a clear utility in identifying the localization of jugular foramen and parapharyngeal retrostyloid space pathology.
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Affiliation(s)
| | - Maria A Castiblanco
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Valentina Osejo-Arcos
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Rafael Aponte-Caballero
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Santiago Gutierrez-Gomez
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Juan Felipe Abaunza-Camacho
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | | | - Camilo Armando Benavides-Burbano
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - William M Riveros-Castillo
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Javier M Saavedra
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
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Ledeganck L, Kromhout K, Chiers K, Van der Vekens E, Van Ham L, Bhatti SFM, Cornelis I. CT diagnosis of occipital condyle fracture in a dog presented for severe cervical hyperesthesia. Vet Radiol Ultrasound 2023; 64:E10-E13. [PMID: 36377038 DOI: 10.1111/vru.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022] Open
Abstract
A 9-month-old male entire Doberman Pinscher presented with acute onset of severe cervical hyperesthesia after a fall. Neurological examination revealed a normal gait with low head carriage and severe cervical hyperesthesia. A CT scan of the cervical vertebral column revealed the presence of a comminuted fracture at the dorsomedial aspect of the right occipital condyle and sclerosis of the underlying bone. Medical management was initiated consisting of an external bandage, strict rest, and pain medication. Due to the lack of clinical improvement, the dog was euthanized 2 months after diagnosis. Histopathology of the lesion was compatible with a healing fracture.
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Affiliation(s)
- Liesbet Ledeganck
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kaatje Kromhout
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Koen Chiers
- Department of Pathology, Bacteriology and Poultry disease, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Elke Van der Vekens
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie F M Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Kalnev M, Uchikov P, Kehayov I. Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Craniocervical fractures are socially important pathology. They represent one-third of the fractures in the cervical region. It is typical that elderly patients suffer from low-energy traumas such as falls, while younger patients suffer from high-energy traumas such as motor vehicle accidents, sport falls and etc. Craniocervical fractures are associated with an increased risk of craniocervical instability or neurological deficit. Primary therapeutic options depend on the type of fracture. Predictors of nonunions are the displacement of fractures, patients’ age, and comorbidities. The observership of the general practitioner in the postoperative period or the period of cervical immobilization could recognize possible malpositioning of the instrumentation, nonunion of the fracture, malsanation of the wound, and possible complications in case of the external immobilization. There is a lack of information on that topic. The goal of the paper is to summarise the most common fractures of the craniocervical region, their etiology, and treatment options and to present the results of our study of patients who underwent operative treatment for craniocervical fracture(s). Mastering the details, the treatment options, and the possible complication of the fractures in the craniocervical region, general practitioners could play an important role in the treatment of patients.
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Batista AVDES, Aguiar GB, Bennett P, Umigi MR, Veiga JCE. Observational study of patients with occipital condyle fracture at a brazilian referral trauma center. Rev Col Bras Cir 2021; 48:e20213024. [PMID: 34852040 PMCID: PMC10683456 DOI: 10.1590/0100-6991e-20213024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. METHODS this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. RESULTS a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. CONCLUSION the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.
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Affiliation(s)
| | | | - Priscilla Bennett
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
| | - Márcia Ramos Umigi
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
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Lam KS, Carriço G, Fernandes FM, Nanni F, de La Torre Escobar C. A rare case of bilateral occipital condyle fractures associated with inferior clivus separation fracture resulting in craniocervical dislocation: a case report and modification of the Anderson and Montesano classification is proposed. Acta Neurochir (Wien) 2021; 163:2307-2311. [PMID: 33987717 DOI: 10.1007/s00701-021-04855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
The authors report a very rare case of bilateral occipital condyle fractures (OCF) that was associated with complete separation fracture of the inferior clivus resulting in craniocervical dislocation alongside dissociation of C1-C2 joint complex. Also, a new type of the Anderson and Montesano classification system is presented with two subtypes of injuries. Type IVA occurs when the OCF is associated a clivus avulsion fracture, while Type IVB occurs when the OCF is associated with complete "en piece" separation fracture of the inferior clivus. Both Type IV injuries are considered highly unstable, and surgical fixation is the recommended treatment option.
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Tomaszewski R, Kler J, Pethe K, Zachurzok A. Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures. J Orthop Surg Res 2021; 16:449. [PMID: 34256792 PMCID: PMC8276397 DOI: 10.1186/s13018-021-02463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. Methods During the years 2013–2020, 6 pediatric patients with OCFs, aged 14–18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. Results Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2–11) and 9.62% (4.4–24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41–99.44). Conclusion The Anderson-Montesano and Tuli’s classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland. .,Faculty of Science and Technology, Institute of Biomedical Engineering, University of Silesia, Katowice, Poland.
| | - Jacek Kler
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Karol Pethe
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Agnieszka Zachurzok
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Tomaszewski R, Gap A, Lucyga M, Rutz E, Mayr JM. Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:530. [PMID: 34070410 PMCID: PMC8228604 DOI: 10.3390/medicina57060530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Medyków 16, 40-752 Katowice, Poland
| | - Artur Gap
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Magdalena Lucyga
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Melbourne, VIC 3052, Australia;
| | - Johannes M. Mayr
- Department of Pediatric Surgery, University Children’s Hospital Basel, University of Basel, 4031 Basel, Switzerland
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Pediatric Retroclival Epidural Hematoma in the Acute Trauma Setting: A Sign of Tectorial Membrane Stripping Injury. AJR Am J Roentgenol 2021; 216:1641-1648. [PMID: 33826356 DOI: 10.2214/ajr.20.22957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. A traumatic retroclival epidural hematoma is a rare imaging finding of severe cervical flexion-extension injury in the pediatric population. The purpose of our study was to identify pediatric patients with a retroclival epidural hematoma, record the hematoma size and extent, and examine the major craniocervical ligaments for injury. MATERIALS AND METHODS. Pediatric patients who suffered a retroclival epidural hematoma were identified retrospectively using the keywords "clivus," "epidural hematoma," and "retroclival" included in head CT reports between 2012 and 2019. The cervical and brain MRI examinations for these patients were reviewed for craniocervical ligament injury by two certified neuroradiologists. Detailed descriptions of patient injuries were recorded along with demographic information, clinical history, patient management, and outcome. RESULTS. Eleven pediatric patients were identified with an acute posttraumatic retroclival epidural hematoma with a mean anteroposterior dimension of 4.4 mm and craniocaudal dimension of 4.3 cm. All patients with a retroclival epidural hematoma who underwent subsequent cervical MRI had a stripping injury of the tectorial membrane (TM). Disruption of additional major craniocervical ligaments on MRI (alar ligament, transverse ligament, longitudinal ligaments, and ligamentum flavum) was relatively rare with the most common associated ligamentous injuries involving the anterior atlantooccipital membrane, apical ligament, and interspinous ligaments. None of the patients suffered a cervical cord or severe intracranial injury. The majority of the patients were managed conservatively with excellent clinical outcomes. CONCLUSION. A posttraumatic retroclival epidural hematoma in the pediatric population is a rare injury often identified initially by head CT and easily overlooked by the radiologist. We propose that a retroclival epidural hematoma in the pediatric population is a direct result of a significant flexion-extension force, with a subsequent stripping injury of the TM from the posterior clivus. Pediatric patients with a posttraumatic retroclival epidural hematoma on initial head CT should undergo a cervical MRI to evaluate the integrity of the TM and other craniocervical ligaments.
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Lassila H, Puolakkainen T, Brinck T, Wilson M, Snäll J. Occipital condyle fracture-A rare but severe injury in cranial fracture patients. J Craniomaxillofac Surg 2021; 49:381-386. [PMID: 33642118 DOI: 10.1016/j.jcms.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/12/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
We clarified occurrence, severity, and associated injuries of occipital condyle fractures (OCFs) in a cranial fracture population. Retrospective data of cranial fracture patients were analyzed. The outcome variable was presence of OCF in cranial fracture patients. Predictor variables were type of associated injury, Glasgow Coma Scale (GCS) value under 6, and death during hospital care. In addition, occurrence of OCF was assessed according to cranial fracture subtypes. Explanatory variables were age, sex, injury mechanism, involvement of alcohol, and high-energy injury. Treatment and outcome of OCFs were analyzed. Of 637 cranial fracture patients, 19 (3.0%) sustained an OCF, eight of whom had no other cranial fractures. In the multivariate adjusted model, increased risk for OCF was detected in patients with cervical injuries (OR 18.66, 95% CI 5.52, 63.12; p < 0.001) and facial fractures (OR 5.99, 95% CI 1.01, 35.45; p = 0.049). Patients with fractures not extending to the skull base were less likely to have OCF (OR 0.01, 95% CI 0.001, 0.25; p = 0.004), and fractures localized solely to the base of the skull offered a protective effect for OCF (OR 0.19, 95% CI 0.06, 0.58; p = 0.003). All OCFs were treated non-operatively with a cervical collar without complications. OCF patients typically sustain other severe injuries, particularly cervical injuries and facial fractures. Careful screening for associated injuries is therefore crucial when examining a patient with OCF. The classification scheme of Mueller et al. seems to be useful in guiding the treatment of OCFs, at least type 1 and 2 fractures.
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Affiliation(s)
- Henri Lassila
- Department of Surgery, Central Hospital of Päijät-Häme, Keskussairaalankatu 7, 15850, Lahti, Finland.
| | - Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
| | - Tuomas Brinck
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO Box 266, 00029 HUS, Helsinki, Finland.
| | - Michael Wilson
- Injury Epidemiology and Prevention (IEP), Turku Brain Injury Center, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
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Liao S, Jung MK, Hörnig L, Grützner PA, Kreinest M. Injuries of the upper cervical spine—how can instability be identified? INTERNATIONAL ORTHOPAEDICS 2020; 44:1239-1253. [DOI: 10.1007/s00264-020-04593-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Dattatreya Sitaram C, Nishanth A, Bhat SN, Kundangar RS. Delayed hypoglossal nerve palsy following occipital condyle fracture. BMJ Case Rep 2019; 12:12/12/e232645. [PMID: 31796442 DOI: 10.1136/bcr-2019-232645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Ampar Nishanth
- Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shyamasunder N Bhat
- Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghuraj Suresh Kundangar
- Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Vadivelu S, Masood Z, Krueger B, Marciano R, Chen D, Houseman C, Insinga S. Long-term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: Case report and review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:149-152. [PMID: 28694600 PMCID: PMC5490350 DOI: 10.4103/jcvjs.jcvjs_34_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a patient that demonstrates resolution of delayed onset hypoglossal nerve palsy (HNP) subsequent to occipital condyle fracture following a motor vehicle accident. Decompression of the hypoglossal nerve and craniocervical fixation led to satisfactory long-term (>5 years) outcome. There is a scarcity of literature in recognizing HNPs following trauma and a lack of pathophysiological understanding to both a delayed presentation and to resolution versus persistence. This is the first report demonstrating long-term resolution of hypoglossal nerve injury following trauma to the craniocervical junction.
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Affiliation(s)
- Sudhakar Vadivelu
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zihan Masood
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bryan Krueger
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rudy Marciano
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - David Chen
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Cliff Houseman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Salvatore Insinga
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
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15
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Byström O, Jensen TS, Poulsen FR. Outcome of conservatively treated occipital condylar fractures - A retrospective study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:322-327. [PMID: 29403243 PMCID: PMC5763588 DOI: 10.4103/jcvjs.jcvjs_97_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Occipital condyle fracture (OCF) is rare. It may, however, pose a serious threat to the patient due to destabilization of the craniocervical junction. Correct diagnosis and effective treatment are essential to prevent long-term complications. The aim of this study was to retrospectively investigate our current treatment program with focus on the functional outcome. Diagnosis and classification systems were evaluated for their usefulness in the clinical practice. Materials and Methods: We retrospectively reviewed all patients treated conservatively for an occipital condylar fracture from 2010 to 2015 at our department. Fracture classifications were performed according to three established systems. The patients were followed up with clinical examination and plain radiographs at weeks 2, 6, and 12 with the addition of a dynamic flexion-extension X-ray at week 14. Results: Totally 24 patients met the inclusion criteria. One was lost to follow-up and two ended treatment before completing the full treatment program due to a clinical decision. Fracture displacement was neither detected nor was any neurological deficits observed. Most patients were pain free after 6 weeks. After 14 weeks’ treatment, two patients still had neck pain; the rest were pain free. Conclusions: Our data suggest that twelve weeks’ conservative treatment is not necessary for unilateral OCFs without atlanto-occipital dissociation (AOD). We recommend 6 weeks of conservative treatment, with clinical control and flexion-extension radiographs before ending treatment. Plain radiography is of limited value in the clinical control of this fracture type. Anderson and Montesano and Tuli et al. classification systems fulfill an academic role. We found the classification system by Mueller et al. to be more helpful in everyday clinical practice.
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Affiliation(s)
- Olof Byström
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
| | - Torben S Jensen
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
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The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging 2016; 8:29-47. [PMID: 27815845 PMCID: PMC5265194 DOI: 10.1007/s13244-016-0530-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/09/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022] Open
Abstract
Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. Knowledge of the embryology and normal anatomy as well as normal variant appearances avoids inappropriate investigations in these trauma patients. Osseous injury can be subtle while representing important radiological red flags for significant underlying ligamentous injury. An understanding of bony and ligamentous injury patterns can also give some idea of the biomechanics and degree of force required to inflict such trauma. This will assist greatly in predicting risk for other critical injuries related to vital neighbouring structures such as vasculature, brain stem, cranial nerves and spinal cord. The embryology and anatomy of the craniocervical junction will be outlined in this review and the relevant osseous and ligamentous injuries which can arise as a result of blunt trauma to this site described together. Appropriate secondary radiological imaging considerations related to potential complications of such trauma will also be discussed. TEACHING POINTS • The craniocervical junction is a distinct osseo-ligamentous entity with specific functional demands. • Understanding the embryology of the craniocervical junction may prevent erroneous radiological interpretation. • In blunt trauma, the anatomical biomechanical demands of the ligaments warrant consideration. • Dedicated MRI sequences can provide accurate evaluation of ligamentous integrity and injury. • Injury of the craniocervical junction carries risk of blunt traumatic cerebrovascular injury.
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Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C. Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know. Radiographics 2016; 35:2121-34. [PMID: 26562241 DOI: 10.1148/rg.2015150035] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. Understanding the anatomy of the CCJ is crucial in properly evaluating the cervical spine, allowing the radiologist to assess its stability in the trauma setting. The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Thin-section multidetector computed tomography with sagittal and coronal reformats is the study of choice in evaluating the extent of injury, allowing the radiologist to thoroughly evaluate the stability of the cervical spine. Furthermore, magnetic resonance (MR) imaging is increasingly being used to evaluate the spinal soft tissues and ligaments, and to identify associated spinal cord injury, if present. MR imaging is also indicated in patients whose neurologic status cannot be evaluated within 48 hours of injury. .
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Affiliation(s)
- Roy Riascos
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Eliana Bonfante
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Claudia Cotes
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Mary Guirguis
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Reza Hakimelahi
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Clark West
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
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Abstract
Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
| | - Wolfgang Grisold
- Department of Neurology, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
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Yoon JW, Lim OK, Park KD, Lee JK. Occipital condyle fracture with isolated unilateral hypoglossal nerve palsy. Ann Rehabil Med 2014; 38:689-93. [PMID: 25379499 PMCID: PMC4221398 DOI: 10.5535/arm.2014.38.5.689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/07/2013] [Indexed: 12/05/2022] Open
Abstract
Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.
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Affiliation(s)
- Jin Won Yoon
- Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Oh Kyung Lim
- Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Ki Deok Park
- Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Ju Kang Lee
- Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea
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20
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Post-traumatic Collet–Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:663-70. [DOI: 10.1007/s00586-014-3527-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
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21
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Kaiser R, Mehdian H. Permanent twelfth nerve palsy secondary to C0 and C1 fracture in patient with craniocervical pneumatisation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 30:381-384. [DOI: 10.1007/s00586-014-3360-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
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Krüger A, Oberkircher L, Frangen T, Ruchholtz S, Kühne C, Junge A. Fractures of the occipital condyle clinical spectrum and course in eight patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 4:49-55. [PMID: 24744561 PMCID: PMC3980555 DOI: 10.4103/0974-8237.128525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs. Materials and Methods: All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years). Results: Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only. Discussion: OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.
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Affiliation(s)
- Antonio Krüger
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Ludwig Oberkircher
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Thomas Frangen
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Christian Kühne
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Andreas Junge
- Department of Trauma and Hand Surgery, Hospital of the Brothers of Mercy, Trier, Germany
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Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro AR, Patel AA. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med 2014; 37:139-51. [PMID: 24559418 PMCID: PMC4066422 DOI: 10.1179/2045772313y.0000000158] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT The complex anatomy and the importance of ligaments in providing stability at the upper cervical spine region (O-C1-C2) require the use of many imaging modalities to evaluate upper cervical injuries (UCI). While separate classifications have been developed for distinct injuries, a more practical treatment algorithm can be derived from the injury pattern in UCI. OBJECTIVE To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. METHODS A literature review was performed on the Pubmed database using the following keywords: (1) "occipital condyle injury"; (2) "craniocervical dislocation or atlanto-occipital dislocation or craniocervical dislocation"; (3) "atlas fractures"; and (4) "axis fractures". Just articles containing the diagnosis, classification, and treatment of specific UCI were included. The data obtained were analyzed by the authors, dividing the UCI into two groups: Group 1 - patients with clear ligamentous injury and Group 2 - patients with fractures without ligament disruption. RESULTS Injuries with ligamentous disruption, suggesting surgical treatment, include: atlanto-occipital dislocation, mid-substance transverse ligament injury, and C1-2 and C2-3 ligamentous injuries. In contrast, condyle, atlas, and axis fractures without significant displacement/misalignment can be initially treated using external orthoses. Odontoid fractures with risk factors for non-union are an exception in Group 2 once they are better treated surgically. Patients with neurological deficits may have more unstable injuries. CONCLUSIONS Ascertaining the status of relevant ligamentous structures, fracture patterns and alignment are important in determining surgical compared with non-surgical treatment for patients with UCI.
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Affiliation(s)
- Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil,Correspondence to: Andrei F. Joaquim, Neurosurgery Division, State University of Campinas, 13083-970, Campinas-SP, Brazil. E-mail:
| | - Enrico Ghizoni
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Helder Tedeschi
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Brandon Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Darrel S. Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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24
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Abstract
Occipital condylar fractures (OCFs) are rare and difficult to diagnose. The routine use of computed tomography (CT) scan in traumatology has however now made their diagnosis easier, with an estimated frequency of 4 to 19% of craniospinal traumatized patients and 0.4 to 0.7% of all severe traumatized patients in emergencies. This paper describes a patient who was not diagnosed with OCF during his first hospitalization after a road accident. However, 15 days later a left sided hypoglossal nerve palsy occurred. In this case report, we underline that an examination of the cranial nerve is a quick and easy procedure to screen each head trauma patient for occipital foramen fractures. Also, careful attention must be paid to X-Rays, CT scans and magnetic resonance imaging of the craniocervical junction.
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Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. Occipital Condyle Fractures. Neurosurgery 2013; 72 Suppl 2:106-13. [DOI: 10.1227/neu.0b013e3182775527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Beverly C. Walters
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark N. Hadley
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
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26
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Schnake KJ, Pingel A, Scholz M, Kandziora F. Temporary occipito-cervical stabilization of a unilateral occipital condyle fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:2198-202. [PMID: 22531894 PMCID: PMC3481092 DOI: 10.1007/s00586-012-2275-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/12/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Injuries of the occipital condyles are rare. While the majority of occipital condyle fractures can be treated conservatively, surgery is recommended in craniocervical misalignment and instability. Open reduction and temporary occipito-cervical stabilization might be an alternative to fusion or halo treatment. MATERIALS AND METHODS This Grand Round case presentation describes temporary C0-C3 stabilization in a 29-year-old man who was involved in a car accident. Radiological examination revealed a rotational burst fracture (type AO C3.1) of C7, and a slight displaced right occipital condyle fracture (Anderson/Montesano type III) with rotational misalignment of the C0-C2 complex. RESULTS The C7 fracture was stabilized and fused from anterior and posterior. The occipital condyle fracture was reduced and temporarily stabilized from C0-C3 from posterior. Bony healing occurred after 6 months and consequently the internal fixator was removed to preserve upper cervical mobility.
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Affiliation(s)
- Klaus John Schnake
- BG Unfallklinik Frankfurt am Main, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
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Occipital condyle fractures. Prospective follow-up of 31 cases within 5 years at a level 1 trauma centre. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:289-94. [PMID: 21833573 DOI: 10.1007/s00586-011-1963-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/25/2011] [Accepted: 07/31/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Prospective investigation of incidence and outcome of occipital condyle fractures (OCF) in a level 1 trauma centre. METHODS Over a period of 5 years, we prospectively recorded all cases of OCF, and performed a 1-year post-injury radiological and clinical follow-up using CT imaging, SF-36 and Neck Disability Index, respectively. RESULTS A total of 31 patients with OCF were identified. Based on a total of 2,616 CT scans that had been performed during this period, the incidence was 1.19%. There were 27 unilateral and 4 bilateral OCFs. Furthermore, 3 out of 31 patients (9.7%) were additionally diagnosed with atlanto-occipital dislocation (AOD), one of which was dorsally stabilised in a surgical procedure. All other patients were treated conservatively. 5 out of 31 patients (16.1%) died due to the severity of associated injuries. 22 out of 31 patients (70.9%) were prospectively followed-up for 1 year after trauma. During this period, CT imaging showed bony consolidation of fractures in all cases except for one, with no evidence of secondary dislocation or nonunion. Evaluation of the Neck Disability Index showed moderate disability. The SF-36 questionnaire showed an impaired quality of life in all areas; however, these were determined by associated injuries and independent of the type of fracture. CONCLUSIONS Both unilateral and bilateral OCFs represent a stable injury regardless of the type of fracture. If AOD has been diagnosed in addition, it requires surgical stabilisation-independent of the OCF-and it is a significant predictor for poor outcomes. The patients quality of life 1 year after trauma has not been affected by the OCF, but by the overall pattern of the injury and by comorbidities. Based on our results, we introduce a new, simple and practical classification for OCFs.
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Isolated paralysis of glossopharyngeal and vagus nerve associated with type II occipital condyle fracture: case report. Childs Nerv Syst 2010; 26:719-22. [PMID: 20054599 DOI: 10.1007/s00381-009-1070-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Occipital condyle fractures (OCFs) can occasionally be complicated with lower cranial nerve palsies. DISCUSSION Isolated 9th and 10th cranial nerve palsies following OCF are very rare. To our knowledge, we report the first case of an early onset of 9th and 10th cranial nerve palsies with an early full recovery in short period of time and discuss the probable mechanism of isolated nerve palsy in the light of the relevant literature.
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29
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Maserati MB, Stephens B, Zohny Z, Lee JY, Kanter AS, Spiro RM, Okonkwo DO. Occipital condyle fractures: clinical decision rule and surgical management. J Neurosurg Spine 2009; 11:388-95. [PMID: 19929333 DOI: 10.3171/2009.5.spine08866] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Occipital condyle fractures (OCFs) are rare injuries and their treatment remains controversial. Several classification systems have been proposed, first by Anderson and Montesano and more recently by Tuli and colleagues and Hanson and associates, who sought to stratify these fractures in a manner that would guide treatment that has typically ranged from semirigid collar immobilization to halo fixation or occipitocervical fusion. It has been the authors' impression, based on experience with OCFs at their institution, that classification is cumbersome and contributes little to the clinical decision-making process, while the identification of craniocervical misalignment and neural element compromise is paramount, and sufficient, for the planning of treatment. METHODS The authors performed a retrospective review of 24,745 consecutive trauma presentations to a single Level I trauma center (UPMC Presbyterian Hospital) over a 6-year period, identifying 100 patients with 106 OCFs. All patients were evaluated by the spine trauma service and underwent imaging of the craniocervical junction using reconstructed CT scans. Patient characteristics, fracture characteristics (including fracture classification according to the 2 major classification systems), initial management, and status at follow-up were recorded. RESULTS The incidence of OCF in this trauma population was 0.4%. Two patients had evidence of craniocervical misalignment on reconstructed CT imaging at the time of admission; both patients underwent occipitocervical fusion. One patient underwent occipitocervical fusion for unrelated C1-2 fractures. The remainder of those surviving to discharge, whose fractures represented all fracture subtypes, received treatment with a rigid cervical collar or counseling alone. No patients, including 4 patients with bilateral OCFs, were found to have developed delayed craniocervical instability or misalignment on follow-up, or to require further neurosurgical intervention for an OCF. Neural element compression was not identified in any of the patients, and there were no cases of delayed cranial neuropathy. CONCLUSIONS Beyond the identification of craniocervical misalignment on reconstructed CT scans at admission, further classification of OCFs is unnecessary. Management should consist of up-front occipitocervical fusion or halo fixation in cases demonstrating occipitocervical misalignment, or of immobilization in a rigid cervical collar followed by delayed clinical and radiographic evaluation in a spine trauma clinic if misalignment is not present.
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Affiliation(s)
- Matthew B Maserati
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh, Pennsylvania 15213, USA
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Huang DW, Tai SH, Hung YC, Fang VK, Lee MY, Lee EJ. A rare occipital condyle fracture in a patient with a minor head injury. Kaohsiung J Med Sci 2009; 25:342-6. [PMID: 19561000 DOI: 10.1016/s1607-551x(09)70526-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Occipital condyle fracture (OCF) is an uncommon but potentially fatal disease entity. It is most commonly identified in patients suffering from severe craniocerebral trauma. The advent of computed tomography has made early detection possible. Traditional treatment using a hard neck collar is sufficient to produce solid fusion in most OCF patients. Delayed diagnosis, however, may result in neurologic deterioration due to potential displacement of fractured condylar fragments. Here we report a case of isolated, stable OCF in a patient with a minor head injury. A high level of clinical awareness of this rare disease entity is imperative for the management of traumatized patients, especially for those who have minor head injuries but persistent neck pain.
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Affiliation(s)
- Da-Wei Huang
- Division of Neurosurgery, Department of Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
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Paiva WS, Rusafa-Neto E, Amorim RLO, Figueiredo EG, de Andrade AF, Teixeira MJ. Occipital condyle fracture in a patient with head trauma. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:119-20. [PMID: 19330228 DOI: 10.1590/s0004-282x2009000100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
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Malham GM, Ackland HM, Jones R, Williamson OD, Varma DK. Occipital condyle fractures: incidence and clinical follow-up at a level 1 trauma centre. Emerg Radiol 2009; 16:291-7. [PMID: 19189141 DOI: 10.1007/s10140-008-0789-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 12/15/2008] [Indexed: 12/01/2022]
Abstract
The purpose of the study was to investigate the incidence, management, and outcomes of occipital condyle fractures at a level 1 trauma center. Blunt trauma patients with occipital condyle fracture admitted to a level 1 trauma center over a 3-year period were identified. Prospective clinical and functional follow-up was undertaken, including further radiographic imaging. The incidence of occipital condyle fracture in patients presenting to our level 1 trauma center was 1.7/1,000 per year. Twenty-four patients were followed up at a mean of 27 months post-injury. There was one case of isolated occipital condyle fracture; all other patients had sustained additional orthopedic, cervical spine, and/or head injury. Seven (29%) patients sustained unilateral Type III avulsion fractures, none of which were isolated injuries. Traumatic brain injury was detected in 46% of study patients, and 42% had cervical spine injury. External halothoracic immobilization was used in 33% of cases. Fracture union with anatomical alignment occurred in 21 patients (88%). No patient had cranial nerve deficit at admission or follow-up. Three patients (12.5%) had moderate to severe neck pain/disability at follow-up, all of whom had sustained multiple injuries. Occipital condyle fractures most frequently occur in conjunction with additional injuries, particularly head and cervical spine injuries. Most cases can be managed successfully nonoperatively. Functional outcome is generally determined by pain and disability related to other injuries, rather than occipital fracture configuration.
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Affiliation(s)
- Gregory M Malham
- Department of Neurosurgery, The Alfred Hospital, Commercial Road, Melbourne, 3004, Australia.
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Tewari MK, Ratnam KL, Shiv VK. Unilateral occipital condylar fracture presenting as neck pain and restriction of neck movements- Report of a case and review of literature. INDIAN JOURNAL OF NEUROTRAUMA 2008. [DOI: 10.1016/s0973-0508(08)80015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractOccipital condylar fractures (OCFs) once rare injuries are not so at present. A young male, victim of motor vehicle accident, presented with severe high cervical pain and restriction of neck movements without any focal neurological deficit, with normal cervical spine x-rays and computerized tomography (CT) scans brain. CT scan and magnetic resonance (MR) imaging of the craniovertebral junction (CVJ) area revealed a retro-pulsed segment in the cervical spinal canal with no cord compression or ligament injury. Patient improved with immobilization of neck. Patients with severe high cervical pain and restricted head movements OCF should be suspected and patient should be evaluated further. Majority of stable OCF improve with immobilization only.
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Alcelik I, Manik KS, Sian PS, Khoshneviszadeh SE. Occipital condylar fractures. Review of the literature and case report. ACTA ACUST UNITED AC 2006; 88:665-9. [PMID: 16645117 DOI: 10.1302/0301-620x.88b5.16598] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.
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Affiliation(s)
- I Alcelik
- Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
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