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Musbahi O, Khan AHA, Anwar MO, Chaudery H, Ali AM, Montgomery AS. Immobilisation in occipital condyle fractures: A systematic review. Clin Neurol Neurosurg 2018; 173:130-139. [PMID: 30125835 DOI: 10.1016/j.clineuro.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of this review are to determine the level of evidence for the management of OCF, compare outcomes of different immobilisation, and to review the prognosis. PATIENTS AND METHODS A literature search was conducted using 3 databases (MEDLINE, PubMed and EMBASE). All papers between 1940 and July 2017 were screened using PRISMA guidelines. Inclusion criteria were patients with a confirmed diagnosis of occipital condyle fracture(s) on CT managed with any form of immobilisation with no age restriction. Primary outcome was clinical improvement in symptoms or Neck Disability Index. MINORS and OCEBM level was assigned to each study. RESULTS 25 studies met the inclusion criteria. Most studies used a single form of C-spine immobilisation support (58%) with a semi rigid collar and halo device being the most common. From these studies, the average length of time for immobilisation was 11.7 weeks, 9 weeks and 8.3 weeks for halo, semi-rigid and rigid cervical collars respectively. Neuro deficit was found in 20.3% of patients. OCEBM level of evidence and MINORS score was low. CONCLUSION Management of OCF is associated with low level of evidence. Further studies are needed to determine optimal management of these under-diagnosed fractures.
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Affiliation(s)
- Omar Musbahi
- Oxford University Clinical Academic Graduate School, Oxford, UK.
| | | | | | - Hannan Chaudery
- Spinal Department, The Royal London Hospital, Whitechapel, London, UK
| | - Adam M Ali
- Department of Trauma and Orthopaedics, Imperial College NHS Trust, London, UK
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Occipital Condyle Fractures and Concomitant Cervical Spine Fractures: Implications for Management. World Neurosurg 2018; 115:e238-e243. [DOI: 10.1016/j.wneu.2018.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
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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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Burke SM, Huhta TA, Mackel CE, Riesenburger RI. Occipital condyle fracture in a patient with occipitalisation of the atlas. BMJ Case Rep 2015; 2015:bcr-2015-209623. [PMID: 25976203 DOI: 10.1136/bcr-2015-209623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Occipital condyle fractures and occipitalisation of the atlas are rare entities of the craniocervical junction. To the best of our knowledge, a patient presenting with a traumatic occipital condyle fracture and pre-existing occipitalisation of the atlas has not been previously reported. We report the case of a 79-year-old man presenting with an Anderson and Montesano type III fracture through a fused occipital condyle and lateral mass. This fracture was noted to extend into the transverse foramen and the C1-C2 joint space. The transverse ligament and ligamentum flavum were calcified but not disrupted and the atlantodental interval was within normal limits. The neurological examination was unremarkable with the exception of neck pain. The patient was treated conservatively and placed in a rigid cervical collar for 10 weeks with serial CT studies to monitor healing of the fracture. At 4 months of follow-up, the patient was pain free with nearly complete resolution of his occipital condyle fracture.
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Affiliation(s)
- Shane M Burke
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Taylor A Huhta
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
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Chugh S, Kamian K, Depreitere B, Schwartz ML. Occipital Condyle Fracture with Associated Hypoglossal Nerve Injury. Can J Neurol Sci 2014; 33:322-4. [PMID: 17001823 DOI: 10.1017/s0317167100005229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Occipital condyle fracture (OCF) is a rare injury that was first described by Bell in 1817. In fact, there have been only 96 more reported cases of occipital condyle fractures from 1817 to 1994 of which only 58 survived. Occipital condyle fractures can sometimes go unnoticed or under-diagnosed as they are not always evident on plain radiographs of the cervical spine. Also, in rare cases OCFs can cause damage to the hypoglossal nerve which passes through the hypoglossal canal which is near the occipital condyle. The presence of specific symptoms and clinical signs should lead to the correct diagnosis. This paper describes a patient who was diagnosed with OCFs, but not hypoglossal nerve damage until 20 days following admission to hospital. We point out many factors that contributed to this delayed diagnosis, which ultimately caused severe discomfort to the patient.
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Abstract
OBJECTIVE The anatomy, clinical presentation, radiologic evaluation, treatment, and outcome of occipital condyle fractures are reviewed. METHODS We review and discuss the literature on occipital condyle fractures. RESULTS Occipital condyle fractures are best diagnosed with computed tomography. The neurologic presentation is variable. The majority of these injuries may be treated nonoperatively, but an occipitocervical fusion is necessary to restore stability across the craniovertebral junction. CONCLUSION Occipital condyle fractures are a rare but serious injury that requires prompt diagnosis and treatment.
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Affiliation(s)
- Youssef R Karam
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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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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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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Elhammady MS, Farhat H, Aziz-Sultan MA, Morcos JJ. Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst. J Neurosurg Spine 2009; 10:234-9. [DOI: 10.3171/2008.12.spine08158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Juxtafacet cysts of the atlantooccipital joint that present with isolated hypoglossal nerve palsy are rare and may mimic more common pathological entities. The authors report on the third such case in the literature and discuss the differential diagnosis, imaging hallmarks, preoperative recognition, and surgical management of this lesion, and provide a review of the literature.
The authors discuss their experience with the treatment of a 67-year-old woman who presented with an isolated hypoglossal nerve palsy caused by a nonenhancing cystic septated lesion abutting the lateral medulla just medial to the left hypoglossal canal. The lesion was presumed to be a necrotic hypoglossal schwannoma or epidermoid tumor. Intradural surgical exploration failed to demonstrate an intradural lesion, but confirmed the presence of an extradural mass caudal to the hypoglossal nerve. Extradural exploration revealed a synovial cyst of the atlantooccipital joint, which was then resected. Postoperatively, the patient developed worsening dysphagia and hoarseness. Failure to recognize this rare entity preoperatively resulted in unnecessary intradural exploration and cranial nerve morbidity. In retrospect, the preoperative diagnosis of this lesion was suggested by lack of central enhancement, absence of dumbbell formation and the presence of erosive synovial changes. Regardless, the extreme rarity of this lesion at this location will always make its recognition challenging.
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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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Kim MS, Cho MS, Kim SH. Delayed bilateral abducens nerve palsy after head trauma. J Korean Neurosurg Soc 2008; 44:396-8. [PMID: 19137087 DOI: 10.3340/jkns.2008.44.6.396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022] Open
Abstract
Although the incidence of unilateral abducens nerve palsy has been reported to be as high as 1% to 2.7% of head trauma cases, bilateral abducens nerve palsy following trauma is extremely rare. In this report, we present the case of a patient who developed a bilateral abducens nerve palsy and hypoglossal nerve palsy 3 days after suffering head trauma. He had a Glasgow Coma Score (GCS) of 15 points. Computed tomography (CT) images demonstrated clivus epidural hematoma and subarachnoid hemorrhage on the basal cistern. Herein, we discuss the possible mechanisms of these nerve palsies and its management.
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Affiliation(s)
- Min-Su Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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Chou CW, Huang WC, Shih YH, Lee LS, Wu C, Cheng H. Occult occipital condyle fracture with normal neurological function and torticollis. J Clin Neurosci 2008; 15:920-2. [DOI: 10.1016/j.jocn.2007.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 03/19/2007] [Accepted: 03/20/2007] [Indexed: 12/01/2022]
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Freedman M, Jayasundara H, Stassen LFA. Idiopathic isolated unilateral hypoglossal nerve palsy: a diagnosis of exclusion. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2008; 106:e22-6. [PMID: 18585607 DOI: 10.1016/j.tripleo.2008.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 02/15/2008] [Accepted: 02/20/2008] [Indexed: 10/21/2022]
Abstract
This report describes the rare case of a 22-year-old male with persistent idiopathic isolated hypoglossal nerve palsy. Thorough history, examination, and investigation were needed to rule out the many causes of such a presentation. The clinical presentation showed unilateral atrophy and fibrillation of the affected side and mild deviation on protrusion to the affected side. The differential diagnosis included neoplasia, trauma, infection, endocrine, autoimmune, neurologic, and vascular causes. Investigations included magnetic resonance imaging, computerized tomography scan, chest x-ray, cerebrospinal fluid culture, and a range of hematologic tests. These led to a diagnosis of persistent idiopathic isolated hypoglossal nerve palsy.
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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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Kuitwaard K, Vandertop WP. A patient with an odontoid fracture and atrophy of the tongue: a case report and systematic review of the literature. SURGICAL NEUROLOGY 2005; 64:525-32, discussion 532-3. [PMID: 16293473 DOI: 10.1016/j.surneu.2005.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 03/28/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic hypoglossal nerve palsy is a rare entity and has rarely been described in association with an odontoid fracture. CASE DESCRIPTION We present a patient with a posttraumatic odontoid fracture who developed selective weakness of his arms and a unilateral hypoglossal nerve palsy. A systematic review of the literature is presented, and hypothetical causes for the injury are discussed. CONCLUSION Bell's cruciate paralysis and central cord syndrome are probably expressions of the same mechanism rather than 2 separate entities based on a preferential damage of pyramidal crossing arm fibers. C2 fractures with concomitant lower cranial nerve injury are relatively rare and have a reasonably good outcome, especially when unilateral.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurosurgery, VU University Medical Center, Postbox 7057, 1007 MB Amsterdam, The Netherlands
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Caroli E, Rocchi G, Orlando ER, Delfini R. Occipital condyle fractures: report of five cases and literature review. 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 2005; 14:487-92. [PMID: 15754215 PMCID: PMC3454667 DOI: 10.1007/s00586-004-0832-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Accepted: 09/26/2004] [Indexed: 11/29/2022]
Abstract
Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Early recognition of some types of OCF is imperative to avoid fatal results. We analyzed 121 cases of OCF (116 from the literature and five of our own). Rarely patients with a deficit of the lower cranial nerves make a complete recovery. However, quoad vitam prognosis of patients with "pure OCFs" remains good. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. We want to emphasize that not only an OCF with instability of O-C1-C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.
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Affiliation(s)
- Emanuela Caroli
- Department of Neurological Sciences, Neurosurgery, S. Andrea Hospital, University of Rome "La Sapienza", Via Meropia, 85-00147 Rome, Italy.
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Freeman BJC, Behensky H. Bilateral occipital condyle fractures leading to retropharyngeal haematoma and acute respiratory distress. Injury 2005; 36:207-12. [PMID: 15589943 DOI: 10.1016/j.injury.2004.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2004] [Indexed: 02/02/2023]
Abstract
Injuries to the occipito-cervical junction are rare and not easily diagnosed on conventional radiographs. The authors report such a case where the diagnosis was delayed. The patient developed a significant retrophyarngeal haematoma resulting in acute respiratory distress and required emergency endotracheal intubation. The patient remained intubated for five days and received a tapered dose of intravenous dexamethazone to reduce swelling in the proximity of the airway. At six weeks the patient had developed a left hypoglossal nerve palsy that persisted at 12 months. Occipital condyle fractures and the difficulties of diagnosis are discussed. The importance of measuring pre-vertebral soft tissue swelling on lateral radiographs is emphasized. Computed tomography of the C0-C2 region should be performed to identify base of skull and upper cervical fractures.
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Affiliation(s)
- Brian J C Freeman
- The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
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