Radiologic and clinical spectrum of occipital condyle fractures. Delayed onset vagus nerve paralysis after occipital condyle. Occipital condyle an overview sciencedirect topics. Isotated impaction fracture of the occipital condyle, due to compression by the atlas or dens. Occipital condyle fracture in a patient with head trauma scielo. Depending on severity, these fractures may or may not present with neurological deficits ranging from lower cranial nerve deficits to quadriparesis.
Occipital condyle fracture and lower cranial nerve palsy. Occipital condyle fracture type i impaction fracture type ii extension of basilar skull fracture type iii alar ligament avulsion must evaluate for craniocervical dissociation andersonmontesano, spine 1988 tuli et al. A case of occipital condylar fracture in a multiply injured and unconscious motor cyclist is reported. Delayed glossopharyngeal and vagus nerve paralysis. The anderson and montesano classification of occipital condylar fracture is described. In our case, an epidural hematoma was seated very close to the bone fragment. Lower cranial nerve ixxii palsy is a rare condition with numerous causes, usually nontraumatic. This patient was successfully treated with immobilization in a rigid cervical collar.
Occipital condyle fracture in a patient with head trauma. Computed tomography scan of the cervical spine revealed a minimally displaced fracture of the right occipital condyle, as seen in the figure. We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. A 19yrold man was brought to the hospital after a motor vehicle accident. Occipital condyle syndrome ocs, a rare cause of pain in the head, consists of a severe and persistent unilateral sub occipital headache with ipsilateral 12th cranial nerve palsy. In this report, we describe the diagnosis and management of the three patients in our series and make general recommendations regarding the management of patients sustaining this rare. Purpose to evaluate the appearance, morphology, and treatment of occipital condyle fractures ocf. Occipital condyle fracture anesthesiology asa publications.
Nov 15, 2018 an occipital condyle fracture ocf is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. Apr, 2020 occipital condyle fractures are caused by a combination of vertical compression and lateral bending. Occipital condyle fractures and occipitalisation of the atlas are rare entities of the craniocervical junction. Delayed hypoglossal nerve palsy following occipital. Subtype i is a skull base fracture extending to the occipital foramen foramen magnum, often involving the foramen nervi hypoglossi exit canal of the 12th cranial nerve in the fracture, potentially resulting in neurological deficits in the area supplied by. Occipital condyle fractures, traumatic brain injury, and management. Occipital condyle fractures neurosurgery wayne state university. It is shown that this site is often inadequately imaged when scanning the head and neck in victims of trauma. A depressed fracture of the occipital condyle was diagnosed using highresolution computerized tomography ct scanning and threedimensional ct images. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the. Some structures provide stability to this condyle region. The type of fracture of detected ocfs was rated in accordance with the anderson and montesano classification 6.
Occipital condyle article about occipital condyle by the. A written informed consent was obtained from the patient. There was not cervical pain or cervical instability sig nal. A lateral cervical spine radiograph is commonly obtained to screen for cervical spine injury in the setting of trauma. This was a postmortem diagnosis of a hospital patient who sustained a fall at. The diagnosis of occipital condyle fracture in all cases was made with ct. Nonoperative management of occipital condyle frature. The close anatomic association of many neural and vascular structures to the occipital condyles explains the great variety of symptoms that may occur in conjunction with an occipital condyle fracture. Methods cases were collected by a retrospective and prospective analysis of teaching files and case logs.
Guidelines for the management of acute cervical spine and spinal cord injuries. Delayed onset vagus nerve paralysis after occipital. This report describes a case of delayed glossopharyngeal and vagus nerve paralysis following a closed head injury. Occipital condyle fracture and lower cranial nerve palsy after. There was no fracture of the cervical spine and no soft tissue swelling. The patient was brought to the operating room for bilateral mandible fracture surgery with a. Occipital condyle fracture should be suspected when paralysis of the 9th through the 12th nerves colletsicard syndrome occurs after minor head trauma.
What is occipital condyle fracture of the cervical spine. Apr 04, 2020 each condyle is located to either side of the foramen magnum, the hole in the skull base through which the spinal cord enters the cranium. The true incidence of fracture of the occipital condyles is unknown. Occipital condyle definition, a protrusion on the occipital bone of the skull that forms a joint with the first cervical vertebra, enabling the head to move relative to the neck. For nondisplaced ocfs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced ocf requiring surgery.
Avulsion of the condylar process or a comminuted compression fracture may. Case discussion this case illustrates a type 1 left occipital condylar fracture. Cervical immobilization, ct imaging, occipital condyle fracture. 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. Occipital condyle fracture ocf can be difficult to diagnose, since plain radiographs of the skull and cervical spine often fail to reveal any abnormality. Morphologically, one presented with an impacted fracture of the occipital condyle type i, one with a basilar skull fracture that included an occipital condyle fracture type ii, and four had avulsion fractures of the occipital condyle. During the last 4 years, the authors have had six cases of occipital condyle fractures, a very rare injury.
To the best of our knowledge, a patient presenting with a traumatic occipital condyle fracture and preexisting occipitalisation of the atlas has. Colletsicard syndrome associated with occipital condyle. A case report mengta liu1,2, guanyu lin2, chunchieh lin 2, chunan cheng. Occipital condyle fractures in the pediatric population. Pdf occipital condyle fracture in a patient with head. Occipital condyle fractures ocfs are rare injuries and their treatment remains controversial. The patient in this report presented with ocfs and c1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. The cervical spine was immobilized with a cervical collar and a neurosurgical consult was obtained. In two cases an occipital condyle fracture with medial displace ment of the fracture fragment figs 18, 1c, 2a. Occipital condyle fractures ocf are rare traumatic injuries and are of critical clinical importance because of the anatomic considerations of the occipitoatlantoaxial joint complex. Trauma to the brain or calvaria may cause some cranial nerve damage. In our opinion, the system of occipital condyle fracture classification proposed in 2012 does not seem superior in everyday clinical practice. Occipital condyle fracture in a patient with occipitalisation.
Occipital condyle fractures are caused by a combination of vertical compression and lateral bending. It may be associated with instability at the craniocervical joint. They are considered a specific type of basilar skull fracture, and importantly can be seen along with craniocervical dissociation. Occipital fracture, such as in the condyle, is rare due to its anatomicalposition. Occipital condyle fractures are a rare finding in trauma victims. Introduction the scottish surgeon and anatomist charles bell published the first case report of an occipital condyle fracture ocf, discovered at autopsy, in 18171. Jan 14, 2014 occipital condyle fractures ocf are rare traumatic injuries and are of critical clinical importance because of the anatomic considerations of the occipitoatlantoaxial joint complex. Such fractures are linear, appearing as a crack in the occipital bone, or compressed, with part of the surface of the condyle being pushed inward.
Occipital condylar fracture was originally described by charles bell in 1817. Fracture of an occipital condyle may occur in isolation, or as part of a more extended basilar skull fracture. To understand the function of the occipital condyle is helpful to know the anatomy of the atlas. Ct scans with occipital condyle fracture and t6t7 vertebral body fracture with spinal cord transection. The patient was initially neurologically intact, but showed secondary. Occipital condyle fracture is a rare injury and the radiology and trauma literature is limited to a few cases24.
However, fractures of the occipital condyle are rare, with only 15 reported in the english literature18 since the initial description by sir charles bell in 1817. Cervical pain, head injury, occipital candyle fracture introduction fracture of the occipital condyle was first. Temporoparietal lesionsare more common in this context. Medline search yielded reports of 20 occipital condyle fractures in the literature. These fractures are divided into three types see box 14. Ct analyses of occipital condyle fractures ocf have been based on low case numbers so far, and prospective studies on fracture morphology are not available yet. Avulsion of the condylar process or a comminuted compression fracture may occur secondary to. Cervical immobilization, ct imaging, occipital condyle fracture neurosurgery 72. An important aspect of ocf relates to the difficulty in. Of the six treated by the authors, one death by pontine hemorrhage occurred in a patient with a displaced.
Traumatic occipital condyle fractures springerlink. A minimally displaced fracture of the right inferior medial occipital condyle was noted figure 1. Isolated condyle fracture is a type of craniocervical injury. Occipital condyle fracture radiology reference article. Ocf can be a diagnostic challenge because of the inability to diagnose. Occipital condyle fractures are often difficult to detect on plain films, and ct with reconstructions is the preferred diagnostic modality bloom et al.
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. Occipital condyle definition of occipital condyle by. Diagnosis and management of occipital condyle fractures. Minimally comminuted nondisplaced left occipital condyle fracture extending to the atlanto occipital articulation without joint disruption or subluxation. Diagnosis of fracture of the occipital condyle requires a high index of suspicion and highresolution tomography. Fractures of the occipital condyle are not uncommon and are often the result of trauma to the neck. Occipital condyle fractures occipital condyle injures are relatively rare and often associated with an occipitocervical dislocation.
Delayed onset cranial nerve paralysis causing dysphagia might be a distinguishable sign of ocf in horses. His demise was attributed to medullary compression by the condylar fragment. Occipital condyle fracture ocf is a rarely encountered pathology not easily diagnosed by routine clinical and radiological evaluation and one of the causes of lower cranial nerve disability. Occipital os occipitale condyle fractures are classified by jeanneret in 4 subtypes. Occipital condyle fractures ocfs have been treated as rare traumatic injuries, but the number of reported ocfs has gradually increased because of the popularization of computed tomography ct. The brainstem, lower cranial nerves, and venous and arterial vessels are particularly at risk. Consequently two values of skull length were compared to the humerus. Occipital condyle fractures ocfs have been treated as rare traumatic injuries, but the number of reported ocfs has gradually increased because of the popularization of computed tomography ct and magnetic resonance imaging mri. Fractures and dislocations of the cervical spine are not uncommon in multiplyinjured patients. To the best of our knowledge, this is the first report on a case of a traumatic posterior atlantooccipital dislocation aod with 3part jefferson and occipital condyle fractures.
Morphology and treatment of occipital condyle fractures. Occipital condyle syndrome as an initial presentation of. Case reports occipital condyle syndrome as an initial presentation of lung cancer. Fractures are best visualized on coronal and sagittal reformatted images. Nonoperative treatment of occipital condyle fractures. A gunshot wound to the upper neck generated the need for ct at the level of the craniocervical junction. The shape of the occipital condyle allows for nodding and very slight lateral movements of the head. In injured patients with unexplained neck pain, spasmodic torticollis and lower cranial nerve injury, one should screen the occipitocervical junction using ct to rule out occipital condyle fracture ocf. The classification of anderson and montesano distinguishes three types of occipital condyle fracture. In this report, we describe the diagnosis and management of the three patients in our series and make general recommendations regarding the management of patients sustaining this rare injury. Fractures of the occipital condyles are extremely rare. Linear fractures are generally less severe, and recommended treatment typically involves wearing a.
Delayed onset dysphagia after head injury should prompt equine clinicians to evaluate the condition of the atlanto. We report the case of a 60yearold male with posterior aod with 3part jefferson fracture and fracture of right occipital condyle. Traditionally thought of as rare, occipital condylar fractures ocfs have recently been. All others attained solid union with appropriate immobilization. There was a reversal of normal cervical lordosis due to muscle spasm. An occipital condyle fracture ocf is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. However, the authors have inaccurately reported the true prevalence of occipital condyle fractures ocf caused by highenergy blunt trauma to the craniocervical junction in the pediatric and young adult population. Condylar fracture an overview sciencedirect topics. We report the case of a 79yearold man presenting with an anderson and montesano type iii fracture through. This injury was clinically unsuspected but found on the lowest cuts of head computed tomography.
Axial left and reconstructed coronal right ct images of an anderson and montesano type ii tuli type 1 ocf. Traumatic posterior atlantooccipital dislocation with. A national library of medicine pubmed computerized literature search of publications from 1966 to 2011 was performed using the following headings. To evaluate the outcomes of patients with occipital condyle fractures ocfs treated nonoperatively and establish factors associated with neck disability summary of background data. For nondisplaced ocfs, conservative treatment is generally recommended, and there is no previous. Occipital condyle definition is an articular surface on the occipital bone by which the skull articulates with the atlas. We present a rare fatal complication of an occipital condylar fracture. Pdf on oct 5, 2016, yuvesh passi and others published occipital condyle fracture find, read and cite all the research you need on. Occipital condyle fractures neurosurgery oxford academic. Occipital condyle fracture with delayed onset cranial nerve paralysis was diagnosed. Delayed nerve injury is related to further displacement of fracture fragments, haematoma formation or oedema and osseous callus. Get a printable copy pdf file of the complete article 738k, or click on a page image below to. To evaluate the outcomes of patients with occipital condyle fractures ocfs treated nonoperatively and establish factors associated with neck disability.
Ct is the best modality for identifying an occipital condyle fracture 6. However, fractures of the occipital condyle are rare, with only 15 reported in the english. Occipital condyle fractures are rarely evident by xray 5,6. Surgical treatment for occipital condyle fracture, c1. Fracture of the occipital condyle emergency medicine journal. To the best of our knowledge, a patient presenting with a traumatic occipital condyle fracture and preexisting occipitalisation of the atlas has not been previously reported. Occipital condyle definition of occipital condyle at. A case of occipital condylar fracture in a multiply injured and unconscious motorcyclist is reported. They are frequently unilateral and are often isolated cervical spine injuries in patients with head injuries. Unexpected death after occipital condylar fracture ncbi. Sep 26, 2019 occipital condyle fracture with delayed onset cranial nerve paralysis was diagnosed.
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