A Rare Case of Spontaneous Intrauterine Skull Fracture.

Skull fractures are rare in newborns and normally caused by maternal abdominal trauma or complicated deliveries. However, in rare cases, these fractures are found in neonates born after an uneventful pregnancy and delivery. We report a case of a primigravida who underwent cesarean delivery due to failure of descent and malpositioning of the fetal head. After birth, a right temporoparietal fracture and congenital muscular torticollis were diagnosed. The newborn's blood tests showed hypocalcemia and relative hypoparathyroidism. Both mother and newborn presented low vitamin D levels. Serial imaging control showed gradual resolution of the lesions, with the newborn being discharged at the 10th day of life with vitamin D supplementation. This is an interesting case because the combination of three conditions - maternal and fetal hypovitaminosis D, congenital torticollis and malposition of the cephalic pole during labor - may have synergistically contributed to a spontaneous intrauterine skull fracture.

As fraturas do crânio são raras em recém-nascidos, sendo mais comummente causadas por trauma abdominal ou como complicação do parto. Contudo, em casos mais raros, estas fraturas são encontradas isoladamente, sem associação a intercorrências da gravidez ou do parto. Apresentamos o caso de uma primigesta submetida a cesariana por ausência de descida da apresentação e mau posicionamento da mesma no canal de parto. Após o nascimento, foi diagnosticada fratura temporoparietal direita e torcicolo congénito. Analiticamente, o recém-nascido apresentava hipocalcemia e hipoparatiroidismo relativo. A díade mãe - recém-nascido apresentaram hipovitaminose D. Estudos imagiológicos seriados demonstraram resolução gradual das lesões, possibilitando a alta do recém-nascido ao 10º dia de vida com suplementação de vitamina D. Este caso é interessante porque se conjugam três condições ­ hipovitaminose D materna e fetal, torcicolo congénito e má orientação do polo cefálico ­ que, conjuntamente, podem ter contribuído para a ocorrência de fratura craniana intrauterina espontânea.

Projectile, blunt, or sharp force trauma? A facial lesion on a Bronze Age skull from Uglemose, Denmark.

This study presents and discusses the differential diagnosis of a unique case of facial trauma. The adult male skull was excavated in 1948 from Uglemose (Owl Bog) outside of Birket, on the island of Lolland (Denmark). Carbon-14 samples from an adult tibia excavated with the skull dates to the end of the Danish Bronze Age and transition period into the pre-Roman Iron Age. The skull shows a traumatic ante-mortem lesion to the left maxilla, directly below the orbit, that opens into the maxillary sinus. The left margin of the injury is slightly rounded and angled into the lesion while the right margin is pulled out from the lesion and has a much sharper border, suggesting a directional force from left to right. A previous assessment of the lesion suggested that projectile trauma caused the injury, but the lesion does not conclusively demonstrate features of projectile trauma. CT scans and 3D visualization of the skull show no evidence of structural changes to the maxillary sinus to support a conclusion of projectile trauma. Differential diagnosis through macroscopic and microscopic analysis of the lesion would suggest rapid blunt force or slow sharp force trauma as a potential etiology. The aim of this case study is to discuss the potential mechanisms of injury, including type of trauma as well as accidental versus intentional etiologies.

Facial nerve stimulation associated with cochlear implant use following temporal bone fractures.

OBJECTIVE: To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture. PATIENTS: One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS. MAIN OUTCOME MEASURES: Presence of FNS after implantation and ability to modify implant programming to avoid FNS. RESULTS: The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS. CONCLUSIONS: CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs.

Potato gun ocular injury.

PURPOSE: This study aimed to identify a dangerous new weapon capable of causing damage to the ocular and periocular regions. METHODS: The authors report two patients who had penetrating ocular injury in the past year because of homemade recreational potato guns. RESULTS: In one 14-year-old boy, projectiles from the firing of a potato gun resulted in orbital and cranial injuries that were life threatening with widespread fractures, marked disruption of facial structures, a cerebrospinal fluid fistula requiring bifrontal surgical repair, and loss of one eye. In a separate accident with a different potato gun, a 14-year-old boy who was wearing glasses at the time of injury had a sight-threatening perforating corneal laceration. CONCLUSION: Practitioners must be aware of the existence of these new, homemade unregulated devices. Information about the use and construction of these guns is widespread on the Internet, but no injuries resulting from these guns currently are documented in the medical literature.

[Radiologic and skeletal-anatomical study of mummies at the Tourin Egyptian Museum]. / Indagine radiologica e anatomo-scheletrica su mummie del Museo Egizio di Torino.

The authors present a study performed on three Egyptian mummies, coming from the same inviolate grave belonging to the Necropolis of Gebelin. The grave bore no indications on the occupiers' identity and for that reason Schiaparelli identified it as "Tomb of the Unknown". The mummies and their funerary furniture are now exposed at the Egyptian Museum of Turin. Standard radiographies of the mummies have been taken in situ by means of a portable radiological equipment. It has also been possible to examine directly the anatomic aspect of one unbandaged skeletal mummy. The procedure was simple, reliable, not expensive and did not expose the mummies to damages due to an eventual transfer. Reliable data on the findings have been taken in that way: the three burials, one of them is likely a reburial, belong to three grown-up subjects, whose sex was male for two and probably female for the third. No bone pathology has been found. One of the cadavers seems to be dead due to a serious cranic injury, probably the effect of a heavy bladed weapon.

Fracture of the sella turcica.

A patient with a fracture of the sella turcica, visible on lateral X-ray films of the skull, is described. This fracture, although not diagnosed during life, was present in approximately 20 per cent of a series of consecutive autopsies on patients who died of head injury. The significance of this injury to the hypothalamopituitary axis is discussed and methods of investigation suggested.