Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

Madelon Thevis; Jolanda Derks; Thijs T.G. Jansen; Allard J.F. Hosman; Henricus P.M. Kunst

doi:10.1055/a-2461-5391

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(06): e8-e16
DOI: 10.1055/a-2461-5391

Original Article

Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

Authors

Madelon Thevis

¹Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Centre, Maastricht University Medical Centre + , Nijmegen/Maastricht, The Netherlands

²Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

³Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Centreþ, Maastricht, The Netherlands
Jolanda Derks

¹Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Centre, Maastricht University Medical Centre + , Nijmegen/Maastricht, The Netherlands

²Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
Thijs T.G. Jansen

¹Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Centre, Maastricht University Medical Centre + , Nijmegen/Maastricht, The Netherlands

²Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
Allard J.F. Hosman

⁴Department of Orthopaedic surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
Henricus P.M. Kunst

¹Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Centre, Maastricht University Medical Centre + , Nijmegen/Maastricht, The Netherlands

²Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

³Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Centreþ, Maastricht, The Netherlands

Abstract

Objectives This study aims to fill in the knowledge gap about patients with occipital condyle fractures (OCFs) and cranial nerve dysfunction (CND) and give advice about when to test the cranial nerves (CNs) and what to do when CND is diagnosed.

Design A 14-year period observational, retrospective cohort study.

Setting Level-I trauma center study.

Participants All 119 surviving cases admitted with an OCF, whereof all 40 cases with either diagnosed CND (confirmed by clinical examination) or expected CND (reported observations high suspicious for CND) were selected for detailed data collection. Early death was the only exclusion criterion because of missing data and clinical irrelevance.

Main Outcome Measures One-third of all surviving OCF patients have CND (n = 40/119, 33.6%), where three-quarters had more than one CN affected with a median of three CNs. Of the cases with a concomitant lateral skull base fracture (n = 24/40, 60%), one in three cases (36%, n = 13/36) had facial nerve palsy and nearly two in three cases (61%, n = 22/36) had hearing loss.

Results The facial nerve was the most commonly diagnosed CND. Solitary OCF cases often had lower CND (n = 11/14). Fifty-eight percent of all CND cases with follow-up data (n = 19/33)—corresponding to one in six of all surviving OCF cases—had chronic CND sequelae.

Conclusion Multiple and chronic CND is common in patients with an OCF. All CNs should be tested in those patients as soon as clinically possible, and testing should be repeated after 3 to 7 days and before discharge. Patients with CND should be counseled about their prognosis and be potentially referred to (e.g.) a speech and language therapist, ophthalmologist, neurologist, or otorhinolaryngologist for early treatment options.

Keywords

occipital condyle fractures - cranial nerve dysfunction - head trauma - traumatic brain injury - cervical spine injury - skull base fractures - facial nerve paralysis - chronic neurological sequelae - patient counseling

Full Text

References

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