Fig. 6.23  Thrombosis of superior orbital vein after right orbital fracture. (a)

Exophthalmus, conjunctival edema, ptosis, and significant restriction of eye motility. (b) MRI (fat-suppressed T1-weighted images after contrast injection): dilatation and central thrombus in the right superior orbital vein

6.1.3  Questionable Signs of Skull Base

Fractures

6.1.3.1  Hematoma Around the Eyes/Lid

Hematoma

There is seldom an absence of a monocular or binocular hematoma following skull base injuries, though this is not necessarily conclusive as hematomas may just as well occur following direct trauma or midface injury.

Lid hematomas may occur as a result of orbital roof or craniofacial injuries. In this case the unior bilaterally swollen, initially blue-colored upper lids are quite impressive. Lid elevation is impaired or impossible. The orbital septum separates the upper lid into compartments and provides a possibility to differentiate between midface fractures and frontal skull base fractures. The examination is carried out by ectropionizing the eyelid.

•Facial skeletal injuries only exhibit hematomas ventral to the orbital septum, which are visible shortly after the accident.

•Skull base injuries exhibit lid hematomas dorsal and ventral to the orbital septum. There may be a delay following injury before the hematoma becomes evident due to the longer distance from the skull base to the lid.

6.1.3.2  Hemorrhage in the Skull Base Region

Basal Mucosal Hemorrhage

Mucosal injuries in the paranasal sinuses adjacent to the skull base caused by fractures may result in temporary, intensive hemorrhage from the nose. As a rule hemorrhaging from extrabasal mucosal tears is selfobliterating.