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

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.