Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms
Anatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or withou...
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| Format: | Article |
| Language: | English |
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Serbian Medical Society
2013-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2013/0370-81791308542Z.pdf |
| _version_ | 1818613273964052480 |
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| author | Živković Vladimir Nikolić Slobodan |
| author_facet | Živković Vladimir Nikolić Slobodan |
| author_sort | Živković Vladimir |
| collection | DOAJ |
| description | Anatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or without a skull base fracture, and most often leads to this fatal injury, due to impact force transmission through the jawbone and temporomandibular joint. The second mechanism includes lateral and posterior head impacts with subsequent hinge fractures, where occurrence of pontomedullary lacerations in these cases may depend on the energy of impact, as well as on the exact position of the fracture line, but less so on the head’s movement. The third mechanism includes frontoposterior hyperextension of the head, due to frontal impact, concomitant with fractures or dislocations of upper spine. In the fourth mechanism, there is an absence of direct impact to the head, due to the indirect force of action after feet or buttocksfirst impact. Most of these cases are accompanied by ring fractures as well. In situations such as these, the impact force is transmitted up the spinal column and upper vertebrae, and telescopically intruded into the skull, causing brainstem laceration. The jawbone and other facial bones can act as shock absorbers, and their fracture could diminish the energy transfer towards the skull and protect the brain and brainstem from injury. In all the cases with pontomedullary laceration posterior neck dissection should be performed during the autopsy, since upper spine injuries are often associated with this type of injury. [Projekat Ministarstva nauke Republike Srbije, br. 45005] |
| first_indexed | 2024-12-16T15:59:30Z |
| format | Article |
| id | doaj.art-9cdfec1b82c149f3b7b2bce020ad2ebd |
| institution | Directory Open Access Journal |
| issn | 0370-8179 |
| language | English |
| last_indexed | 2024-12-16T15:59:30Z |
| publishDate | 2013-01-01 |
| publisher | Serbian Medical Society |
| record_format | Article |
| series | Srpski Arhiv za Celokupno Lekarstvo |
| spelling | doaj.art-9cdfec1b82c149f3b7b2bce020ad2ebd2022-12-21T22:25:29ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792013-01-011417-854254710.2298/SARH1308542ZPontomedullary lacerations and concomitant injuries: A review of possible underlying mechanismsŽivković VladimirNikolić SlobodanAnatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or without a skull base fracture, and most often leads to this fatal injury, due to impact force transmission through the jawbone and temporomandibular joint. The second mechanism includes lateral and posterior head impacts with subsequent hinge fractures, where occurrence of pontomedullary lacerations in these cases may depend on the energy of impact, as well as on the exact position of the fracture line, but less so on the head’s movement. The third mechanism includes frontoposterior hyperextension of the head, due to frontal impact, concomitant with fractures or dislocations of upper spine. In the fourth mechanism, there is an absence of direct impact to the head, due to the indirect force of action after feet or buttocksfirst impact. Most of these cases are accompanied by ring fractures as well. In situations such as these, the impact force is transmitted up the spinal column and upper vertebrae, and telescopically intruded into the skull, causing brainstem laceration. The jawbone and other facial bones can act as shock absorbers, and their fracture could diminish the energy transfer towards the skull and protect the brain and brainstem from injury. In all the cases with pontomedullary laceration posterior neck dissection should be performed during the autopsy, since upper spine injuries are often associated with this type of injury. [Projekat Ministarstva nauke Republike Srbije, br. 45005]http://www.doiserbia.nb.rs/img/doi/0370-8179/2013/0370-81791308542Z.pdfpontomedullary lacerationbrainstem injuryskull base fracturespinal fracturesmandibular fractures |
| spellingShingle | Živković Vladimir Nikolić Slobodan Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms Srpski Arhiv za Celokupno Lekarstvo pontomedullary laceration brainstem injury skull base fracture spinal fractures mandibular fractures |
| title | Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms |
| title_full | Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms |
| title_fullStr | Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms |
| title_full_unstemmed | Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms |
| title_short | Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms |
| title_sort | pontomedullary lacerations and concomitant injuries a review of possible underlying mechanisms |
| topic | pontomedullary laceration brainstem injury skull base fracture spinal fractures mandibular fractures |
| url | http://www.doiserbia.nb.rs/img/doi/0370-8179/2013/0370-81791308542Z.pdf |
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