Isolated lower cranial nerve (CN) palsy affecting the CN X resulting from a skull base fracture is very rare. The clinical manifestation and natural history is related closely to the complex anatomy of this region and mechanism of injury. Here, we report a case of a 54 year-old man who presented with a delayed onset of dysphonia and dysphagia with aspiration following a closed head injury sustained from a motor vehicle accident. Injection laryngoplasty was implemented to alleviate symptoms of his CN X palsy, which eventually almost completely resolved. High index of suspicion should be maintained when investigating possible skull base fractures, especially with a suggestive clinical presentation of lower CN palsies affecting one or all the lower CNs. Delayed onset of these CN palsies are likely to have more favourable outcomes.
CSF leak in penetrating skull base injury is relatively rare compared to close head injury involving skull base fracture. We report a 5-year-old boy presented with epistaxis and impacted pencil into the left nostril. The child was hemodynamically stable without any neurological deficit. Intraoperatively, there was a nasal septal defect posteriorly with anterior skull base fracture associated with CSF leak. The pencil was removed from the left nostril and the CSF leak was repaired using harvested abdominal fat under the same setting. Computed Tomography (CT) of the brain showed right cribriform plate fracture with small pneumocranium. Postoperatively, a prophylactic antibiotic was given for seven days and he was discharged well. Subsequent clinic visits up to one-year postoperative period showed no recurrence of the CSF leak. History taking, physical examination and CT imaging give valuable diagnostic values in managing the penetrating skull base injury. Early intervention for removal of the foreign body and repair of the CSF leak is advocated to prevent catastrophic complication.