Bilateral occipital condyle fractures leading to retropharyngeal haematoma and acute respiratory distress

Injuries to the occipito-cervical junction are rare and not easily diagnosed on conventional radiographs. The authors report such a case where the diagnosis was delayed. The patient developed a significant retrophyarngeal haematoma resulting in acute respiratory distress and required emergency endotracheal intubation. The patient remained intubated for five days and received a tapered dose of intravenous dexamethazone to reduce swelling in the proximity of the airway. At six weeks the patient had developed a left hypoglossal nerve palsy that persisted at 12 months. Occipital condyle fractures and the difficulties of diagnosis are discussed. The importance of measuring pre-vertebral soft tissue swelling on lateral radiographs is emphasized. Computed tomography of the C0-C2 region should be performed to identify base of skull and upper cervical fractures.