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Avatar universal

Can maxillary fracture cause csf leak?

I would like to know if an injury caused by brutal force continuously applied for several minutes that caused a crack from the gum line up into the area behind the left nostril would be sufficient to cause a csf leak? A dental student was doing impressions and became irritated with a number of things about my procedure, including my first set of impressions not coming out correctly. He proceeded to wedge both of his hands inside my mouth and forcibly lock my head between his abdomen and his hands while applying so much pressure that my maxilla cracked. I was left with black and purple gums, the roof of my mouth was bruised all the way back and I could not eat anything for over a week and could not eat solids for over a month. This is not a legal matter, the time has already passed on that. This is a matter of my health and well being.

I have a majority of the symptoms of a csf leak. In fact I learned of csf leaks because I was dx with basilar migraines and advised to "look them up on the internet". In the information it says "if you have these symptoms along with clear fluid coming from nose, ears or eyes see also; csf leak. I've had 3 MRI's the first to rule out Chiari Malformation, as my neuro was certain that I had this due to my symptoms. If requested I can put the entire report, but most everything they listed said "normal" next to it . The things that concern me are, the first MRI (w/o contrast) came back with findings that included "Visualized paranasal sinuses show mild mucosal thickening of maxillary sinuses and ethmoid air cells." Impression: Normal MRI brain and no Chiari Malformation  My Cine MRI CSF flow study (w/o contrast) says the images are suboptimal and the impression: No significant abnormality. My latest MRI, skull base with intravenous contrast, I've not seen the report but the doctor sent me an email response: "As for the MRI, there was mild arthritis, but not enough to cause any blockage and the base of the skull-meninges looked fine. It makes me wonder about your sinuses anyway. Did you have sinus surgery?"

I have shared the above information about the maxillary fracture though the only xrays I have are the little dental type that are taken of the teeth, but the fracture can be seen. I am trying to get a copy of those.

I have intermittent leaking of fluid (looks like water, tastes salty) that ranges from a few uniform drops here and there to streaming non-stop at times, depending on the pressure build up in my head. I have debilitating headaches (especially after exerting myself, ie: cleaning house) that can only be relieved (not stopped, but made more bearable) by laying completely flat on my back with my neck propped on a rolled towel or pillow so that my head tilts back. I've been to the ER a number of times for these HA, they used to give me toradol shots but they haven't been working, the last time they gave me dilaudid. My vision has gotten progressively worse. Vision was perfect prior to injury and onset of symptoms, then I started having stars and floaters a year ago. The floaters used to be almost transparent and could only be seen at times. Now they are gray and are constantly in my field of vision, also I was told recently that I now need bifocals. I have also been diagnosed with Sicca syndrome due to my constant extreme dryness in all of my mucous membranes (neg SS-A and SS-B) Prior to learning about CSF I used to say it was like all of the fluid in my body comes out of my nose. I wake up every day feeling as if my brain is dehydrated...I know that is probably a weird description, but that is what it feels like.

I would also like to know for a B2Tr test is it only worth while to collect when the fluid is pure water? Typically I get a few drops at a time when I'm doing something that requires tilting my head down. When it starts streaming out (due to pressure build up) it aggravates my sinuses or something and a massive amount of crystal clear thin mucous starts pouring out with it. (ie: I was sitting on the couch watching a movie, propped my head up on my hand and the liquid started, before I could make it to the bathroom to grab a tissue I had to put my hand out in front of me to catch the copious stream of clear fluid) The mucous is never sticky. It is almost like a slightly thicker version of water. I soaked through one of the thick 4x4 gauze pads from the ER and when it dried it was as if it had never even been used.  I have the test tubes to collect in but I don't want to risk a false negative by sending any that have mucous. Can the mucous interfere with proper testing? I am really suffering, I have an HMO that I'm locked into until Nov. and feel as if nobody is taking this very seriously because the MRI findings are "normal". I've not had any MRIs or CTs that include a tracing agent being injected into the CSF. I would like to know, based on the information given here would this be a reasonable test for me to have done? (I worry because I know that it can potentially open you up to more leaks)

I thank you in advance for any help you can provide.
5 Responses
Avatar universal
I should also mention that while the leaking from my nose is intermittent their is almost always leaking into my throat. It is salty with a tinge of bitterness, tastes kind of like the flavor of baking soda mixed in water.
620923 tn?1452915648
HI...may I ask u how u feel in general?..With a CSF leak u would most deff be in the dark, lying down and not able to do much. I had one and believe me...u would know if u had one.

U can get a CSF leak from dental work and even surgery on ur sinues....and there are articles on spontanious CSF leaks....

Have u been to an ENT dr?....this may be a place to start since u have the drainage in ur nose and throat area.Maybe it is post nasal drip?

Keep us posted
Avatar universal
Thank you for your reply *smile* When I have symptom flare-ups, guaranteed onset with any strenuous activity, I have a very stiff neck, debilitating HA and head pressure that require me to be in a dark room, no noise, no light, laying flat with neck propped up on a bolster, head tilted back and icepacks all around my head/neck. Often times vomiting. I do understand your experience with a csf leak and this is very similar to what my first neuro told me. However I have since talked to a number of people that have ongoing small, slow and/or intermittent leaks (sometimes for a decade or more before they are properly diagnosed/treated) that have experiences similar to, if not exactly like mine.
I did see an ENT and he said "I do sinus surgery and from what I can see you don't need sinus surgery". He referred me back to neuro.
Avatar universal
its been april 1 2009  this post been out there,
i have lots to share with girlygirl333

i got my csf leak june11th 2010  and just seeing this post.
i wish i seen this then.  
beta2transferrin is lab results and yes its a son of a ?)({}?  .    head pressure like a vicegrip and feels like water balloon. aka  empty nose syndrom especiaallly when turbonates taken out.
i had sinus surgery and regret every day of it.  i also  had #11 tooth pulled and i experienced  passing out when lying down.   ended up with right after surgery trigeminal neuralgia, occipital neuralgia, peripheal neurapothy

mine is no lawsuite or am i trying to but when hypocraatic oath is broken of do no harm.
that's when i lose trust in mri's and ct scans xrays but lets avoid the contrast in spine to see where im leaking yet call me back to reschedule procedure and here im stripped of anxiety meds till i comply into pshyco therapy and pshyciatrist.

later i find out i got 3 calls from dr's oh i got csf leak alright!   no on want's to work on me.  
im a risk.        but to be  told by phone message left on machine i re recorded n sent to them and risk managment to be told protocol was followed.
its not bout money its bout healing holes i found in physicians report  and for aarea i didnt sign up for and thats sphenoidectomy aand to my astonishment amazingly i see 2 afrin soaked pledgets in sphenoid to stop leak.  yet im told i dont have one.

why all the ruckus and all in my head theory.  welll ilearned in news paper my e$t  surgeon engaged  now married to v.p. of the usa daughter.
it be big bad news to  get out in the open.

so new plan is to givee 5 star ratings  across board for him by his staff.
he is a good guy in person.  but i was and am still injured and need help. no money, argument and  even going as far as messing with my cable nd internet deleting my files.  files i transfer on fb or anywhere. it vanishes soon i post images and that video  phone message.
cat's out of the bag. my life is ruined so why not go the distance.

i cant run or hide.  i cant travel to get help in another state.   soon i show up in e.r.  triage notify security and b4 you know it im watched and guarded.
my files are red.  flagged.  pain meds abuse alert.  when i was on pain meds well controlled 2008 pilonidal cyst 2x.  up to 2011 then it spun out of control. yet im still hanging in there.

i try seeing this surgeon to shake his hand and just throw this ovr our shoulders and figure out a mathmatical solution.
but soon as mom and i got off the elevator  here we go again.!  security and manager   and im not wanted or to be seen so i'm back on the elevator fast i came off it.
that's part of my story. i will always suffer and hurt as if i am fixed the 1st question to be asked is...why now and if it is fixed then this means it exist.    logical ?  and maxillary jawbone i needed to be fixed.  hole in jaw. oroanular fistula communication as it requires a e.n.t. and maxillofaciaal surgeon but  maxillo doc never showed. !  my surgery changed and i was lied to. now i suffer.    it dont exist.  

so who do i go to?  anyone trust anyone?    
thank you.
Avatar universal
I know it's been a couple of years since the initial post, but if you're still struggling, I wanted to give you my experience. In November of '99, I fell and hit my head running out of school. Very mild concussion, no big deal. The next day, however, I woke up with a very severe headache that would last the next 12 years. I spent those years going from doctor to doctor searching for an answer to my pain. It was the kind of pain you've described; a kind of dehydration of my brain, like my brain was rubbing against the skull causing intolerable amounts of pain. It was made semi-tolerable by laying down or sleeping, but nothing would make it go completely away. Fast forward to January of 2003... I got in a car accident. Again, only mild concussion, but my pain escalated to a place I never imagined it could go. During this time, I was diagnosed with all sorts of things, had MRI's, CT scans, etc., yet nothing was ever definitive enough to tell any "specialist" what was happening to me. Another six years pass, and finally my angel of a fiancé finally finds the doctor I need to see (an Otolaryngologist who specialized in CSF leaks). Sent me in for a specialized CT scan, but it took another year before I went back, because the tech who read the scan didn't see anything worth reporting. When I took the disc in to the doc so he could see if for himself, he spent 30 seconds looking at it and told me there was definitely something there that needed further scrutiny. Went in for exploratory sinus surgery, and it turned out I had TWO leaks in my ethmoid sinuses caused by a bone spur that cracked when I hit my head both times. I was losing a liter of fluid a day. I had my repair done in June of 2010 and I still suffer from daily pain. It's nowhere near the level it used to be, and I feel hopeful that one day I will be able to live a life without pain meds, but I still use them everyday. It is such a difficult place to be in. I want anyone to reads this to know that you're not alone in your struggle.
If you feel as though you may have a CSF leak and you feel fluid dripping from your nose or ears, take a glucose testing strip and swab the fluid. If it turns brown in color, the chances are pretty good you may have a leak. CSF fluid has a lot more glucose than mucous does. This is a very quick and dirty way to test yourself, but it's a way to give proof to doctors who may doubt you. You may even be able to recreate the experiment in front of them so they can see it for themselves. This was the way we were first able to get the doctors' attention in my case.
Whatever the case, PLEASE don't give up hope. I went through 12 years of pure hell before I was able to even get any answers. Even though I still have pain on a daily basis, it's so much better than it was and I have a quality of life that I had previously grieved and given up hope of ever having.
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