The skull, composed of 8 cranial bones, the 14 bones of the face, and the teeth, makes up the bony framework of the head. The tables of the skull, which are separated by cancellous bony tissue, include inner and outer condensed layers of the cranial bones. Loss of skull components results in loss of the structural protection of the brain that is involved.

Possible causes of skull losses might be related to the following factors: trauma, gunshot wounds, falls, or blows to the head.

May include: extensive bleeding, and brain swelling which could lead to possible fatal brain herniation. Skull loss and fracture may lead to cerebrospinal fluid (CSF) leaks and CSF rhinorrhea; pneumocephalus; optic nerve damage; neuroendocrine dysfunction; facial palsy; amnesia; hemotympanum; periorbital ecchymosis; anosmia; loss of taste; unequal pupils; or skull deformity.

Diagnostic measures include: skull x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI); cerebral angiograms; and lumbar puncture.

Depending on the severity of the loss, treatment may range from observation to surgical intervention. Surgery may be used to treat cerebrospinal fluid leaks; hemorrhage; remove foreign bodies (e.g., bullets); correct bone loss; or reduce compression on the brainstem.

Subdural hematoma or epidural hematoma may appear early or several weeks later. Emergency treatment is required to relieve the pressure. Post-traumatic epilepsy may occur as late as several years after the trauma.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Rate separately for intracranial complications.