A retrospective analysis of 268 trauma patients with facial fractures who received computed tomography of the head was undertaken to assess an association with skull base fractures. The incidence of skull base fracture was compared to facial fractures of various anatomic locations. Skull base fractures were significantly increased in orbital wall/rim fractures (36.0%, P = .0823). In contrast, skull base fractures related to orbital floor (27.3%, P = .6191) and maxillary/zygomatic (29.4%, P = .1148) fractures were not significantly greater and were infrequently seen with mandible (4.0%, P = .0454) and nasal (7.7%, P = .0345) fractures. The incidence of skull base fracture was directly associated with the number of facial fractures per patient; one facial fracture (21.0%), two facial fractures (30.4%), and three or more facial fractures (33.3%) (P < .05). The incidence of skull base fractures was related to the location of facial fractures and the number of facial fractures per patient. The results provide additional clinical information to facilitate the prompt detection and diagnoses of skull base fracture.

C a r o t i d artery injury secondary to blunt neck trauma is much less common than carotid damage from penetrating neck injury.' Before 1978, 96 cases were reported.',' Since 1978, an additional 86 cases have been reported in the English-language literature. '.3-14 The clinical manifestations of carotid injury from blunt neck trauma can be subtle. In such situations, the clinician must have a high level of suspicion for a correct diagnosis to be made. This is especially true when a patient seeks treatment after an interval without symptoms. We report a unique mechanism of extracranial carotid injury from a blunt blow to the neck. This injury resulted in a fracture of the greater cornu of the thyroid cartilage and a subsequent transmural tear of the common carotid artery. CASE REPORTA 41-year-old man was admitted for progressive dysphagia. The patient reported that he had sustained a punch to the left jaw and neck approximately 1 week before admission.He denied dyspnea, hoarseness, hemoptysis, or hematemesis. He smoked 30 packs of cigarettes per year.Physical examination revealed an alert, well-nourished, middled-aged man in no distress. He had no fever and had a stable blood pressure of 130/70 mm Hg. There was no stridor or tachycardia. Ecchymosis and edema of the posterior pharyngeal wall were greater on the left side. Fiberoptic nasopharyngoscopy revealed bilaterally mobile vocal cords and a clear airway. There was bilateral neck fullness but no subcutaneous emphysema or discrete masses. There was no tenderness over the thyroid cartilage and no laryngeal crepitus. The carotid, facial, and superficial temporal artery pulses were full and symmetric. There were no bruits or thrills. Results of neurologic examination were normal.Soft-tissue radiographs of the neck showed a retropharyn-

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