Battle's Sign

Battle's sign is bruising over the mastoid sinus (just behind the auricle) and is a delayed physical finding associated with basilar skull fractures. Hemotympanum (blood behind the ear drum) and "raccoon eyes" (periorbital bruising) are other delayed findings consistent with basilar skull fractures." San Francisco General Hospital Emergency Services.

The "Battle" sign or other evidence slowing basal skull fracture (e.g. CSF rhinorrhea) usually contraindicates nasal intubation. However, the nasal route can be used despite concerns about entering the cranial vault via a skull base fracture; but, discretion must be used and special sensitivity to unusual resistance encountered in endotracheal tube passage exhibited. The nasal route should definitely be avoided in the presence of obvious facial crush injury. At all events, a nasally-placed endotracheal tube will ultimately require replacement due to patency difficulty for because of maxillary sinusitis risk.