Presentation
Pedestrian hit by a tram.
Patient Data
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There is a longitudinal fracture through the left temporal bone extending into the middle ear and associated with incudomalleolar disruption and partial obliteration of the middle ear and mastoid air cells. This fracture extends also through the squamous and lambdoid sutures posteriorly and into the glenoid fossa of the left TMJ, without displacement. No signs of involvement of the carotid canal. No other skull fractures were seen. Left parieto-occipital subgaleal hematoma. A small amount of pneumocephalus noted along the middle and posterior fossa on the left. There are small foci of subarachnoid hemorrhage along the left silvan fissure. Ventricular system and cisternal spaces appear normal. Orbits have normal appearances. The paranasal sinuses are mostly clear and aerated.
CT Temporal Bones (reconstruction)
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Longitudinal comminuted fracture line through the left mastoid bone, associated with ossicular chain disruption with incudomalleolar disruption. Minor pneumocephalus is present. The membranous labyrinth is preserved.
Case Discussion
Note how the temporal bone reconstruction appears blurry when compared to CT acquisitions with a dedicated high-resolution temporal bone algorithm.
Longitudinal temporal bone fractures normally occur parallel to the long axis of the petrous bone, as shown in this case. A more current classification of the extent of temporal bone fractures describes the integrity of the otic capsule rather than the fracture orientation, as the involvement of the otic capsule is a predictor of more serious complications. Our case has no signs of fracture extension into the otic capsule.
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