Ossicular chain disruption (temporal bone fracture)

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient presents with acute conductive hearing loss on the left following head trauma.

Patient Data

Age: 25
Gender: Female
CT

CT temporal bones

On the left, there is a fracture in orientation parallell to the long axis of the temporal bone. There is malalignment of the incudomalleolar joint, and also malalignment of the incudostapedial joint.

The right side is normal.

Photo

Normal and abnormal incudomalleolar joint alignments

These spot images from this case illustrate the normal ice cream and cone relationship of incus and malleolus on the right, and the abnormal alignment on the left. 

The image of the ice cream cone is from Wikimedia Commons and in the public domain. The flavour is strawberry.

Case Discussion

Longitudinal temporal bone fractures are more common than the transverse type. Conductive hearing loss in can be due to middle ear haemorrhage, or as in this case due to ossicular chain disruption. In any case of temporal bone fracture, ossicular joint alignments should be assessed. The ice cream cone sign is helpful in determining whether the incudomalleolar articulation is normal.

See also:

PlayAdd to Share

Case information

rID: 23290
Case created: 2nd Jun 2013
Last edited: 16th Apr 2017
Tag: trauma
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.