Presentation
Motor vehicle accident (MVA) with head and spine trauma. Referred for odontoid process fracture fixation.
Patient Data
Mildly displaced fracture of the base of odontoid process (type II odontoid fracture). Loss of physiologic cervical lordosis denoting muscle spasm; however, alignment of cervical spine is intact. Small radiopaque focus in the left submandibular soft tissues (bone fragment or foreign body). Left middle ear ossicular chain disruption (incudomalleolar disruption). Partially opacified left mastoid air cells along with a subtle transverse left temporal bone fracture (mastoid part).
Re-demonstration of left middle ear ossicular chain disruption (incudomalleolar disruption) with reformatted magnified coronal oblique and MIP images showing the broken heart sign, also known as "Y sign, of incudo-malleolar disruption. Normal right middle ear ossicular chain.
Re-demonstration of partially opacified left mastoid air cells. Left temporal bone fracture not clearly seen on the current study. Odontoid process fracture had been fixed.
No cervical spine fracture or dislocation is seen. Morphology of the bilateral middle ear structures is unremarkable as well.
Case Discussion
The patient had history of polytrauma and was initially admitted in another health facility where the baseline imaging was done which showed hemorrhagic brain contusions, diffuse axonal injury, base of skull fracture and a few spinal fractures, particularly the odontoid process (imaging record not available). Later on, he was transferred to our hospital for fixation of the odontoid process fracture. Preoperative CT cervical spine was done which showed type II fracture of the odontoid process (which was fixed); however, the left middle ear ossicular chain disruption was overlooked on this scan. Three months later, the patient was seen by an ENT surgeon for his complaint of left-sided decreased hearing and an audiometry was done which showed mild left-sided mixed sensorineural hearing loss (SNHL) for high frequencies. Temporal bone CT scan was requested after the audiometry on which the left-sided incudomalleolar disruption was picked up. This case is a nice example to remind us that special attention should be paid to the ear structures in the setting of trauma, particularly, when it is associated with a temporal bone fracture.
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