Emergency #7 – Long case

21-year-old male
* High-energy trauma (HET)
* Car vs. car

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What do you see?

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Findings:

* Complex transverse and longitudinal type petrous temporal bone fracture.
* Involvement of inner ear (cochlea, posterior semicircular canal) round window and facial canal.
* Fracture through middle ear ossicular chain (malleolus and incus).
* Soft tissue in middle ear and filled mastoid air cells.
* Some free air bubbles intracranial (pneumocephalus).
* Fracture continuation (not shown here) in temporal, occipital and parietal bone, occipital condyles.

Late complications:
* Sensory and conductive hearing loss
* Facial nerve involvement

Teaching point: Beware of fracture through carotid canal (not shown here), indication to perform additional CTA to look for carotid dissection
Teaching point: Beware of rupture of tegmen tympani, for late complication CSF leakage otorrhoea, with probable CSF hypotension.