Traumatic Acute Brain Herniation through the Ear in a Child: Concealed compound fracture

Abstract

A seven-year-old girl presented to Sultan Qaboos University Hospital, Oman, with a history of having been hit by a motor vehicle. After this, she had right-sided cerebrospinal fluid otorrhoea, and a week later, brain matter extruded through the right ear. A computed tomography scan of the brain demonstrated a tegmen fracture communicating with the external auditory canal. There was no hearing or facial nerve impairment and an otoscopic examination showed an intact tympanic membrane. She underwent a transcranial repair of the middle cranial fossa base, which revealed a wide dural and bony defect of the tegmen with herniation of the temporal lobe. Repair was made with an intradural patch of artificial dura. The rarity of this type of presentation of temporal bone fracture and its management are discussed.

Keywords: Case Report; Encephalocele; Oman; Pediatric; Skull fracture, Basilar.

Figure 1:

(A) Axial computed tomography scan showing an oblique fracture of the right petrous temporal bone sparing the otic capsule (arrow). (B) Coronal reconstruction of computed tomography scan showing the fracture involving the squamous and petrous temporal bone with wide separation of the fragments and involvement of the external auditory canal (arrow). (C) 3D-reconstruction computed tomography scan showing the fracture line isolating the squamous and mastoid parts of the temporal bone as a single unit.

Figure 2:

(A) Post operative axial computed tomography (CT) scan after 4 months showing an almost completely healed fracture line (arrow). (B) Post operative coronal reconstruction CT scan after 4 months showing the tegmen defect with no brain herniation into the external auditory canal (arrow).