A Case of Ottorhea Induced by a Fall From a Skateboard

Abstract

HISTORY: 19 year old male with negative past medical history presented to the Student Health Center with right jaw pain after a fall from his skateboard. He lost control on a downhill sidewalk and fell directly onto his chin. He was not wearing a helmet. He also complained of blood coming from his right ear and decreased ability to hear on right. He denied loss of consciousness, headache, focal neurologic deficits, vision changes, nausea, vomiting, abdominal pain, chest pain, shortness of breath, neck pain, back pain, or hip pain. PHYSICAL EXAMINATION: The patient was hemodynamicaly stable and in no acute distress. Pupils were equal, round and reactive. He had a 2.5cm superficial laceration to chin. There was tenderness over the right TMJ and decreased ability to open mouth. He had bleeding from the right ear canal. Otoscopic exam revealed what appeared to be a small bump with associated laceration, oozing blood. There was no hemotympany. No clear leakage from ears or nares. No battle’s sign or raccoon eyes. There were no other remarkable findings, but given the extent of his injuries, the patient was sent to the Emergency Department (ED) for further evaluation. DIFFERENTIAL DIAGNOSIS:1.Basilar skull fracture. 2. Mandibular fracture. 3. Cervical spine fracture. 4. Foreign body introduced into ear canal from fall. TEST AND RESULTS: Cat Scan Head, Cervical Spine and Maxillo-facial bones FINAL WORKING DIAGNOSIS: Comminuted fracture of the right mandibular neck with anterior angulation of the mandibular condyle and dislocation of the TMJ. Additionally, there is fracture of the anterior bony wall of the External Auditory Canal. No other acute abnormality noted. These findings combined with a chin laceration suggest impact on the chin, with traumatic impaction of the mandibular condyle onto the mandibular fossa of the right temporal bone. TREATMENT AND OUTCOMES: The chin laceration was repaired in the ED. Neurosurgery was consulted as there was concern for basilar skull fracture. Per their recommendation, there was no need for any neurosurgical intervention. Plastic surgery and ENT were also consulted. He received a prescription for ciprofloxaxin otic drops and then followed up with ENT and Plastic Surgery as an outpatient. He had wire fixation with arch bars to treat the mandibular fracture and has not had any complications to date.