We report an indirect temporal bone fracture with ossicular chain injury occurring only on the side opposite a facial bone fracture caused by a direct blow. A 45-year-old female was referred to our clinic complaining of right hearing loss. She had suffered a left facial bone fracture in a traffic accident 6 months earlier. Her right hearing impairment was conductive. Exploration of her right middle ear revealed a temporal bone fracture, with ossicular chain separation and a dislocated stapes with a perilymphatic fistula. These injuries were considered to be caused by an indirect force following a blow to the face on the opposite side. Well-developed mastoid cells are composed of sparse, light bone in contrast to the compact bone of the bony canal, ossicles, and otic capsule, and therefore their mechanical compliance may differ.
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