Closed-head injuries followed by detached brain tissue in the external auditory canals


We describe five cases of fatally injured males (occupational accident, car driver, pedestrian, motorcyclist and suicidal jump from great height) with one universal autopsy finding – the presence of brain tissue in one or both auditory canals. Internal examination revealed that all victims had multiple head fractures with dura lacerations. In four cases, the petrous part of the temporal bone was fractured (hinge fracture), while in one case the fracture of both the petrous part of the temporal bones and the occipital bone (ring fracture) was present. In all of these cases, considerable pressure was applied to the head, pushing brain tissue equally in all directions (due to incompressibility of the tissue). The tissue followed the path of least resistance, going through the lacerated dura into the fractured petrous part of the temporal bones and finally reaching the middle ear cavity and auditory canal. This phenomenon is almost exclusively encountered in closed-head injuries. In an open-head injury, brain tissue would be expelled through the open bone fracture and scalp wound. The presence of brain tissue in the ears could indicate a hinge or ring fracture in a closed-head injury which occurred as the result of excessive impulse force or considerable pressure applied to the head, i.e. the head was compressed and/or squeezed.

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  1. 1.

    Spitz WU, Spitz DJ, editors. Spitz and Fisher’s medicolegal investigation of death: guidelines for the application of pathology to crime investigation. 4th ed. Springfield: Charles C Thomas; 2006.

    Google Scholar 

  2. 2.

    Shkrum M, Ramsay D. Forensic pathology of trauma – common problems for the pathologist. Totowa: Humana Press; 2007.

    Google Scholar 

  3. 3.

    Saukko P, Knight B. Knight’s forensic pathology. 4th ed. Boca Raton: CRC Press; 2016.

    Google Scholar 

  4. 4.

    Byard RW, Langlois N, Gilbert JD. Positive "water test" – an external indicator of base of skull hinge-ring fracture. J Forensic Sci. 2010;55:519–20.

    Article  Google Scholar 

  5. 5.

    Dettmeyer RB. Forensic histopathology – fundamentals and perspectives. Berlin: Springer; 2011.

    Google Scholar 

  6. 6.

    Dettmeyer R, Verhoff M, Schuetz H. Forensic pathology – fundamentals and perspectives. Heidelberg: Springer; 2014.

    Google Scholar 

  7. 7.

    Živković V, Cvetković D, Obradović D, Nikolić S. Mechanism of brain swelling in cases of brain evisceration due to catastrophic craniocerebral injury – an autopsy study. Forensic Sci Med Pathol. 2020;16:107–12.

    Article  Google Scholar 

  8. 8.

    Voigt E, Skold G. Ring fractures of the base of the skull. J Trauma. 1974;14:494–505.

    CAS  Article  Google Scholar 

  9. 9.

    Živković V, Nikolić S, Babić D, Djonić D, Atanasijević T, Djurić M. Pontomedullary lacerations in falls from a height – a retrospective autopsy study. J Forensic Sci. 2012;57:654–7.

    Article  Google Scholar 

Download references


This work was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia, Grant No. 45005.

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Correspondence to Slobodan Nikolić.

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Cvetković, D., Živković, V. & Nikolić, S. Closed-head injuries followed by detached brain tissue in the external auditory canals. Forensic Sci Med Pathol (2020).

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  • Brain tissue
  • Ear
  • Hinge fracture
  • Ring fracture
  • Head compression