the internal jugular vein ( ijv ) is a major vessel that collects blood from the head and neck areas and is connected with ipsilateral cavernous sinuses through the inferior petrosal sinus ( ips ) .
the superior petrosal sinus ( sps ) is a dural sinus that communicates with the cavernous sinus anteriorly and with the transverse sinus posteriorly .
a 62-year - old male bus driver with a history of hearing loss in the right ear presented to the ear , nose , and throat ( ent ) clinic for a follow - up exam .
the hearing loss resulted from a fracture of the temporal bone following a fall from a horse in his infancy .
the otolaryngological exam was normal , but a cone beam computed tomography ( cbct ) showed an intrapetrous communication between the ijv and the sps , revealing an ascendant tortuous path passing through the middle of the ipsilateral superior semicircular canal .
three - dimensional bone and soft tissues volume renderings were generated to demonstrate this anatomical variant [ figures 1 and 2 ] .
magnetic resonance imaging ( mri ) was not performed because the sensorineural hearing loss is not an acute complication of his fracture .
presently , the patient does not have any other complication and continues with his normal life and will be monitored with follow - up examinations .
62-year - old male patient with clinical history of unilateral sensorineural hearing loss and fracture of the right temporal bone in his infancy .
cbct of temporal bone : ( a ) sagittal , ( b ) axial , ( c ) coronal , and ( d ) three - dimensional images with osseous volume rendering show the intrapetrous communication between the ijv and the sps ( red arrows ) with an ascendant tortuous path , passing through the middle of the superior semicircular canal .
62-year - old male patient with clinical history of unilateral sensorineural hearing loss and fracture of the right temporal bone in his infancy .
3d soft tissues volume rendering : ( a ) shows intrapetrous communicationpath ( red arrows ) ; ( b ) inferior view shows ijv bulb , ( white star ) ; ( c ) superior semicircular canal ( yellow arrow ) ; ( d ) 3d osseous volume rendering shows sps canal ( black arrow ) .
development of the intracerebral veins and their extracranial drainage is a complex process in humans .
the superficial vessels drain into the external jugular vein and the middle and deep vessels into the ijv .
the ijv is a major vein that collects blood from the head and neck region and is also a clinically important vein .
the ijv is formed by the union of the lateral sinus and the inferior petrous vein .
the size of the ijv is directly affected by the drainage pattern of the dural sinuses , particularly the superior sagittal sinus ( sss ) and rectal sinus ( rs ) .
the ijv is connected to ipsilateral cavernous sinuses through the ips , a dural venous sinus running along the intracranial surface of the petroclivial fissure . actually , in the literature
, there are no reports about anastomosis between ijv and sps in humans and animals .
the sps is also known as a dural sinus which communicates with the cavernous sinus anteriorly and with the transverse sinus posteriorly .
it runs over the trigeminal nerve in the lateral margin of the tentorium and in the superior petrosal sulcus of the temporal bone .
the sps normally works as a drainage route receiving blood from the anterior cerebellar and brain stem , venous systems , and does not work as a normal drainage route from the cavernous sinus .
in addition , the sps receives different drainages from the complex superior petrosal vein : type i above and lateral to the facial nerve , type ii between the lateral limit of the trigeminal nerve and the medial limit of the facial nerve , and type iii empties above and medial to the trigeminal nerve .
evaluation of the temporal bone region requires higher - resolution imaging as demonstrated in this particular case .
high - resolution imaging should be used in the periodic assessment of patients with history of temporal bone fractures .
this is due to the risk of meningitis resulting from a middle ear infection disseminating through membranous consolidation of the fracture .
several studies have been published on the use of cbct technology for imaging of the temporal bone , specifically the middle and inner ear structures .
cbct offers lower radiation dose , thinner slices , and provides reliable morphologic assessment of the temporal bone resulting from an increase in spatial resolution , when compared to multidetector computed tomography ( mdct ) . the computed tomographic dose index ( ctdi ) of an mdct scan of the middle ear is around 170 mgy , compared to 1530 mgy from cbct imaging .
this is a clear anatomical variant discovered as an incidental finding in a routine follow - up cbct examination .
cbct imaging plays a highly important role for the surgeon when planning surgical intervention in the temporal bone which may be required either because of complications due to underlying disease or for other reasons .
 this is a case report of a 62-year - old male who presented to the ear , nose , and throat clinic for a follow - up exam for hearing loss stemming from a fall from a horse in his infancy . a cone beam computed tomography ( cbct ) examination revealed an intrapetrous communication between the internal jugular vein bulb and the superior petrosal sinus . 
 three - dimensional bone and soft tissues volume renderings were generated to demonstrate this incidental anatomical variant . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
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