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Signs in Normal CT Temporal Bone | Ice Cream Cone Sign & Snake Eyes Sign

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Signs in Normal CT Temporal Bone

Two classical radiological signs are seen in a normal CT scan of the temporal bone. In this post, we will discuss:

  • Ice Cream Cone Sign
  • Snake Eyes Sign

Ice Cream Cone Sign

๐Ÿ“Œ Type of Sign

๐Ÿ‘‰ Radiological Sign seen on Axial section of CT Temporal Bone.

๐Ÿ” What is the Sign?

Ice Cream Cone Sign refers to the normal configuration of the malleus head and the incus body seen on CT temporal bone.

It represents Normal middle ear anatomy.

PartFormed By
ScoopMalleus head
ConeBody of incus

The space lateral to the malleus and incus is Prussak's space, also known as the Lateral epitympanic space.

What are the boundaries of Prussak's space?

๐Ÿฆ Why is it Called Ice Cream Cone Sign?

The malleus head and body of incus together resemble an ice cream cone, hence the name Ice Cream Cone Sign.

โš ๏ธ Clinical Significance

Loss of the Ice Cream Cone Sign suggests:

โœ… Incudomalleolar disarticulation

What are the causes of incudomalleolar disarticulation?

What is the other ice cream sign seen in a pathological condition of the ear? And what is the reason behind it?


Snake Eyes Sign

๐Ÿ“Œ Type of Sign

๐Ÿ‘‰ Radiological Sign seen on Coronal section of CT Temporal Bone.

๐Ÿ“Œ Also Known As

๐Ÿ‘‰ Snail Eyes Sign

๐Ÿ” What is the Sign?

Snake Eyes Sign refers to two facial nerve segments appearing like the two eyes of a snake, superior to the cochlea.

The two "eyes" are formed by:

1- Proximal tympanic segment of facial nerve

2- Distal labyrinthine segment of facial nerve

What are the different segments of the facial nerve?

๐Ÿง  Clinical Significance

Helps in Identifying the course of the facial nerve.

๐Ÿ Why is it Called Snake Eyes Sign?

The two facial nerve segments superior to the cochlea resemble the two eyes of a snake, hence the name Snake Eyes Sign.


โญ High Yield Rapid Revision Table

SignTypeSection on CT Temporal BoneFormed BySignificance
Ice Cream Cone SignRadiologicalAxialMalleus head (scoop) and body of incus (cone)Loss suggests incudomalleolar disarticulation
Snake Eyes SignRadiologicalCoronalProximal tympanic and distal labyrinthine segments of facial nerveIdentification of facial nerve course

๐Ÿง  Viva Pearls

  • Ice Cream Cone Sign and Snake Eyes Sign are seen in a normal CT temporal bone.
  • Ice Cream Cone Sign is seen in the axial section of CT temporal bone.
  • In the Ice Cream Cone Sign, the malleus head forms the scoop and the body of incus forms the cone.
  • Prussak's space is also known as the lateral epitympanic space.
  • Loss of the Ice Cream Cone Sign suggests incudomalleolar disarticulation.
  • Snake Eyes Sign is seen in the coronal section of CT temporal bone.
  • Snake Eyes Sign is also known as Snail Eyes Sign.
  • Snake Eyes Sign is formed by the proximal tympanic and distal labyrinthine segments of the facial nerve, superior to the cochlea.
  • Snake Eyes Sign helps in identifying the course of the facial nerve.
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