Figure 1 demonstrates an extensive skull base fracture with a posterior fracture line that begins at the junction of the parietal and occipital bones (Figure 1, D) and extends horizontally through the mastoid air cells. Fluid can be seen in the left mastoid air cells in all images. Anteriorly, a vertical fracture can be seen at the vestibular aqueduct extending through the vestibule and basal turn of the cochlea, adjacent to the round window (Figure 1, A). Air bubbles may be seen in the middle turn of the cochlea and vestibule, consistent with fracture of the otic capsule (Figure 1, B). Air is also evident in the superior semicircular canal (Figure 1, C). The ossicular chain is intact.