The incudomallear joint is the small synovial joint between the head of the malleus and the body of the incus in the middle ear. It is saddle-shaped and tightly bound, so the two ossicles usually vibrate together, passing sound energy from the tympanic membrane towards the stapes and inner ear.
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The incudomallear joint can be disrupted by head injury, especially temporal bone fractures, causing conductive hearing loss. It may become fixed by tympanosclerosis or chronic otitis media, and cholesteatoma can erode the ossicles around it. CT of the temporal bone shows the malleus head and incus body as the classic ice cream cone appearance, and loss of this shape suggests dislocation. Surgical repair (ossiculoplasty) restores the sound conduction chain.
Traumatic separation of the incus from the malleus, usually from temporal bone fracture or blast injury, producing conductive hearing loss treated with ossiculoplasty if it does not recover.
Stiffening of the joint by tympanosclerosis or fibrosis after chronic middle ear inflammation, reducing ossicular movement and causing conductive hearing loss.
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