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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2005 January-December;16(1-3):67-72
Herniation of the temporomandibular joint content into the external auditory canal: a rare congenital case with a review of the literature
Cozzolino A. 1, Ruggiero G. 1, Passali F. 2, Caruso G. 2
1 Department of Maxillo-Facial Surgery University of Siena, Siena, Italy.
2 Department of Otorhinolaryngology University of Siena, Siena, Italy
The temporomandibular joint and the surrounding soft tissues can protrude into the external auditory canal by a defect in the tympanic bone. The loss of bony substance can be a result of maxillo-facial trauma or tumours, complications after arthroscopy or otological surgical procedures, infections or inflammatory processes or, in rare cases, of congenital nature. The diagnosis is especially clinical and then it’s confirmed by instrumental examinations. In fact, when the patient close the mouth, a dome shaped swelling observe arising from the anterior wall of bony external auditory canal; when the patient open the mouth, the swelling retract anteriorly, producing an invagination of the skin of the external auditory canal at the site of the previous herniation. The therapeutic approach depend on patient symptomatology: arthralgia, trismus, pain and/or unpleasant noise in the ear, masticator difficult or the high risk of septic arthritis are indications for surgical operation. The use of autologous or eterologous graft can be used for the defect reconstruction. At the last, the authors present, for its particular rarity, a case of congenital bony dehiscence in the tympanic plate following from temporomandibular joint content protruding into the external ear canal. This condition is to ascribe to the persistence of Huschke’s foramen, which form during development of the tympanic bone and, in physiological condition, close in adulthood about fifth year of life.