Temporomandibular Joint Herniation Research Articles

Temporomandibular joint herniation into the external auditory canal presenting as clicking tinnitus: A case report

ABSTRACT Background Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation. Clinical presentation A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery. Conclusion This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.

Management of External Auditory Canal Anterior Wall Defect: A Case Series and Literature Review.

Although rare in etiology, anterior bony wall defects of the external auditory canal (EAC) accompanied by temporomandibular joint herniation may cause various otologic symptoms. Surgical treatment can be considered based on symptom severity because many previous case reports have highlighted its efficacy. This study aimed to review the long-term results of surgical treatment of EAC anterior wall defect and to suggest a stepwise approach when creating a treatment plan. We performed a retrospective review of 10 patients who underwent surgical management to address the EAC anterior wall defect and its associated symptoms. Medical records, temporal bone computed tomography scans, audiometry, and endoscopic examination findings were analyzed. The primary repair of the EAC defect was the first to be surgically addressed in most cases, excluding one case with a severe combined infection. Of the 10 cases, 3 patients exhibited either postoperative complications or symptom recurrence. Six patients had resolved symptoms consequent to primary surgical repair, and four patients underwent revision surgery undergoing a more invasive procedure, such as canalplasty or mastoidectomy. Primary repair of the anterior wall defect of the EAC seems to be overpromoted for lasting results but is not as promising as previously noted. We therefore propose to create a novel treatment flowchart regarding the surgical treatment of anterior wall defects of the EAC based on clinical experience. IV.

A Rare Case of Spontaneous Herniation of Temporomandibular Joint Through Patent Foramen Huschke Presenting with Otalgia: A Case Report and Literature Reviews

We report a rare case of Spontaneous Temporomandibular joint herniation through patent foramen Huschke, which is a congenital bony defect in the external auditory canal. Herniation of temporomandibular joint tissue through the ear canal usually results from infection, trauma, or surgery. Awareness of this rare clinical entity is vital to help the correct diagnosis.

Reconstruction of the Anterior External Auditory Canal With Mastoid Cortex Autologous Bone Graft.

To describe the surgical management of temporomandibular joint (TMJ) herniation with external auditory canal (EAC) reconstruction using autologous bone grafting from the mastoid cortex. Retrospective case series. A tertiary university medical center. Three patients who presented to our Otolaryngology clinic with evidence of TMJ herniation through an anterior EAC defect, both on otoscopy and computed tomography (CT) imaging. Reconstruction of the anterior EAC with mastoid cortex bone grafting using an endaural approach. Successful reconstruction of anterior EAC bony defect without recurrence of herniation. All three patients presented with otalgia, hearing loss, and either tinnitus or a clicking sensation with jaw movement. Etiologies for TMJ herniation included osteoradionecrosis following external beam radiation therapy for head and neck carcinoma and iatrogenic injury following multiple tympanoplasties and canalplasties. A mastoid cortex bone graft was placed and secured anterior to the bony EAC defect through an endaural approach. Two patients wore a dental retainer postoperatively to keep the condyle in an open position. After reconstruction, patients reported an improvement in their presenting symptoms. There was no recurrence of TMJ herniation in all cases after 1, 4, and 9 years. Anterior EAC reconstruction with autologous bone grafting can be an effective definitive treatment in TMJ herniation. To our knowledge, this is the first report of the use of bone grafting to reconstruct the canal defect in TMJ herniation.Level of Evidence: V.

Protrusion of Implant after Surgical Wall Reconstruction due to Temporomandibular Joint Herniation

Herniation of the temporomandibular joint (TMJ) into the external auditory canal is rare as TMJ and external auditory canal are separated by an anterior bony wall of external auditory canal. The bony defect of the anterior external auditory canal can be caused by trauma, otologic procedure, neoplasm, inflammation and a rare congenital bony defect. Conservative treatment is available if the severity of the symptom is mild or asymptomatic. However, surgical procedure is considered if the patient experiences severe distress. There have been no reported cases of surgical-related complications and recurrence during postoperative follow-up period. Herein we report the very first case of foreign body prolapse involving herniation from TMJ extending into the external auditory canal.

Clinical characteristics and etiology of temporomandibular joint herniation into external ear canal

Objective:To summarize the cases of temporomandibular joint herniation into external auditory canal found and treated in our hospital, to improve the understanding of oral and maxillofacial diseases and otological diseases, and to explore the potential long-term effects of local radiotherapy on temporomandibular joint function. Method:Analyzed the causes of temporomandibular joint herniation into external auditory canal comprehensively through combining history, clinical manifestations and imaging examination. Result:All otoscope results showed soft tissue mass in the deep anterior wall of the external auditory canal. The soft tissue mass moved inside and outside along with the opening and closing of the mouth. CT examination revealed obvious bone defects in the anterior wall of the ear canal. Conclusion:Delayed radiotherapy injury may be a inducing factor of temporomandibular joint herniation into external auditory canal. CT and MRI examination have guiding significance on the disease treatment selection. The specific signs found by otoscope can confirm the diagnosis.

Otoscopy and imaging features of spontaneous temporomandibular joint herniation into the external auditory canal.

Objective:To explore the otoscopy, CT and MRI features of spontaneous temporomandibular joint(TMJ）herniation(STMJH) into the external auditory canal (EAC) through the persistent foramen of Huschke (PFH).Methods:15 cases diagnosed STMJH were collected. The otoscopy, CT data of 15 cases and MRI data of 6 cases were retrospectively reviewed.Results:Otoscopy revealed a mass located in the anterior wall of the bony EAC that moved forwards and backwards during mouth opening and closing, respectively. CT showed a soft mass with bony defect in the anterior wall of the EAC, with no enhancement; the bony defect margin was well defined in all cases. The bone adjacent to the PFH was pressed and partially wrapped around the soft mass, as if “holding a ball,” in seven cases. Pseudobone shell around the soft mass was observed in eight cases. Six cases included MRI scans, which showed TMJ soft tissue herniated into the EAC.Conclusion:STMJHs have unique otoscopic, CT and MRI features. The examination strategy recommended is dynamic otoscopy and conventional CT, MRI can be chosen when the herniation is complicated by infection or otitis externa or when the patient has TMJ dysfunction; conservative management and follow-up observations are the main treatment strategy recommended.Advances in knowledge:Mechanical stress of TMJ on the EAC is thought to cause herniation and the special CT features, the location and size of the PFH, especially the location, are the major risk factors for TMJ herniation in patients with FH.

A Case of Bony Defect of the Anterior External Auditory Canal Wall Causing Ear Fullness

A congenital defect of the anterior wall of the external auditory canal (EAC) is known as foramen of Huschke. The tympanic bone is incompletely developed and has a U shape at birth. The foramen of Huschke closes via continuous bone growth, which occurs before the age of 5 years. A persistent foramen of Huschke is an anatomic variation located in the anteroinferior portion of EAC, which can cause ear discomfort with spontaneous temporomandibular joint (TMJ) herniation into the EAC bony defect. We present a case of 50-year-old man who had a symptomatic TMJ herniation through an osseous defect. The physical examination showed a bulging mass of anterioinferior portion of EAC when the patient closed his mouth, which was retracted when the mouth openned. We report a case of surgical reconstruction of the EAC wall defect, and the foramen of Huschke with titanium mesh via preauricular approach along with literature’s review.

Objektif Tinnitusun Nedeni Olarak Temporomandibular Eklem Herniasyonu

Objektif Tinnitusun Nedeni Olarak Temporomandibular Eklem Herniasyonu

Temporomandibular Joint Herniation: Review of the Literature

To define clear clinical characteristics and management strategies of herniation of temporomandibular joint (TMJ) into the external auditory canal (EAC). MEDLINE, PubMed, and EMBASE databases. A search was conducted using the keywords "temporomandibular joint" and "herniation" with all of their synonyms. Literature selection criteria included articles published in English, and articles dating back no further than 1970. Forty articles regarding 51 cases were eligible for critical appraisal. According to the previously published papers, TMJ herniation has following characteristics; symptoms are nonspecific, but a distinguishable feature is a protruding mass into the EAC that can be seen to appear and disappear as the mouth opens and closes. High-resolution computed tomography scans are sensitive to the bony defect and are helpful in diagnosing TMJ herniation. In the surgical treatment of TMJ herniation, wall reconstruction rather than simple mass excision could be a safe and long-lasting strategy. Herniation of TMJ into the EAC is a rare condition, but can be encountered in the clinic at any time. This literature review could be helpful in the diagnosis and treatment of TMJ herniation into the EAC.

A Case of Tinnitus due to Temporomandibular Joint Herniation

Herein, I report a case of a temporomandibular joint herniation. A 77-year-old male patient presented with the complaint of developing tinnitus in his left ear when he bit into foods. On examination, I confirmed projection of the anterior wall of the external auditory canal during biting, with the projection retracting when the patient opened his mouth. Computed tomographic examination revealed a partial defect of the anterior wall of the bony external ear canal. I thought that this defect was caused by failure of the foramen of Huschke to close during development. The projecting anterior wall of the external auditory canal pressed on the eardrum, causing tinnitus of the left ear. This case underscores the need to bear in mind temporomandibular joint herniation as a cause of tinnitus.

Extended endaural approachで内視鏡下に外耳道前壁再建を施行した顎関節ヘルニア例

Extended endaural approachで内視鏡下に外耳道前壁再建を施行した顎関節ヘルニア例

Temporomandibular joint herniation through the foramen of Huschke with clicking tinnitus

IntroductionThe foramen of Huschke (FH) is an uncommon anatomical variation of the tympanic portion of the temporal bone. It is located on the anteroinferior aspect of the external auditory canal; extremely rarely, the soft tissues around the temporomandibular joint (TMJ) can herniate through it. Case summaryWe report two cases of TMJ herniation through the FH presenting with clicking tinnitus that were treated differently. DiscussionThe treatment of TMJ herniation depends on the presenting symptoms and the patient's willingness to undergo surgical correction. If surgical management is chosen, the bone can be obliterated using tragal cartilage and temporalis fascia.

Repairing the spontaneous temporomandibular joint herniation through endaural approach by oto-endoscope: a case report

本文报道了南昌大学第二附属医院收治的1例自发性颞下颌关节外耳道疝患者，老年男性，因反复右耳道渗液伴耳鸣3年，疼痛半年就诊，经专科及影像学检查诊断为右侧自发性颞下颌关节外耳道疝，经耳内镜行疝囊切除+Huschke孔修补术，术后外耳道无狭窄，颞下颌关节活动良好，耳鸣消失。.

Relationship of age to foramen of Huschke and investigation of the development of spontaneous temporomandibular joint herniation

The aim of this study was to determine the prevalence, localization, and width of the foramen of Huschke (FH) and the relationship between age and FH. Another aim was to investigate the development of spontaneous temporomandibular joint (TMJ) herniation. This was a retrospective review of high-resolution computed tomography images of the temporal bone of 1025 patients. The prevalence of FH and the axial and sagittal diameters of the foramen were evaluated. Cases were found in which the TMJ had herniated through FH into the EAC. FH was detected in 137 (13.4%) of 1025 patients. The prevalence of FH was higher in females (18.4%) than in males (6.6%) (P<0.001). The presence of FH increased with age (P=0.005). Herniation of the TMJ through FH into the EAC was seen in four patients (0.4%), and 2.9% of patients with FH detected had TMJ herniation into the EAC. As well as being congenital, FH can also be senile; the prevalence may increase with age. Herniation of the TMJ through FH into the EAC is very rare; this was observed in 0.4% of all patients and 2.9% of patients with FH detected.

Examination of foramen tympanicum: an anatomical study using cone-beam computed tomography.

The foramen tympanicum (FT) is an osseous dehiscence of the temporal bone and usually closes by the age of 5 years. The foramen is located posteromedial to the temporomandibular joint and anteroinferior of the external auditory canal. The aim of this study is to define the prevalence, location and size of the foramen. We retrospectively examined 200 cone-beam computed tomography (CBCT) images (400 ears). We used a CBCT dental imaging system (GALILEOS, Sirona Dental Systems, Bensheim, Germany) working at 15-30 mA and 98 kV. We noted size and location (unilateral and bilateral) of the present FT. Foramen tympanicum was determined in 11.5% of 200 patients (they had FT at least on one side of the head). This was bilateral in 5 (2.5%) patients. Prevalence of the FT was significintly higher in females (8%) than in males (3.5%). FT was found more frequently on the left side (7.5%) than on the right side (4%). Mean axial diameter was 1.13 mm (range 0.23-4.43 mm), and mean sagittal diameter was 1.44 mm (range 0.22-3.99 mm). Considering that FT was present in 11.75% of patients, radiologists and clinicians should be aware of the possible presence of this defect. It is known that this developmental dehiscence may cause herniation of temporomandibular joint, formation of salivary otorrhea, and spread of tumour or infection to the infratemporal fossa from external auditory canal. This study showed that CBCT may be preferred for imaging these conditions. (Folia Morphol 2018; 77, 2: 335-339).

Bilateral spontaneous symptomatic temporomandibular joint herniation into the external auditory canal: A case report and literature review

Spontaneous temporomandibular joint (TMJ) herniation is the entity of protrusion of the retrodiscal contents of the TMJ into the external auditory canal (EAC) through a persistent Huschke’s foramen. There have been a number of reports of spontaneous TMJ herniation, but there are no reports of bilateral symptomatic TMJ herniation. We report a case of a 70-year-old man who complained of a crunching sound in both ears during mastication. Examination showed bulging from the anterosuperior wall of the EAC on each side when the patient opened his mouth, which pushed the tympanic membrane medially. Bony defects in the corresponding area were seen on computed tomography. We describe a very rare case of bilateral spontaneous TMJ herniation that caused symptoms by having a direct impact on the tympanic membrane.

Peer review report 4 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 4 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 1 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 1 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 2 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 2 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”