Temporomandibular Joint Herniation Research Articles

Peer review report 6 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 6 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 3 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 3 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 5 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

Peer review report 5 on “Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Patent Foramen of Huschke: A Case Report”

The spontaneous herniation of temporomandibular joint into external auditory canal: diagnosis of otoscopy, CT and MRI

To summarize the otoscopy, CT and MRI features of spontaneous herniation of the temporomandibular joint(TMJ) into the external auditory canal(EAC) through the persistence Huschke's foramen(PHF). The otoscopy, CT and MRI images of three cases with the herniation of the TMJ into the EAC through the PHF were analyzed retrospectively. Otoscopy revealed the masses located in the antero-inferior aspect of the bony EAC, and the mass displayed an alternative of forward and backward motion during opening and closing of the mouth.CT of the temporal bone showed a bony defect and a consecutive soft mass in the antero-inferior wall of the bony EAC. The margin of the bony defects were well-defined in all cases, the bone adjacent to PHF was pressed and partially wrapped around the soft mass as 'holding ball' in two cases, partly peripheral pseudo bony shell of the soft mass were showed in two cases. The soft mass in EAC appeared equal attenuated with the soft tissue of TMJ, and on enhanced CT scans showed no enhancement of the soft mass. On MRI scans, the imaging displayed a bony defect in the antero-inferior wall of the EAC with a soft mass which was formed by the capsule of the TMJ, and the mass showed iso-signal to the capsule of the TMJ on all sequences, and there was no enhancement after contrast administration. The otoscopy, CT and MRI features of the spontaneous herniation of the TMJ into the EAC through the PHF is special, and the above examinations are valuable for diagnosis of the disease.

Temporoparietal fascia flap and total temporomandibular joint replacement for the management of patent foramen of Huschke

Spontaneous herniation of the condylar head into the external auditory canal (EAC) through the foramen of Huschke is extremely rare, with approximately 30 cases reported in the international literature. The typical presentation is a constellation of non-specific symptoms including otalgia, temporomandibular joint (TMJ) pain, malocclusion, otorrhea, tinnitus while chewing, and hearing loss. Clinical examination may reveal pain, granulation tissue in the EAC, or the exposed mandibular condyle with the mouth closed. With mouth opening, the tissue or exposed bone retracts anteriorly leaving an often normal-appearing EAC. Having the patient open and close the mouth while performing otoscopy will show the displacement of tissue, which is critical for diagnosis of the condition. Radiographic examination with a computed tomography scan typically reveals a discontinuous anterior wall of the EAC with visible soft tissue in the protruding in the EAC. A case of spontaneous TMJ herniation into the EAC in a 54-year-old male patient with a history of otalgia and malocclusion is reported here. Total joint replacement therapy for the treatment of this rare condition is reported, and its importance in providing a posterior mechanical stop to prevent joint relapse is discussed.

Incidence of Foramen of Huschke in South Andhra Population of India.

Foramen of Huschke (FH) is an opening present in anteroinferior wall of External Acoustic Meatus (EAM) on the tympanic plate of temporal bone. The developing tympanic ring normally gets closed by the age of 5 years, if not, leads to the persistence of FH, shows a communication between the EAM and mandibular fossa of temporal bone. The aim of the present study was to report on the incidence of FH in adult skulls and individual temporal bones, belonging to South Coastal Andhra population. Ninety three skulls and 34 temporal bones (18 right and 16 left) obtained from the Department of Anatomy and ENT respectively, irrespective of their sex were utilized. This Tympanic Plates (TP) was observed for the occurrence of FH. Incidence of FH was found in 18 (16.22%) on right and 24 (22.02%) on left side. Bilateral FH was seen in 13 (13.98%) and multiple FH was 13 (5.91%). Mostly it was situated on left than the right side. This study revealed that about 38% of South Coastal Andhra crania have FH. The presence of FH may render external and middle ear structures vulnerable to injury during arthroscopy of the Temporomandibular Joint (TMJ). Since FH can result in TMJ herniation and salivary gland fistulisation through the anterior wall of the bony EAM, surgeons working in this area must be cautious during surgical procedures. Also, data obtained from different populations, as observed from our study can be useful in racial and anthropological studies.

Study of foramen tympanicum with its clinical implications in North Indian Crania

Introduction: The foramen tympanicum also known as foramen Huschke is present in the anteroinferior wall of external auditory canal after 5 years of age. It has anatomical significance and in adult life it can be involved in different abnormalities of external auditory canal and various Otological complications ranging from salivary otorrhoea to temporomandibular joint herniation. Methods: The current study was done on 100 dry adult north Indian crania to study the incidence, sex, sides and shape of foramen tympanicum. Results: Out of 100 skulls studied foramen tympanicum was observed in 18 skulls (26 sides). The incidence of foramen tympanicum was found in 13% skulls and it was more in females as compared to males. The most common shape of foramen was found to be irregular. Conclusions: The ENT as well as maxillofacial surgeons should be aware of persistent foramen tympanicum and should be careful while performing endoscopy of temporomandibular joint to prevent its accidental damage. Keywords: Foramen Tympanicum, Crania, Otological complications, External auditory canal, Temporomandibular joint

Temporomandibular Joint Herniation Into the External Auditory Canal

A congenital bony defect of the external auditory canal (EAC) may cause temporomandibular joint (TMJ) herniation into the EAC. This rare condition is known as persistent foramen tympanicum. We report 2 cases of symptomatic TMJ herniation through a patent foramen tympanicum. The patients complained of mastication-induced tinnitus. Otoscopic examination revealed that a whitish protruding mass at the anterior wall of the EAC bulged when the patients closed their mouths. After conservative managements such as avoidance of chewing foods on the affected side for 2 months, mastication-induced tinnitus disappeared and the size of protruding mass was decreased in one of the patients. Surgical repair of the bony defect has been the treatment of choice. In cases when symptoms are trivial and patients do not want surgical treatment, however, conservative management would be a sound alternative.

Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Persistent Foramen Tympanicum (Huschke): Otologic Features

A persistent foramen tympanicum (Huschke) is an anatomic variation located in the anterior inferior portion of the bony external ear canal. We present a case of symptomatic temporomandibular joint (TMJ) herniation into the right external auditory canal though an enlarged osseous defect. The herniated retrodiscal temporo-mandibular joint (TMJ) tissue moved backward when the patient’s mouth was closed, and forward, when opened. Imaging findings were useful for differentiating TMJ herniation from salivary fistula or a true granuloma of the anterior bony canal wall near the tympanic membrane. The purpose of this presentation is to alert otologists that a large granuloma near the anterior inferior or anterior superior portion of the bony ear canal adjacent to the anterior superior tympanic membrane can be a herniation of either the parotid gland or in this case, the temporomandibular joint capsule. Several attempts at removal of this through the ear canal failed because of the initially incorrect diagnosis of a primary lesion of the ear canal. Only after considerable thought was it realized that this was a rare herniation of the temporomandibular joint capsule through a patent foramen of Huschke.

Spontaneous Herniation of Temporomandibular Joint through the External Auditory Canal

The first case was a 56-year-old female patient, and she applied to our clinic because of itching at the EAC. On physical examination, herniation of the TMJ to the left EAC was detected. On computerized tomography, there was a bony defect at the anterior portion of the left EAC. The second case was a 52-year-old female, and she attended our clinic with sore throat. On routine physical examination, herniation of the TMJ through the left EAC was detected. Both patients were asymptomatic; none of them underwent surgery and follow-up visits were recommended.

외이도내 양측성 자발성 측두하악관절 탈출의 1예

This article is a case report of a person presenting with bilateral spontaneous temporomandibular joint herniation (TMJ) into the external auditory canal (EAC), and study is consist of case report and literature review. The patient was a 59-year-old woman who has bilateral tinnitus. Physical examination was done, but there was nothing special except bilateral whitish eminence which was observed by mouth opening. She was diagnosed as bilateral TMJ herniation by CT scan. As there was no symptom except tinnitus, so medication was perfomed without any manipulation. (J Clinical Otolaryngol 2014;25:169–171)

Objective Tinnitus due to Spontaneous Temporomandibular Joint Herniation Treated by Reconstruction with Titanium Mesh

Objective Tinnitus due to Spontaneous Temporomandibular Joint Herniation Treated by Reconstruction with Titanium Mesh

Spontaneous Temporomandibular Joint Herniation Into the External Auditory Canal Through a Persistent Foramen Tympanicum (Huschke)

Persistent foramen tympanicum (Huschke) is an anatomical variation located in the anteroinferior portion of the external auditory canal. We present a case of symptomatic temporomandibular joint (TMJ) herniation into the external auditory canal though an enlarged osseous defect. The herniated retrodiscal TMJ tissue moved backward when the patient's mouth was closed, and forward, when opened. Magnetic resonance imaging findings were useful for differentiating TMJ herniation from salivary fistula caused by an ectopic salivary gland.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal with Clicking Sound

A bony defect of the external auditory canal (EAC) and herniation of the temporomandibular joint (TMJ) can be caused by tumorous conditions, inflammation, trauma, and otologic procedures. Spontaneous TMJ herniation into the EAC can be caused by a congenital bony defect known as patent Huschke's foramen, which is a very rare condition. In our case, an objective clicking sound was produced when the patient opened his mouth. A protruding mass was found in the anterior wall of the EAC during mouth closing, and herniation of the TMJ was confirmed with computed tomography. Therefore, we thought the clicking sound of our case could have resulted from spontaneous TMJ herniation through the patent foramen of Huschke.

TMJ Herniation Associated With Lymphangioma of the Parotid Region

The objective of this study was to present clinical, audiological, and radiologic findings of a rare case of the temporomandibular joint herniation associated with lymphangioma of the parotid region. A 21-year-old man with the complaints of a mass on the right side of the face, otalgia, and hearing loss in the right ear was referred to our department. The examination revealed a herniating temporomandibular joint into the right external auditory meatus when the patient closed his mouth. He had also hearing loss when he closed his mouth. Upon opening the mouth, the temporomandibular joint returned into its normal position within the glenoid fossa, and the hearing became normal. The patient had also lymphangioma involving mainly the parotid region. Temporomandibular joint herniation into the external auditory meatus may be rarely due to parotid lymphangioma, which leads to pseudo-conductive hearing loss.

Temporomandibular joint herniation and the foramen of Huschke: an unusual external auditory canal mass

We describe a rare case of spontaneous temporomandibular joint herniation into the external auditory canal, and we also review the presentation, aetiology and management of such cases. An 87-year-old woman presented with a four-month history of left-sided otorrhoea and otalgia. Examination revealed a soft, polypoid mass in the left ear canal. When the patient opened her mouth the lesion disappeared. Subsequent computed tomographic imaging of the patient's temporal bones confirmed an 8.6 mm defect in the antero-inferior portion of the left ear canal, with herniation of retrodiscal soft tissues. The external auditory canal is intimately related to the temporomandibular joint, separated only by its bony anterior wall. Neoplasm, trauma or inflammation in this area can result in displacement of the temporomandibular joint into the ear canal; however, spontaneous herniation is rare. Persistence of the primitive foramen of Huschke can result in dehiscence of the anterior canal wall, allowing articular tissue to prolapse into the ear canal. Surgical closure of these defects is known to be effective in ameliorating symptomatic cases.

The foramen of Huschke: age and gender specific features after childhood

The foramen of Huschke (FH) is an aperture that is formed in the tympanic plate of the temporal bone at the age of about 1 year. The FH usually closes before the age of 5 years; but it occasionally persists throughout life. A persistent FH may result in complications such as temporomandibular joint (TMJ) herniation and salivary fistula formation, and facilitate ear injury during TMJ arthroscopy. In this study, the authors examined 1994 temporal bones from 997 Japanese dry skulls, in order to define age and gender specific features of the persistent FH after childhood. A persistent FH was found in 12% of men and in 20% of women, representing a female predominance (P<0.0001). The incidence of a persistent FH decreased with age in both genders, suggesting that a persistent FH can close over time.

Temporomandibular joint herniation into the external ear canal through foramen of Huschke

Foramen of Huschke, which is also known as the foramen tympanicum, is an anatomical variation of the tympanic portion of the temporal bone. This foramen is located on the anteroinferior aspect of the external auditory canal, posteromedial to the temporomandibular joint. Herein, a rare case of foramen Huschke with a herniation of the soft tissues around the temporomandibular joint that result in severe otalgia and its treatment are presented.

Temporomandibular joint herniation into the external auditory canal

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) is a very rare condition, and it mostly occurs in patients with bony wall defects in the anterior EAC. The purpose of this study was to evaluate the clinical and radiological findings and the treatment results of TMJ herniation into the EAC by reviewing a large sample of temporal bone computed tomography (CT) scans. A retrospective study. We reviewed 985 adult temporal bone CT scans and evaluated the presence of defects, the size and location of defects, and TMJ herniation. We enrolled 23 cases with anterior EAC wall defects. Twenty-three (2.3%) patients from the 985 temporal bone CT cases revealed an anterior wall defect involving the EAC. We identified the causes for the defects, such as canal cholesteatoma and trauma, in eight of the 23 cases. We observed 15 (1.5%) patients with patent foramen of Huschke. The mean defect size was 3.06 × 2.69 mm. Among the patients with these lesions, six had a TMJ herniation into the EAC. Four of the six cases were surgically reconstructed using a titanium mesh via a preauricular approach, whereas the remaining two cases were managed with endaural removal and skin graft. TMJ herniation into the EAC is very rare and may not occur even if an anterior wall defect of the EAC is present. Lesions can be successfully managed with surgical reconstruction of the TMJ via a preauricular approach, whereas small lesions can be managed using an endaural approach.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal

Bony defects of the external auditory canal (EAC) may arise from a tumor, infection, inflammation, trauma, complications from ear surgery, or congenital disease. Congenital bony defects of the EAC are known as a patent Huschke’s foramen. Here, we describe a 76-year-old male patient who presented an otalgia in his right ear. Physical examination revealed a dome shaped swelling of the anterior EAC wall, which repeated swelling and retraction as the patient’s mouth closed and opened. Computed tomography revealed a bony defect of the anterior EAC wall. We believe that the patent Huschke’s foramen allowed spontaneous herniation of the temporomandibular joint into the EAC. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:175-8 Key WordsZZHuschke’s foramen·External auditory canal·Temporomandibular joint·Otalgia.