Persistent Foramen of Huschke Mimicking a Branchial Cleft Anomaly

Abstract

A persistent foramen of Huschke, or foramen tympanicum, results from the defective ossification of the anteroinferior aspect of the tympanic portion of the temporal bone. We describe 2 girls, aged 5 and 6 years, with histories of recurrent cervical abscesses, draining submandibular sinuses, and defective tympanic plates adjacent to the tympanic ring. Surgical resection of the fistulous tract extending from the submandibular triangle to the bony ear canal successfully controlled the symptoms. REPORT OF CASES CASE 1A 5-year-old girl presented to a tertiary care pediatric otolaryngology outpatient clinic with a history of swelling in the anterior aspect of the left side of her neck. She had the sudden onset of left submandibular swelling and erythema 5 weeks before presentation, which then developed into cutaneous drainage and improved after the administration of intravenous antibiotics at a different institution. Her medical history was remarkable for a tympanoplasty and mastoidectomy that had been performed on that same side 1 year earlier, with a diagnosis of chronic suppurative otitis media. On physical examination, she had a draining sinus that was surrounded by granulation tissue right above the hyoid but was afebrile and nontoxic. Computed tomography (CT) revealed a tract extending from the cervical skin up into the bony external auditory canal (EAC) through a dysmorphic anteroinferior wall (Figure 1). The patient was then taken to the operating suite, and the tract was resected through a superficial parotidectomy approach, with facial nerve identification and preservation. The tract extended into the styloid process, which was amputated and packed with a fat plug. Examination of the surgical specimen revealed a 3-cm-long fibrotic tract with acute and chronic inflammation. There were no complications or evidence of recurrence during the 1-year follow-up period. CASE 2A 6-year-old girl presented to the emergency department with the sudden onset of right submandibular swelling, tenderness, and erythema. Associated symptoms also included right-sided otalgia and otorrhea. Her medical history was notable for 2 previous procedures for excision of right submandibular cysts. On physical examination, she had a draining sinus approximately 1 cm below the right angle of the mandible as well as substantial otorrhea and granulation tissue occluding the ear canal. A CT of the neck with contrast showed significant inflammatory changes in the parotid gland, temporomandibular joint, and parapharyngeal space. A superficial parotid fluid collection was drained, and oral and ototopical antibiotic therapy was initiated. After the infection subsided, the results of magnetic resonance imaging confirmed the CT findings of a fistulous tract extending from the submandibular area into the medial aspect of the EAC through a dysmorphic styloid bone and an anteroinferior wall (Figure 2). The patient was also

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

“…6 Herniation of a first branchial arch cyst migrating through this defect has also been reported. 7 Another abnormal condition which is the one presented in this communication is a spontaneous temporomandibular joint herniation into the external ear canal through the osseous dehiscence. 8 This is, in most cases, a very rare condition that is observed in only 0.4% of the population.…”

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

“…STMJH causes stenosis of the EAC, interfering with the discharge of secretions and water. The skin of the EAC becomes more easily damaged, and herniation is often accompanied by inflammatory lesions in the EAC, such as eczema and granulation tissue 17 ; thus, the differential diagnosis of inflammatory lesions in the EAC is difficult. If extensive inflammation of the EAC and herniation is observed, dynamic otoscopy is often ignored, and the condition is often misdiagnosed as otitis externa.…”

Foramen of Huschke (tympanicum) in a Nigerian male with articular soft-tissue herniation into the external auditory meatus

“…In children, it could mimic a branchial cleft anomaly. [9] Several imaging studies have been employed to describe this foramen. A study done by Lacout et al [1] examined 65 patients (130 ears) using high resolution Figure 1: There is a bony defect in the postero medial aspect of the right temporomandibular joint.…”