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

Abstract

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.

Soft tissue lesion of the ear canal – Now you see it, now you don’t

“…This will lead to the occurrence of symptoms over time. Therefore, the mean age of presentation for this condition is about 55 years (Bernstein, 2015).…”

Bilateral Spontaneous Temporomandibular Joint Herniation: A Case Report and Literature Review

“…2,4 In our review of the literature regarding spontaneous herniation of the TMJ, the most common presenting symptoms were otalgia, tinnitus, progressive hearing loss, temporomandibular joint pain, otorrhea, clicking, cracking, and other noises during mastication and opening and closing of the mouth, or even vague ear fullness and pressure (table). 2,6,[8][9][10] On examination, a bulge or mass may be seen in the anteroinferior segment of the EAC, and it is more prominent with the mouth closed. When the mouth is opened, the bulge may disappear or at least decrease in size.…”