Surgical reconstruction of the foramen tympanicum: What is known and how we do it

Persistent foramen of Huschke: Presentation, evaluation, and management

“…For patients with symptomatic persistent FH, management is generally surgical with a goal to reduce the herniation and close the dehiscence between the EAC and the herniated tissue. 6,11,12,[14][15][16][17] Decision-making regarding surgical approach considers both the size of the dehiscence as well as the status of the temporomandibular joint and capsule. A fistula that is ≥4-5 mm may require a combined approach, while a smaller fistula may allow for a less invasive transcanal approach.…”

“…For smaller defects, perichondrium may be sufficient for reconstruction; however, more robust grafting material, such as tragal cartilage, temporalis muscle, bone pâté, iliac bone crest, collagen mesh, polypropylene, or titanium mesh, may be beneficial in reconstructing larger defects. 6,12,14,16,17 It is the authors' practice to utilize perichondrium and/or tragal cartilage given its adaptability, availability, and limited associated morbidity contrasted with the potential risk of extrusion of non-native substances through thin canal skin. Grafts may be secured with fibrin glue or tacking sutures to minimize graft displacement with temporomandibular joint movement during the postoperative healing period.…”

“…Although incidental persistent FH is diagnosed in 11.5%-20% of individuals undergoing temporal bone imaging, few studies have described the clinical nature of this pathology. [2][3][4] Available literature reports on single cases [5][6][7][8][9][10][11][12][13][14] or small case series 15,16 that highlight the presentation and management variability associated with this pathology. Understanding of this pathology from the lone review examining temporomandibular joint herniation into the EAC is limited given the wide variance in literature and the presentation of all EAC fistula patients, including spontaneous and non-spontaneous fistulae, as a single group in this study; therefore, conclusions are restricted when looking specifically at persistent FH.…”

Malignant myoepithelioma of the external auditory canal — a rare case report with literature review and clinical importance of foramen of Huschke

“…The foramen of Huschke is present in up to 20% of the population and can be identified in about 65% unilaterally and in 35% bilaterally [ 18 ]. The shape of the tympanic foramen is mostly oval [ 19 ]. The mean axial diameter is described as between 3.2 and 4.5 mm, and the sagittal diameter is between 2.4 and 3.6 mm [ 8 ].…”

“…The symptoms of the tympanic foramen are nonspecific, and the most common include TMJ herniation to the external auditory canal during mastication, or otologic symptoms like otalgia, clicking tinnitus, aural fullness, or otorrhea, which could indicate an ear canal salivary fistula [ 17 – 19 ].…”