[Otosialorrhoea - a rare case of a spontaneous salivary fistula of the external auditory canal]

Usefulness of Cone-Bean Computed Tomography Exams to Detect Foramen of Huschke in Diverse Age Group

The foramen of Huschke (FH) is present in the early stages of the temporal bone tympanic portion development. The literature shows that FH may persist in adult individuals and several authors acknowledge its clinical importance, reporting being associated with the dissemination of diseases. Some authors believe that FH presents importance in archeology and forensic situations.Considering that the identification of FH by conventional imaging methods is extremely impaired or impossible due to overlapping bone structures and that cone-bean computed tomography presents quality in the evaluation of this structure, the authors conducted this research to determine the FH prevalence and dimensions through the Invivo5 software, and correlated its size with age.The foramen was present in 19 scans (12.7%), 6 (8.8%) were present among male and 13 (15.8%) among female. The χ test was performed, with no statistically significant difference for gender and age. Considering the age, in individuals aged 7 to 18 years, 16.4% of persistent FH was found compared with 10.5% in individuals over 18 years of age. The diameter ranged from 2.58 to 3.28 mm. No correlation was found between size and age (p between 0.25 and 0.88).The authors conclude that the cone-bean computed tomography is an examination that allows the correct evaluation of the FH and, although the persistence of this unusual anatomical variation presents different frequencies in the different populations and age groups, it can have clinical consequences, so that the professionals who work in the area must be aware of its existence.

Incidence of Foramen Tympanicum (of Huschke): Comparing Cadaveric and Radiologic Studies

PURPOSE

The foramen tympanicum (FT) represents a developmental anomaly that forms due to incomplete fusion of processes of the tympanic ring. Its presence in the population is controversial and it has been associated with a number of otologic complications. The aim of this study was to systematically analyze the prevalence, anatomical characteristics, and ethnic variations of the FT and compare these parameters in cadaveric and radiologic studies.

METHODS

An extensive search was conducted through the major electronic databases, and identified articles were separated into 2 groups based on their methodology: cadaveric and radiologic studies. Data extracted included study modality, prevalence data, ethnicity, gender, side, laterality, and diameter.

RESULTS

A total of 8 studies (n = 2671 patients) were included into our meta-analysis. The main findings revealed that the prevalence of the FT in the population is 14.9%, it is more often unilateral (62.5%) than bilateral (37.5%), it is most often reported in Asia (21.4%), and it is more prevalent in cadavers (21.2%) than in radiologic studies (8.8%) (not statistically significant).

CONCLUSION

As the FT is present in more than one-tenth of the population, it is important to consider the possibilities of its presence when undertaking surgical procedures in the temporomandibular joint and ear region and plan accordingly to avoid injuries. Clinicians should keep it as one of the possible diagnoses while confronted with patients presenting with otologic complications. The use of newer imaging techniques was recommended, such as cone-beam computer tomography to detect the FT prior to surgery.

Incidence of Foramen of Huschke in South Andhra Population of India

INTRODUCTION

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.

AIM

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

Bilateral spontaneous salivary otorrhoea: Case report and a review of the literature

Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.

Evaluation of foramen tympanicum using cone-beam computed tomography in orthodontic malocclusions

The foramen tympanicum is a persistent anatomic formation of the temporal bone due to a defect in ossification normal bone physiology in neonatal or postnatal period. This study determined the occurrence and location of the foramen tympanicum in a Turkish sample using cone-beam computed tomography. Scans of 370 sites in 185 patients were retrospectively analyzed to determine foramen tympanicum occurrence, sizes, and locations according to their orthodontic malocclusions. Measurements were done on axial and sagittal sections to identify the dimensions. Differences in foramen tympanicum incidence by measurements, sex, side, malocclusions, and location were statistically evaluated. Foramen tympanicum was determined in 42 (22.7%) of 185 patients. No statistical difference was found considering location and sex (P > 0.05), but it was found more bilaterally in female patients within significance level at P = 0.024. Mean sizes did not differ significantly by sex but were found to be greater in females. In axial diameter, the average measurement was found wider on the right side of all patients (P = 0.017). The findings showed a greater foramen tympanicum dimension among class II than among class I and III subjects (P < 0.05). Knowledge about these structures is helpful for the interpretation of imaging (especially cone-beam computed tomography) and provides valuable information especially before orthognathic surgery to avoid intraoperative reconstruction and complications.

Foramen tympanicum or foramen of Huschke: anatomical cone beam CT study

OBJECTIVE

The foramen of Huschke (foramen tympanicum) represents a developmental defect in the antero-inferior aspect of the bony external auditory meatus. The foramen is located at the antero-inferior aspect of the external auditory canal, posteromedial to the temporomandibular joint. The aim of this study is to define the prevalence and location of the foramen of Huschke.

METHODS

We retrospectively examined 207 cone beam CT (CBCT) studies (414 ears). We used flat panel detector (FPD)-based CBCT (New Tom FP; Quantitative Radiology, Verona, Italy) for imaging in our department. We noted the location of the foramen tympanicum and calculated its prevalence as a percentage.

RESULTS

We found a foramen tympanicum in 37 (17.9%) of 207 patients. This was unilateral in 24 patients (11.6%) and bilateral in 13 patients (6.3%). Mean axial diameter was 5 mm and mean sagittal diameter was 2 mm.

CONCLUSION

The foramen tympanicum is an uncommon disorder and is well demonstrated on CBCT. This is the first study to detect the foramen tympanicum using FPD-based CBCT.

Lower third molar infection with purulent discharge through the external auditory meatus. Case report and review of literature

This manuscript reports an uncommon case of inferior third molar facial abscess with purulent secretion drainage through the left external acoustic meatus. The patient's left external acoustic meatus was filled with a purulent secretion observed on a CT scan. He underwent surgery to drain the facial abscess. Despite facial abscesses being routine occurrences, the literature does not contain many case reports of odontogenic facial abscesses with drainage via the external acoustic meatus. These situations occur in two possible ways: multiple fissures in the anterior wall of the cartilaginous portion of the external acoustic meatus; and congenital defects that are occasionally present in the anterior-superior aspect of the external acoustic meatus, known as the foramen of Huschke, which allow communication between the external acoustic meatus and mandibular fossa. These defects may also predispose the patient to the spread of the infection or tumour from the external auditory canal to the infratemporal fossa and vice versa. No otological sequelae were observed in this case. The authors conclude that the hypothesis of bone malformation cannot be excluded, and affirm that any facial abscess requires appropriate and immediate treatment for adequate resolution, by removing the causal factor and providing systemic support.

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.

Diagnosis and Management of Salivary Fistula after Surgery for Congenital Aural Atresia

OBJECTIVE

Salivary fistula is an uncommon and unreported yet meaningful complication associated with the repair of congenital aural atresia. The capsule of the parotid gland may be violated during two steps of the operation: the initial dissection around the glenoid fossa or while aligning the auricle with the bony canal at the end of the procedure. We present the first described series of patients with salivary fistula after repair of congenital aural atresia.

STUDY DESIGN

Retrospective case review from 1985 to 2004.

SETTING

Tertiary referral center.

PATIENTS

We included all patients who were diagnosed with a salivary fistula after congenital aural atresia repair.

MAIN OUTCOME MEASURE

The diagnosis of a salivary fistula or salivary tissue in the external auditory canal after atresia repair was based on one of the following criteria: 1) identification of a fistula tract or salivary tissue in the external auditory canal, 2) otorrhea positive for amylase, or 3) intermittent otorrhea associated with eating.

RESULTS

Of 1,500 patients operated on for aural atresia, we identified 6 with salivary fistula after atresia repair. Salivary fistulas were diagnosed from 15 days to 10 years postoperatively, and the duration ranged from 6 months to 14 years. Treatment included observation, medical management, and surgical intervention.

CONCLUSION

Salivary fistulas in the external auditory canal may present with granulation tissue, persistent crusting, or persistent otorrhea; it is therefore necessary to consider salivary fistula when managing these findings in postoperative congenital aural atresia patients. Salivary fistula secondary to repair of congenital aural atresia may be managed conservatively or surgically.

Salivary otorrhoea: a case report and a review of the literature

This report presents an unusual case of spontaneous salivary otorrhoea in which advanced imaging was used to identify a developmental defect in the anterior wall of the bony external auditory meatus. This defect, the so-called foramen of Huschke, was subsequently found to be the source of the fistula. A review of the literature highlights the diagnostic dilemmas that such cases pose for the clinician.

[Herniation of the soft tissue of the temporomandibular joint into the external auditory canal]

The bone between the external auditory meatus and temporomandibular joint may be destroyed as a result of canaloplasty or malignant otitis externa. This may lead to herniation of the joint capsule into the external auditory canal. Spontaneous herniation through a foramen of Huschke (bony dehiscence in the anterior wall of the tympanic bone) is rare. We present a case of spontaneous herniation with otorrhea.

[Frey's syndrome of the external auditory canal]

Frey's syndrome of the external auditory canal is extremely rare. A 55-year old woman presented with a 6 month history of unilateral gustatory otorrhea. She never complained of hearing impairment, tinnitus, vertigo or otalgia. No trauma or surgical signs were evident near the ear or parotid gland. Examination of the ear showed an intact tympanic membrane without disease. A diagnosis of gustatory sweating syndrome was suggested by the observation of sweat production after chewing and by Minor's starch-iodine test. Symptoms were relieved after tympanic neurectomy. The pathogenesis, differential diagnosis and treatment options are discussed.