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Fagundes RJ, Felipe BC, Couto MK, Silva MC, Iwaki LCV. The relation between persistent foramen tympanicum and degenerative bone alterations in temporomandibular joint region. Oral Radiol 2024; 40:445-453. [PMID: 38587690 DOI: 10.1007/s11282-024-00749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. METHOD Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. RESULTS Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. CONCLUSION Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. TRIAL REGISTRATION NUMBER CAAE: 34328214.3.0000.0104 (11/30/2014).
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Affiliation(s)
- Ruth Jorge Fagundes
- Department of Dentistry, State University of Maringa, Mandacaru Avenue, Maringa, Parana, 1550, 87080-000, Brazil
| | - Beatriz Caio Felipe
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Matheus Kawana Couto
- Department of Dentistry, State University of Maringa, Mandacaru Avenue, Maringa, Parana, 1550, 87080-000, Brazil.
| | - Mariliani Chicarelli Silva
- Department of Dentistry, State University of Maringa, Mandacaru Avenue, Maringa, Parana, 1550, 87080-000, Brazil
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Liu R, Lai H, Davis C, Almeida FT. Association of anatomical features of the petrotympanic fissure and presence of foramen of Huschke with otalgia and tinnitus. Int J Oral Maxillofac Surg 2024; 53:165-169. [PMID: 37442688 DOI: 10.1016/j.ijom.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
The petrotympanic fissure (PTF) and foramen of Huschke (FH) are anatomical structures in the temporal bone that can connect the temporomandibular joint (TMJ) and the ear. The purpose of this retrospective study was to investigate the association between PTF morphology and otalgia and tinnitus, as well as the prevalence of the FH and otological symptoms, using cone beam computed tomography (CBCT). CBCT images from 114 patients presenting with symptoms of a temporomandibular disorder were examined retrospectively. The PTF was classified into three subtypes (open, semi-open, closed) and the presence of the FH was identified. Symptoms of otalgia and tinnitus were obtained from the patient files. The FH was observed in 12.3% of patients examined, and in 12.0% of those with otalgia and 18.9% of those with tinnitus. There was no significant association between the PTF subtypes or the presence of the FH and otalgia or tinnitus (all P > 0.05). The PTF subtype and presence of the FH alone do not appear to contribute to otalgia or tinnitus in patients with temporomandibular disorders.
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Affiliation(s)
- R Liu
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - H Lai
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - C Davis
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - F T Almeida
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
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Patel ST, Dusu K, Moharrum T, Salem M. An unusual presentation: temporomandibular tissue herniation through congenital foramen of Huschke. J Laryngol Otol 2024:1-3. [PMID: 38221853 DOI: 10.1017/s0022215124000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND The herniation of temporomandibular tissue through the foramen of Huschke into the external auditory canal is a rare clinical anomaly. This paper describes one such case and provides an overview of the relevant literature. This paper elaborates upon the aetiology, clinical assessment, management and associated complications. CASE REPORT A 54-year-old woman presented with a 3-month history of right ear pain and a polypoid lesion in her right ear canal. This lesion expanded during a Valsalva manoeuvre, and imaging demonstrated a defect in the antero-superior aspect of the canal with herniation of soft tissue. The patient was managed conservatively as the symptoms resided. CONCLUSION Ear canal lesions that protrude or change in size with a Valsalva manoeuvre could be due to a persistent foramen of Huschke. In symptomatic cases needing surgical intervention, a variety of materials may be used to close the defect. Titanium mesh, with or without cartilage overlay, appears to be the most popular choice.
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Affiliation(s)
| | - Keli Dusu
- Department of Otorhinolaryngology, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
| | - Tamir Moharrum
- Department of Otorhinolaryngology, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
| | - Mohammed Salem
- Department of Otorhinolaryngology, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
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Ko SY, Baeg MS, Kwon HR, Cho HS. Temporomandibular joint herniation into the external auditory canal presenting as clicking tinnitus: A case report. Cranio 2024; 42:90-93. [PMID: 37325909 DOI: 10.1080/08869634.2023.2221990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation. CLINICAL PRESENTATION A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery. CONCLUSION This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.
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Affiliation(s)
- So Young Ko
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Moon Seung Baeg
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyeok Ro Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Teoh T, Abdullah A, Kumarasamy G. Finding the Silver Bullet for Persistent Foramen Hushke. Cureus 2024; 16:e52791. [PMID: 38389601 PMCID: PMC10883106 DOI: 10.7759/cureus.52791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
We report a case of persistent foramen Hushke and embark on a literature search from 1990 to 2021. The search was done using electronic databases of PubMed and Google Scholar using the MESH words 'TMJ herniation', 'persistent foramen Hushke', 'TMJ prolapse', 'EAC dehiscence', and 'ear canal mass'. A total of 37 other case reports were included after excluding duplicates and non-English publications. The most common presentations, treatment modalities, complications, and outcomes were discussed. Common presentations include otalgia, tinnitus, otorrhea, and aural fullness. Surgical intervention shows a good outcome, whereas conservative treatment shows a mixed response. Despite the overwhelming success of surgical interventions in treating symptomatic persistent foramen of Hushke, it is still early to establish a guideline to manage these patients, as this condition is rare and presents with variable symptoms. More high-quality studies and a long-term follow-up of the patients may be essential to observe and compare the outcome and recurrence rate of temporomandibular joint (TMJ) herniation.
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Affiliation(s)
- Theresa Teoh
- Otorhinolaryngology, University Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Asma Abdullah
- Otolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Guhan Kumarasamy
- Otorhinolaryngology and Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Perak, MYS
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Chappuis L, Barthelemy I, Pham Dang N. Persistent foramen of Huschke: Clinical manifestations and complications, systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101455. [PMID: 36965816 DOI: 10.1016/j.jormas.2023.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Foramen of Huschke is a bone defect with wide clinical symptoms which ca can be responsible for severe complications. Clinical history and imaging are unspecific, it is therefore essential to recognize and treat the pathology related to the persistence of this foramen, to avoid destruction of the TMJ, chronic pain or OBJECTIVE: The aim of this review was to summarise the clinical manifestations and complications of persistent foramen of Huschke in adult patients, through a review of the cases reported in the literature. METHODS & MATERIALS A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to November 2022 to identify studies and case reports concerning clinical manifestations and complications of persistent foramen of Huschke in adult patients, with the key words "foramen of Huschke" or "foramen tympanicum". RESULTS 74 papers where firstly identify, and 21 were selected. This correspond to 46 patients with the additional case from our department. Symptoms mostly reported consisted of otitis (63%, 29/46), otorrhea (28.26%, 13/46), and masticatory tinnitus (19.57%, 9/46). Diagnosis was priority made by CT-scan (95.65%, 44/46). Surgery was the most performed treatment (28.26%, 13/46). In our case, the use of FLUOBEAM® NIR camera was help-full for TMJ surgery. CONCLUSION Persistent foramen of Huschke should be suspected in the presence of otitis, otorrhea and masticatory tinnitus. Knowledge of this anatomical variation could help to treat certain pathology like TMJ disorders or TMJ septic arthritis.
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Affiliation(s)
- Louis Chappuis
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France.
| | - Isabelle Barthelemy
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, F-63100 Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France; Université d'Auvergne, Faculty of Medicine, F- 63001, Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, F-63100 Clermont-Ferrand, France
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Hasani M, Haghnegahdar A, Khojastepour L, Golbahar Haghighi MJ. Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study. BMC Med Imaging 2022; 22:145. [PMID: 35963990 PMCID: PMC9375943 DOI: 10.1186/s12880-022-00850-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Foramen of Huschke has been presented as an unusual developmental defect in anteroinferior aspect of external auditory canal. It can be associated with significant otologic complications. The purpose of this study was to determine the association between existence of foramen of Huschke and temporomandibular joint disorders in Cone Beam Computed Tomography (CBCT) images. Methods Of an initial sample of 465 patients, we retrospectively evaluated the CBCT images of 118 individuals with clinical signs and symptoms of temporomandibular joint disorders as case group and 256 individuals as control group. The presence, size and localization of foramen of Huschke were assessed in the axial and corrected sagittal images. The sex and age distribution were determined. Fisher’s exact test, T-test and Pearson’s Chi-square were applied to assess the relationship between foramen of Huschke and temporomandibular joint disorders in the case and control groups considering age and sex. Results The foramen of Huschke prevalence was slightly higher in patients with temporomandibular joint disorders (3.4%) than patients without temporomandibular joint disorders (0.8%). However, the difference was not statistically significant (P = 0.082). foramen of Huschke was found in five females and one male. There was no significant difference between case and control groups considering the age of patients with foramen of Huschke (P = 0.683). There was no significant difference between the case and control groups, considering the right and left ears in distribution of foramen of Huschke (P = 0.099) (P = 0.183). Conclusions Higher prevalence of foramen of Huschke in patients with temporomandibular joint disorders may suggest possible mechanism for temporomandibular joint disorders development that can be affected by presence of foramen of Huschke.
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Affiliation(s)
- Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
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Macielak RJ, Nassiri AM, Fillmore WJ, Lane JI, Driscoll CLW, Carlson ML. Persistent foramen of Huschke: Presentation, evaluation, and management. Laryngoscope Investig Otolaryngol 2022; 7:237-241. [PMID: 35155803 PMCID: PMC8823160 DOI: 10.1002/lio2.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Describe the presentation and management strategy for patients with symptomatic foramen of Huschke (FH). PATIENTS Adults with persistent FH confirmed on imaging. INTERVENTIONS Diagnosis and management of symptomatic persistent FH. MAIN OUTCOME MEASURE Resolution of otologic symptoms. RESULTS A total of four patients with symptomatic, radiographically-confirmed persistent FH were included. The majority of patients endorsed otalgia (n = 4) and otorrhea (n = 3), and only one patient was noted to have a conductive hearing loss. All patients were noted to have dynamic movement of an external auditory canal mass with mandible manipulation on examination, and all patients had an identifiable fistula on imaging. Patients underwent surgical intervention, including both preauricular (n = 2) and transcanal (n = 2) approaches, and all endorsed symptomatic resolution after convalescence. CONCLUSIONS Persistent FH remains an uncommon and potentially underrecognized cause of otologic symptoms. Diagnosis requires a high index of suspicion, and one must rely on both key examination findings and imaging to confirm this diagnosis. In appropriately selected patients, surgical intervention can provide durable symptomatic resolution. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert J. Macielak
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Ashley M. Nassiri
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - W. Jonathan Fillmore
- Division of Oral and Maxillofacial Surgery, Department of SurgeryMayo ClinicRochesterMinnesotaUSA
| | - John I. Lane
- Department of RadiologyMayo ClinicRochesterMNUSA
| | - Colin L. W. Driscoll
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
- Department of Neurologic SurgeryMayo ClinicRochesterMinnesotaUnited States
| | - Matthew L. Carlson
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
- Department of Neurologic SurgeryMayo ClinicRochesterMinnesotaUnited States
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Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques. Am J Otolaryngol 2021; 42:103094. [PMID: 34102581 DOI: 10.1016/j.amjoto.2021.103094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects. METHODS The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar. RESULTS Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect. CONCLUSION There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.
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Pons M, Lutz JC, Sigaux N, Tavernier L, Graillon N, Louvrier A. Surgical reconstruction of the foramen tympanicum: What is known and how we do it. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:545-549. [PMID: 32360752 DOI: 10.1016/j.jormas.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022]
Abstract
Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.
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Affiliation(s)
- M Pons
- Inserm, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, Besançon, University of Bourgogne Franche-Comté, Besançon, France.
| | - J-C Lutz
- Inserm, Regenerative Nanomedicine Laboratory, UMR 1260, Laboratory of Engineering Science, Computer Science and Imaging, CNRS, Department of Maxillofacial and Plastic Surgery, Faculty of Medicine, ICUBE University of Strasbourg, University Hospital and UFR Medicine of Strasbourg, Strasbourg, France.
| | - N Sigaux
- Department of Maxillofacial and Stomatology, Lyon-Sud Hospital Center, Pierre-Bénite, France.
| | - L Tavernier
- Otorhinolaryngology, University Hospital of Besançon, Besançon, France.
| | - N Graillon
- IFSTTAR, LBA UMR T24, Department of Oral and Maxillofacial Surgery, Aix-Marseille University, CHU Conception, AP-HM, Marseille, France.
| | - A Louvrier
- Inserm, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Department of Oral and Maxillofacial Surgery, Medical Faculty, University of Franche-Comté, University Hospital of Besançon, Besançon, France.
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Choi JW, Nahm H, Shin JE, Kim CH. Temporomandibular joint herniation into the middle ear: A rare cause of mastication-induced tinnitus. Radiol Case Rep 2019; 15:125-127. [PMID: 31798759 PMCID: PMC6881616 DOI: 10.1016/j.radcr.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/20/2022] Open
Abstract
A 75-year-old patient complained of mastication-induced clicking tinnitus on the left side, and otoendoscopic examination revealed that the left tympanic membraneTM was outwardly bulged by clenching her teeth. Temporal bone computed tomography demonstrated that the posteromedial bony wall of the glenoid was partially dehiscent, allowing herniation of soft tissue contents of temporomandibular joint into the middle ear. Increased middle ear pressure due to soft tissue herniation can induce left tympanic membrane bulging and accompanying clicking tinnitus. Herniation of temporomandibular joint soft tissue into the middle ear should be considered as a differential diagnosis when clicking tinnitus is evoked by mastication.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - HyunJoo Nahm
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, Republic of Korea, 05030, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, Republic of Korea, 05030, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, Republic of Korea, 05030, Seoul, Republic of Korea
- Corresponding author.
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