Malignant (invasive) otitis externa involving the temporomandibular joint

Comparison between Glenoid Fossa Roof Thickness in TMD and non-TMD Patients, a CBCT Study

Statement of the Problem

Various pathologic conditions can affect the thickness of the roof of glenoid fossa (RGF). The relationship between the RGF thickness and temporomandibular joint disorder (TMD) is not explicitly investigated. Considering the changes in RGF thickness, as a radiographic sign for TMD diagnosis, the phenomenon may necessitate specific treatment and may influence the treatment course and results.

Purpose

This research was designed to examine the relationship between TMD and RGF thickness changes compared to non-TMD group.

Materials and Method

In this cross sectional analytic research CBCT images of 70 TMD patients (140 joints) and 70 non-TMD individuals (140 joints) as control group were evaluated for thickness of RGF and presence of discontinuity in RGF. The distance between superior and inferior cortex of glenoid fossa was measured as RGF thickness. Inability to follow the course of cortex in any given image was considered as discontinuity. T-test, Chi-square and odds ratio (OR) were used for statistical analysis. In this study, p< 0.05 was considered meaningful.

Results

The mean thickness of RGF in our non-TMD samples was 1.12 mm. RGF thickness was significantly increased in TMD patients compared non-TMD group (p= 0.00). This value was also greater in males. On the other hand, TMD patient showed a higher incidence of discontinuity in RGF, in comparison with non-TMD patients (p= 0.006).

Conclusion

The increased thickness of RGF can be considered as a sign of TMD, which may help in diagnosis of TMD. It seems that there is a direct relationship between TMD and discontinuity of RGF.

Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues

The authors describe a case of a rare infectious disease of intra-articular tissues of the temporomandibular joint caused mainly by Pseudomonas aeruginosa. In scientific literature, under the heading invasive (malignant) external otitis, we can find cases of an infectious disease of the external acoustic meatus caused by a microbial agent of Pseudomonas aeruginosa which can subsequently penetrate into structures. However, a primary affliction of the abovementioned structures has not been described. Localisation and severity of the infection requires long-term and massive treatment with antibiotics.

Osteomyelitis of the Temporomandibular Joint Following Canal Wall Down Mastoidectomy

Osteomyelitis of the temporomandibular joint (TMJ) is a rare disease that is characterized by osteitis of the mandibular condyle or glenoid fossa. Although this condition is usually associated with trauma, dental disease, or extension of a local infection, it may also occur as a complication of otologic infection. However, osteomyelitis of the TMJ as a complication of otologic surgery has not yet been reported. I present the case of a 54-year-old woman who developed a polyp on the superior portion of the tympanic membrane 9 weeks after canal wall down mastoidectomy. This is an extremely rare case of a patient with osteomyelitis of the TMJ as a complication of otologic surgery.

Prognostic scoring in necrotising otitis externa

Objective:

To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms.

Design:

Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms.

Results:

Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented.

Conclusions:

A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.

[Temporomandibular osteomyelitis secondary to progressive necrotizing otitis externa]

INTRODUCTION

Osteomyelitis of the temporomandibular joint is a rare complication of invasive external otitis, often occurring after inappropriate initial treatment of the causal affection.

OBSERVATION

A 65-year-old diabetic man was treated for invasive otitis externa complicated by destructive osteomyelitis of the ipsilateral temporomandibular joint. The diagnosis was suspected clinically and confirmed by imaging. The course was favorable with medical treatment.

DISCUSSION

Osteomyelitis is an extremely unusual complication of invasive otitis externa. Diffusion of the infection toward the temporomandibular joint can be secondary to an osteitis of the bony canal or spread via congenital dehiscences of the external auditory canal. Pain, limitation of mouth opening and auricular swelling are the main clinical signs. Treatment is essentially medical, based on adapted antibiotic therapy.