Temporomandibular Joint Herniation and External Auditory Canal Anatomy

The temporomandibular joint (TMJ) is a synovial articulation that links the mandible to the temporal bone immediately anterior to the external auditory canal (EAC). In a subset of individuals a congenital defect known as the foramen of Huschke (or foramen tympanicum) persists in the anteroinferior wall of the bony EAC. This dehiscence can permit soft tissues of the TMJ to herniate into the canal, giving rise to symptoms such as otalgia, aural fullness, clicking or crepitus with jaw movement and, in rare cases, infectious or neoplastic spread between the infratemporal and ear regions. Herniation may be transient and position-dependent, best appreciated during mouth opening and closing, or it may present as a fixed mass. High‐resolution imaging and dynamic clinical examination are central to diagnosis. A thorough appreciation of EAC anatomy and its variants is essential for ear, dental and maxillofacial specialists to avoid misdiagnosis, prevent iatrogenic injury during TMJ arthroscopy and guide appropriate management, which ranges from conservative observation to surgical repair of the canal defect.

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Temporomandibular Joint Herniation and External Auditory Canal Anatomy publication trend

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Technical terms

Temporomandibular joint (TMJ): The articulation between the mandibular condyle and the temporal bone, allowing jaw movement.

External auditory canal (EAC): The bony and cartilaginous passage leading from the auricle to the tympanic membrane.

Foramen of Huschke (foramen tympanicum): A congenital defect in the anteroinferior wall of the bony EAC that normally closes by age five.

Herniation: Protrusion of tissue through a defect in its containing structure; in this context, TMJ soft tissues into the EAC.

Cone beam computed tomography (CBCT): A specialised CT technique providing high-resolution, three-dimensional images of bony structures with lower radiation dose.

Dynamic otoscopy: Real-time examination of the ear canal and tympanic membrane during movements such as mouth opening and closing to assess lesion mobility.

References

1. Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study. BMC Medical Imaging (2022).
2. Otoscopy and imaging features of spontaneous temporomandibular joint herniation into the external auditory canal. BJR|Open (2020).