Ethiology of tinnitus. Discomalleolar ligament in fresh human cadavers. Anatomical and clinical aspect: a surgical proposal

Background: Several anatomic relationships between the ear and the TMJ have been proposed to account for the presence of tinnitus during TMD. Most important otomandibular structures are tympanomandibular ligament and discomalleolar ligament. The latter connects the malleus bone of the middle ear and the postero-medial region of the temporomandibular joint. Objectives: For this reason, the aim of the present paper is to study, on fresh adult cadavers, the frequency of discomalleolar ligaments, its correlation with the middle ear and its role in the ethiology of tinnitus. Methods: The study was conducted on 5 fresh adult cadavers through two dissection approaches bilaterally: lateral and superior approach. Findings: The discomalleolar ligament was present in all 10 examined cases. Conclusion: In regard to the relationship between tinnitus and temporomandibular disorders, some authors demonstrated that there is a slight movement of the malleus and the tympanic membrane during the application of tension to the ligament; other authors have shown no movement of the malleus in the same condition. In this study, we have detected an evident movement only in one cadaver; imperceptible movement in the remaining 4. In our opinion, in vivo, microscopic movements to generate tinnitus are sufficient. For this reason, we have carried out a surgical resection of extratympanic portion of discomalleolar ligament in a patient with tinnitus and TMD. One month after surgery the tinnitus had disappeared in the patient.