Temporomandibular-external auditory canal fistulas treatment: patient with air into the synovial compartment

Fistulas of the temporomandibular joint-external auditory canal (TMJ-EAC) are permanently epithelialized communications extending between the temporomandibular joint (TMJ) and the external auditory canal.1,2 A TMJ-EAC fistula may be secondary to otitis externa, radiotherapy of the head and neck, fractures of the mandibular condyles or otologic, and TMJ surgery.2,3 Spontaneous fistula is a very rare entity.1,4 A defect of the antero-inferior part of the tympanic bone, better known as foramen of Huschke, could be the cause of this rare condition.1–4 The authors describe the unusual case of a patient with a congenital Huschke foramen who developed a TMJ-EAC fistula secondary to radiation therapy, allowing the entry of air into the synovial compartment during jaw movements. In the literature, very few studies have described TMJ-EAC fistulae1–6: only 1 patient of TMJ air because of EAC communication has been described so far.7 At the time of this writing, there is no consensus on how to manage TMJ-EAC fistulas, particularly those in which previous radiotherapy was performed. We propose closure of the fistula through a temporalis muscle rotation flap.2,