Temporomandibular joint involvement in malignant external otitis

Objective. The purpose of this study was to present 6 patients with malignant external otitis (MEO) that resulted in temporomandibular joint (TMJ) involvement and to discuss the incidence, clinical presentation, and treatment modalities. Study design. All patients diagnosed with MEO between 1994 and 2002 were reviewed for cases in which the TMJ was invaded by the infectious process. Only patients in whom TMJ involvement was documented radiographically and in whom the clinical course was well documented were included in this study. Results. MEO was diagnosed in 42 patients over an 8-year period; TMJ involvement was recorded in 6 patients (14%). The medical history revealed controlled type 2 diabetes mellitus in 4 of the 6 patients. All patients reported early ear symptoms, mainly otalgia and otorrhea. Local signs included an ear canal filled with granulation material, edematous overlying skin, and sensitivity to palpation. Cultures taken from the external ear were positive for either Pseudomonas aeruginosa, Staphylococcus epidermidis, Aspergillus, or Proteus mirabilis. TMJ symptoms developed between 1 and 5 months after admission and included painful periauricular swelling and trismus. In 3 patients, healing was uneventful; 3 also died of the disease. Conclusions. TMJ involvement in MEO is associated with a resistant disease process, often with several recurrences. Prolonged administration of antibiotics is the treatment of choice. Surgical debridement of the TMJ is necessary for the positive identification of the pathogenic organism, in cases of abscess formation, or when osteomyelitic bone destruction of the condyle and glenoid fossa develop.