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.


METHODS
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.
Mardinger
Ofer
O
Unit of Oral and Maxillofacial Surgery, Sapir Medical Center, Kfar-Saba, Israel.
Rosen
Daren
D
Minkow
Benny
B
Tulzinsky
Zeev
Z
Ophir
Dov
D
Hirshberg
Abraham
A
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011513:Proteus mirabilis / Q000302:isolation & purification; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013705:Temporomandibular Joint Disorders / Q000209:etiology* / Q000601:surgery
D000900:Anti-Bacterial Agents