title: Temporomandibular joint involvement in malignant external otitis.
abstract: 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.
authors.affiliation: Unit of Oral and Maxillofacial Surgery, Sapir Medical Center, Kfar-Saba, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Mardinger
authors.forename: Daren
authors.initials: D
authors.lastname: Rosen
authors.forename: Benny
authors.initials: B
authors.lastname: Minkow
authors.forename: Zeev
authors.initials: Z
authors.lastname: Tulzinsky
authors.forename: Dov
authors.initials: D
authors.lastname: Ophir
authors.forename: Abraham
authors.initials: A
authors.lastname: Hirshberg
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents