A spectrum of auditory canal injuries ensuing from direct or indirect trauma to the temporomandibular joint: A 2-year prospective study

Facial trauma is associated with various types of auditory canal injury (Martis and Karakasis, 1974; Langton et al., 1996; Shu et al., 2010; Altay et al., 2014; Wood et al., 2014; Lu et al., 2014; Burchhardt et al., 2015; Ali et al., 2017). The foremost facial trauma leading to these injuries is either direct trauma to the TMJ, causing fracture of the condyle, or indirect trauma to the TMJ, causing either subcondylar fracture or abrupt dislocation of either of the condyles posteriorly (Antoniades et al., 1992; Gomes et al., 2005; Dang, 2007). The external auditory canal (EAC) is divided into cartilaginous and bony segments. The bony canal represents the inner two-thirds of the EAC, while the cartilaginous portion represents the other one-third of the canal. The tympanic plate is part of the anterior wall of the external auditory canal (EAC), and is located adjacent to the temporomandibular joint.

To date, many case reports and retrospective studies have examined either condylar fracture or posterior dislocation of the condyle, leading to tympanic plate fracture and associated bleeding through the EAC. However, specific examinations can reveal a range of other injuries in patients sustaining TMJ trauma. There are case reports of condylar fracture cases presenting with various complications of the EAC because auditory canal injuries were overlooked at the time of fracture management (Shu et al., 2010; Langton et al., 1996).

A prospective study would reveal the necessity to inspect for auditory canal injuries, because proper management and mitigation of these complications can only be achieved if these patients are referred to an otolaryngologist before the maxillofacial trauma management. Cases of facial trauma, especially trauma to the TMJ, are generally not examined for auditory canal injury, while the patient remains unaware about such complications unless there exists an ear bleed from the EAC (Graham and Larouere, 1994). The role of an otolaryngologist is neglected if no obvious symptoms are presented by the patient.

Thus, our study aimed to assess the various auditory canal injuries occurring in patients with TMJ trauma and, in collaboration with an otolaryngologist on the diagnosis of those injuries, evaluate the need for intervention.

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