Endoscopic transcanal repair of temporomandibular joint herniation into the external auditory canal: literature review.

Temporomandibular joint (TMJ) herniation into the external auditory canal is a rare condition associated with anterior canal wall defects, most commonly due to a patent foramen of Huschke, trauma, or infection. The clinical presentation is variable and often non-specific, which may lead to misdiagnosis. High-resolution computed tomography is crucial for accurate diagnosis and effective surgical planning. While open surgical repair remains standard, minimally invasive approaches have not been widely reported. An 81-year-old male presented with right-sided otalgia exacerbated by mandibular movement and unresponsive to topical and oral antibiotics. He was initially diagnosed with malignant otitis externa. Otoscopic and radiological evaluations revealed a soft-tissue mass protruding through an anterior external auditory canal defect, consistent with TMJ herniation. After acute inflammation resolved, the patient underwent endoscopic transcanal surgical repair under general anaesthesia. The herniated TMJ capsule was dissected, and the osseous defect was reconstructed using layered autologous conchal cartilage and perichondrium. The procedure was completed entirely through the endoscopic approach without external incisions. At the 6-month follow-up, the patient remained asymptomatic, with complete graft integration and no recurrent herniation. Histopathological analysis excluded malignancy. This case illustrates the diagnostic challenge of TMJ herniation mimicking malignant otitis externa and demonstrates the feasibility of a fully endoscopic transcanal surgical approach for defect repair. The described minimally invasive technique offers a promising alternative to traditional open procedures, with reduced morbidity and favourable functional outcomes.