Isolated Temporomandibular Joint Involvement in a Rare Case of Malignant Otitis Externa.

Abstract

Introduction: Malignant otitis externa (MOE) is a potentially life-threatening infection of the external auditory canal that predominantly affects elderly, diabetic, or immunocompromised patients. Although the temporomandibular joint (TMJ) is anatomically close to the external auditory canal, its involvement is rare.

Case presentation: The authors present a 69-year-old male with uncontrolled diabetes mellitus and stage 3 chronic kidney disease who was admitted to ENT clinic with persistent ear pain and otorrhea unresponsive to prior treatments. Ear swab cultures revealed Pseudomonas aeruginosa. Despite prolonged intravenous antibiotic therapy and hyperbaric oxygen treatment, the patient experienced recurrence 3 times and imaging revealed osteomyelitis of the TMJ. The patient improved after a further course of intravenous meropenem and hyperbaric oxygen therapy over 2 months.

Conclusion: MOE is a challenging, recurrent infection requiring early diagnosis and a multidisciplinary approach. Although TMJ involvement is rare, it should be considered in patients presenting with trismus and preauricular swelling. Imaging modalities, ear swab cultures with antibiogram-guided antibiotic therapy, and hyperbaric oxygen treatment may improve therapeutic outcomes.