Endocrine Abstracts

Aims

To describe the epidemiological and clinical characteristics of temporal-osteomyelitis mandibular complicating necrotizing otitis externa and discuss how to take it in load.

Materials and methods

This is an 18-year retrospective study [2010–2017], conducted in our ENT department, collecting 74 hospitalized patients for management of necrotizing otitis externa.

Results

The average age was 67 with a sex ratio of 1.13. All patients were diabetic. Otalgia was the master symptom. A chewing pain with a limitation of the mouth opening was found in 3 patients. Clinical examination confirmed the diagnosis of otitis externa. The palpation was painful on palpation compared to TMJ in all patients. Trismus was present in 4 patients. A biological inflammatory syndrome was present in all patients. Otitis externa was bacterial in 4 patients with Pseudomonas and mycosic in 2 patients. A CT of the rocks confirmed the achievement of TMJ with signs in favor of temporo-arthritis mandibular in all patients. Facial mass MRI performed in addition to computed tomography in one case confirmed the extension of infection to the para pharyngeal space and showed condyle involvement mandibular and infiltration of the external pterygoid muscle. Treatment was medical in all cases.

Conclusion

Temporal-mandibular osteomyelitis is a rare complication of necrotizing otitis externa. The spread of infection may be secondary to tympanal osteitis or occur through congenital dehiscence of the external auditory canal. Pain, limitation of opening oral and pre-tragic swelling are the main clinical signs. The treatment is mainly medical, based on antibiotic therapy.