Objective: To define clear clinical characteristics and management strategies of herniation of temporomandibular joint (TMJ) into the external auditory canal (EAC). Data Source: MEDLINE, PubMed, and EMBASE databases. Study Selection: A search was conducted using the keywords “temporomandibular joint” and “herniation” with all of their synonyms. Literature selection criteria included articles published in English, and articles dating back no further than 1970. Results: Forty articles regarding 51 cases were eligible for critical appraisal. According to the previously published papers, TMJ herniation has following characteristics; symptoms are nonspecific, but a distinguishable feature is a protruding mass into the EAC that can be seen to appear and disappear as the mouth opens and closes. High-resolution computed tomography scans are sensitive to the bony defect and are helpful in diagnosing TMJ herniation. In the surgical treatment of TMJ herniation, wall reconstruction rather than simple mass excision could be a safe and long-lasting strategy. Conclusions: Herniation of TMJ into the EAC is a rare condition, but can be encountered in the clinic at any time. This literature review could be helpful in the diagnosis and treatment of TMJ herniation into the EAC.

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Background and Objectives Nasal obstruction has been assumed to be correlated with sleep-related breathing disorder (SRBD). However, a definite correlation between nasal obstruction and SRBD is still controversial. This study aimed to define whether symptoms and severity of the deviated septum of nose (DSN) and inferior turbinate hypertrophy (ITH) are correlated with the severity of SRBD. Subjects and Method This is a retrospective study of 60 patients' preoperative polysomnography who have undergone septoplasty and turbinoplasty. Patients with obesity, tonsillar hypertrophy, high Mallampati class, mandibular problem, and nasal polyp or concha bullosa were excluded from the analysis. Subjective nasal obstruction scores, and DSN/ITH grades were collected, and correlations between apnea-hypopnea index (AHI), lowest oxygen saturation, and snoring time were analyzed. Results The average of AHI, lowest saturation and relative snoring time were 3.72±5.79, 89.78%±6.81%, and 8.45%±10.43%, respectively. The number of patients who were normal, obstructive sleep apnea (OSA) syndrome mild, moderate, and severe were 49 (82%), 6 (10%), 4 (7%) and 1 (1%), respectively. The degrees of DSN and ITH, and subjective nasal congestion scores showed no significant correlation with polysomnographic results. Age and AHI had a correlation coefficient of 0.54 (p<0.001) and AHI increased with increasing age. Multiple linear regression demonstrated that age (regression coefficient 0.229, 95% confidence interval 0.135 to 0.322, p<0.001) was significantly associated with AHI, while other variables showed no statistically significant association with AHI (p>0.05). Conclusion Septal deviation and turbinate hypertrophy are unlikely to cause OSA/snoring independently without other causes of SRBD.

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Generally, a nasal septal abscess (NSA) is defined as a collection of pus between the cartilage and mucoperichondrium or bony septum and mucoperiosteum. It usually occurs after nasal trauma. It is commonly resolved without any complications, however, it can lead to serious complications including sepsis, cerebral spreading, and nasal deformities if not taken early diagnosis and proper management. Recently, we experienced a case of nasal septal abscess of 59 year-old female that developed after electrical cauterization for epistaxis. In this case, abscess pocket was located around Keystone area where the septum joins the nasal bones and the upper lateral cartilage. Incision and drainage was done and symptoms were improved. Any otorhinolaryngologist can encounter septal abscess at any time. This case was unusual because it was developed after electrical cauterization and localized in Keystone area. We report this case and discuss about disease and our thesis for this case.