Recognition and Diagnosis of the Complication
Recognition of penetration into the EAC during TMJ arthroscopy typically occurs when the irrigation line is connected to the cannula and fluid emerges from the ear and EAC or upon initial inspection with the arthroscope while maintaining a safe depth (25 mm), when the normal joint space anatomy is not seen and the tympanic membrane may be seen directly. Although unlikely, it is possible that the TM can be mistaken for a pseudo wall within the joint, so confirmation that the arthroscope is indeed in the joint space is necessary before any mechanical disruption of the pseudo wall is performed.
Management of the Complication
Once puncture into the EAC is recognized, the extent of injury should immediately be evaluated by detailed otoscopic examination, possibly with the otomicrosope, to determine if the injury is isolated to the EAC wall or if the TM and/or ossicles are also involved. If the surgeon is not comfortable doing this, an otorhinolaryngology (ENT) consultation should be obtained immediately to assist in full evaluation.