Distance between Temporomandibular Joint and Mastoid process: A Novel Independent Factor to Consider for Surgical Management of CAA
Keywords:
Congenital aural atresia, CAA, atresiaplasty, canaloplasty, TMJ, mastoid and TMJ distanceAbstract
Material and method: This is a prospective interventional study done on 07 patients who presented at our tertiary health care centre in year 2024. All patients underwent detailed preoperative clinical, radiological and audiological evaluation. Clinical assessment of distance between mastoid process and TMJ was done by finger placing method. This was later quantified by exact measurement on HRCT temporal bone (“n” score). Jahrsdoefer (J) score was calculated for all patients. Post operative complication rate and surgical failure was then assessed in all patients with comparision of “n” score and “J” score. Results: Out of 07 patients included in our study M:F ratio was 3:4. 03 patients had less than 01 finger breadth distance between TMJ and mastoid process. Distance between TMJ and mastoid process anterior border on HRCT temporal bone is “n score” which ranged from 3.6mm to 12.9mm and Jahrsdoefer score “J” ranged from 03 to 09. 01 patient had non pneumatized mastoid (n = 3.6 mm, J=03) cavity and 2 patients had partially pneumatized mastoid cavity ( n = 7.5mm,J=07 & n = 7.6 mm, J=06 ). In 3 cases who had undergone atresia-plasty the distance between TMJ and mastoid process was </= 7.5 mm we observed higher rate of complication of re-stenosis and inadequate space for drilling intraoperatively. We observed that even in cases with high J score if n score is less (n=3.9mm and J=7.5), there are higher rates of post operative complications. Conclusion: In addition to Jahrsdoefer score, a distance of >7.5mm between TMJ and mastoid process is important in determining the surgical management plan and intra-operative feasibility, outcome and post-operative complications in CAA patients.
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