Dynamic MRI of the Temporomandibular Joint for Symptomatic Foramen Tympanicum (Huschke Foramen)

Persistent foramen tympanicum, otherwise known as Huschke foramen, is a rare anatomic variant allowing connection of the external auditory canal (EAC) to the temporomandibular joint (TMJ). Although often asymptomatic, it can present with otalgia, hearing loss, and complications, including TMJ herniation or salivary fistulas. In this Case Report, dynamic MRI was used to diagnose symptomatic persistent foramen tympanicum in a 73-year-old man with hearing loss, otalgia, and jaw-related symptoms. Dynamic MRI revealed tissue protrusion through the persistent foramen tympanicum with simultaneous ingress of gas from the EAC through the persistent foramen tympanicum during jaw movements and accumulation of gas and fluid in the medial temporomandibular space. This case highlights the utility of cine MRI in capturing TMJ biomechanics and pathologies linked to persistent foramen tympanicum, offering insights into its potential clinical applications. Future studies are warranted to explore the role of dynamic MRI in evaluating persistent foramen tympanicum complications and refining TMJ disorder management.