Recently, surgeons at Rambam Health Care Campus (Rambam) performed several complex surgeries to remove the mandibular joints of four young children. In each case, the children suffered severe complications stemming from what began as routine ear infections—a pattern more commonly seen in developing countries.
Ear infections, though painful and distressing, are extremely common in young children and typically respond well to antibiotics. They can occur year round, and approximately 75% of children under age three experience at least one episode and are treated with antibiotics. In rare instances, however, the infection can spread and lead to complications.
According to Dr. Omri Emodi, Director of Rambam's Department of Oral and Maxillofacial Surgery, these cases could have been resolved early with simple treatment and close follow up.
Recently, Dr. Emodi and his surgical team—physicians Dr. Boaz Frenkel, Dr. Tal Capusha, and Dr. Yair Israel—operated on a group of three children ages three and four, as well as a seven year old with a similar complication but treated by a different method. “Most such cases occur in developing countries, where healthcare systems are less advanced,” he explains. “In countries like Israel, where medical services are routinely available, these complications are rare and therefore may be overlooked. In these cases, early signs of a worsening infection were missed, allowing the condition to spread beyond the ear. These children could have been treated successfully much earlier with simple measures.”
One of the patients, a three year old from northern Israel, gradually lost the ability to open his mouth until his jaw became completely locked. “The infection spreads from the ear to the mastoid bone—the bony protrusion behind the ear—causing mastoiditis. From there, the inflammation can reach the jaw joint and trigger calcification,” explains Dr. Andrei Krasovsky, a senior physician in the Department of Oral and Maxillofacial Surgery. "The joint, which should move freely, essentially turns into solid bone, locking the jaw in place.”
Once calcification occurs, the damage is irreversible, and surgical removal of the affected bone is the only option. “To prevent the bone from reforming and fusing again, we insert soft tissue into the gap as a barrier,” adds Dr. Krasovsky.
Following surgery, the children undergo intensive physiotherapy to restore jaw movement. The orthodontic team also places small elevations on the back teeth to keep the lower jaw positioned downward, preventing the bone segments from touching and re fusing during healing.
When the children reach adolescence and their facial bones have fully developed, many will require corrective surgery and artificial joint replacement.
“We cannot rely solely on antibiotics because they don’t address every complication. Patients must be monitored to ensure the infection truly resolves,” concludes Dr. Emodi. “This sudden cluster of cases is a red flag for our healthcare system, and with proper follow up, it is entirely preventable.”
This story is based on a Hebrew language article first published on Mako.
