Spontaneous herniation of the temporomandibular joint into the external auditory canal is rare and generally results from inflammation or trauma but is rarely documented as a result of osteoradionecrosis. We report the novel surgical management of TMJ herniation by reconstructing the anterior EAC using conchal cartilage and a vascularized pedicled muscle flap in two patients. At follow-up, both had healing of the ear canal and TM without any evidence of joint herniation, with improved QOL and hearing. TMJ herniation due to an anterior EAC defect from osteoradionecrosis or trauma can be reconstructed with a cartilage graft and vascularized fascia flap. Laryngoscope, 135:1078-1082, 2025.