A 16-year-old woman with an unremarkable medical history developed right preauricular pain. Examination revealed positive direct and indirect Mahan’s signs. A diagnostic lidocaine block relieved the pain, and the patient was advised to undergo arthrocentesis of the right temporomandibular joint (TMJ). Note: TMJ arthroscopy and arthrocentesis are the most common therapeutic approaches to TMJ disorders when all conservative/medical treatments fail to reduce symptoms. Right TMJ arthrocentesis was performed in a standard fashion by an experienced maxillofacial surgeon with one minor complication. Upon removal of the correct TMJ inflow port, minor pulsatile bleeding was noted and manually controlled by the surgeon with gauze pressure. The joint space was irrigated with normal saline, and intra-articular triamcinolone (corticosteroid) was injected. One day after surgery, the patient complained of loud, permanent, right-sided, disabling, pulsatile tinnitus. Over the next few weeks, the tinnitus became more audible, interfering with concentration during demanding tasks and regular sleep. The tinnitus affected the patient’s hearing, and she began using her telephone with her left ear. It was so intense that she could even record the pulsating noise with her iPhone. Examination of the preauricular region revealed an approximately 1 × 1 cm nontender, soft, pulsatile mass with a palpable thrill and a continuous machine-like buzzing sound in synchrony with the heartbeat (palpable preauricular thrill). When the bell of the stethoscope was applied to the preauricular region, a whooshing pulsatile bruit was auscultated. The patient was unable to tolerate Weber and Rinne’s tests. An audiogram revealed moderate to profound hearing loss on the right side at all frequencies. Hearing improved with intense single-digit manual pressure over the palpable bruit zone. Brain MRI and MR angiography (MRA) revealed an abnormal tangle of vessels in the superficial preauricular region representing an arteriovenous shunt. The arteriovenous fistula (AVF) was successfully treated by embolization in a procedure that required coil occlusion of the superficial temporal artery (STA) on both sides of the arterial injury. After the procedure, the patient reported immediate resolution of pulsatile tinnitus and complete resolution of her hearing loss, confirmed by repeat audiometry.