Extra-pulmonary tuberculosis (TB) of the temporomandibular joint (TMJ) and orofacial region is a diagnostic challenge and a high index of suspicion is required for a correct diagnosis. A patient was referred to us with a provisional diagnosis of a parotid fistula in the left submandibular region. Further evaluation revealed this to be TB of the left TMJ with involvement of the adjoining muscle. We report this case of TB involving the TMJ because of its rarity and the associated diagnostic dilemma.