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Krishnan P, Dineshkumar T, Divya B, Krishnan R, Rameshkumar A. Ganglion cyst of temporomandibular joint - A systematic review. Ann Diagn Pathol 2023; 67:152212. [PMID: 37748213 DOI: 10.1016/j.anndiagpath.2023.152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.
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Affiliation(s)
- Padmajaa Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Thayalan Dineshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Bose Divya
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India.
| | - Rajkumar Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Annasamy Rameshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
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Maribo Y, Stokbro K, Aagaard E, Larsen SR, Thygesen T. Synovial Cysts in the Temporomandibular Joint: a Case Report and Critical Review of the Literature. J Oral Maxillofac Res 2019; 10:e4. [PMID: 31069041 PMCID: PMC6498815 DOI: 10.5037/jomr.2019.10104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
Abstract
Background Synovial cysts of the temporomandibular joint are rare and treatment is based on consensus from cases reporting unilateral successful outcomes. A patient with a synovial cyst is presented, treated with successful surgical excision of the cyst, but without remission of joint symptoms. Furthermore, the case is supplemented by a critical, literature review. Methods This case report deals with a patient with a synovial cyst that presented with temporomandibular joint (TMJ) pain and reduced mouth opening. Magnetic resonance imaging verified a TMJ cyst. Results Surgical excision removed the synovial cyst, and the patient was followed-up for 4 years, with no recurrence of the cyst. Despite successful excision of the cyst, the symptoms did not subside, and the patient is still in treatment. The critical, literature review found 23 case reports describing 24 synovial cysts. In addition, 4 cases were included as their synovial cysts were erroneously described as ganglion cysts. In 4 cases, histological diagnosis could not be confirmed, and they were excluded. All cases described treatment by surgical excision without recurrence. The reported median follow-up was 10 months and postoperative TMJ symptoms were rarely examined or described. Conclusions The temporomandibular joint symptoms may persist despite successful removal of the synovial cyst. Furthermore, the 4 identified synovial cysts, mislabelled as ganglion cysts, represents almost a quarter of the cases of the reported synovial cysts. Correct labelling and reporting of synovial cysts are still imperative to describe the diverse aspects of treatment outcomes following surgical excision.
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Affiliation(s)
- Ynn Maribo
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
| | - Kasper Stokbro
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark.,Clinical institute, Faculty of Health, University of Southern DenmarkDenmark
| | - Esben Aagaard
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
| | | | - Torben Thygesen
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
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Segami N, Nojima T. Ganglion cyst in the temporomandibular joint: A case report and discussion of surgical approaches. Cranio 2018; 37:400-404. [PMID: 29685088 DOI: 10.1080/08869634.2018.1465512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Ganglion cysts in the temporomandibular joint are treated by resection; however, there has been insufficient discussion regarding the appropriate approach for surgical resection. Clinical presentation: A 55-year-old man presented with a left preauricular swelling for one year. The examination revealed a moderately hard mass with a 30-mm diameter, tenderness, and restricted movement. Magnetic resonance imaging showed a cystic lesion with a 25 mm-long axis. Considering a diagnosis of temporomandibular cyst, separation of the cyst wall through a preauricular incision was attempted. However, the cyst ruptured due to strong adherence on the reverse side. Curettage followed by discectomy was performed. Histopathological diagnosis was of a ganglion cyst. Among 39 reported cases, 24 were excised via the preauricular approach, with 8 intraoperative cyst ruptures. Conclusion: The parotidectomy approach should be employed when the cyst is large, at a low position, or adherent to the surrounding tissue, in order to achieve reliable excision.
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Affiliation(s)
- Natsuki Segami
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University , Ishikawa , Japan
| | - Takayuki Nojima
- Department of Pathology, Kanazawa University Hospital , Ishikawa , Japan
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Kerwell S, Alfaro M, Pourzal R, Lundberg HJ, Liao Y, Sukotjo C, Mercuri LG, Mathew MT. Examination of failed retrieved temporomandibular joint (TMJ) implants. Acta Biomater 2016; 32:324-335. [PMID: 26768232 DOI: 10.1016/j.actbio.2016.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/09/2015] [Accepted: 01/03/2016] [Indexed: 12/27/2022]
Abstract
In the management of end-stage temporomandibular joint disorders (TMD), surgeons must often resort to alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) to increase mandibular function and form, as well as reduce pain. Understanding wear and failure mechanisms of TMJ TJR implants is important to their in vivo longevity. However, compared to orthopedic TJR devices, functional wear of failed TMJ TJR implants has not been examined. Not only do wear and corrosion influence TJR implant in vivo longevity, but so does reactivity of peri-implant tissue to these two events. The aim of this study was to examine and report on the wear of retrieved, failed metal-on-metal (MoM), metal-on-polymer (MoP), and titanium-nitride coated (TiN Coated) TMJ TJR implant components. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. The mean time from implantation to removal was 7.24 years (range 3-15), SD 3.01. Optical microscopy, White Light Interferometry (WLI), Scanning Electron Microscopy (SEM), and Raman spectroscopy were utilized to characterize the surfaces of the devices. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Damage included pitting corrosion, evidence of deposited corrosion products, specific wear patterns, hard phases, surface depressions, and bi-directional scratches. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. Electrochemical tests consisted of open circuit potential (OCP) and electrochemical impedance spectroscopy (EIS) tests conducted using the condylar head of the retrieved failed devices. EIS confirmed material properties as well as corrosion kinetics in vivo help to mitigate corrosion as reflected by the Raman spectroscopy results. In summary, this study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, studies such as this can provide data that will improve future embodiment paradigms for both. Further studies will include in vitro investigation of corrosion kinetics and the underlying tribocorrosion mechanism of TMJ TJR devices. STATEMENT OF SIGNIFICANCE An attempt is made in this study, to examine the retrieved TMJ implants and conduct surface and electrochemical analysis; further a translation research approach is employed to compare the observations from the total hip replacement (THR) retrievals. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. This study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, a comparison study was conducted.
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Affiliation(s)
- S Kerwell
- Department of Bioengineering, University of Illinois at Chicago, Chicago, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - M Alfaro
- Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - R Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - H J Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Y Liao
- Department of Material Science and Engineering, Northwestern University, Evanston, IL, USA
| | - C Sukotjo
- Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - M T Mathew
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA.
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Ganglion and Synovial Cyst of the Temporomandibular Joint: A Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e524. [PMID: 26495237 PMCID: PMC4596449 DOI: 10.1097/gox.0000000000000494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 07/22/2015] [Indexed: 12/21/2022]
Abstract
Ganglion and synovial cysts of the temporomandibular joint (TMJ) are rare. Although histopathological findings differ, clinical presentation is comparable. This study adds a case report of a ganglion of the TMJ to existing literature and a review of all available case reports on ganglion and synovial cysts of the TMJ. Including our own case report, we reviewed 49 cases of ganglion and synovial cysts of the TMJ. They occurred in a female:male ratio of 3:1, at an median age of 46 years (range, 11-64 years). Patients mainly presented with preauricular swelling and pain. After imaging, the ganglion or synovial cyst was most commonly excised under general anesthesia. No recurrences were described.
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Capek S, Koutlas IG, Strasia RP, Amrami KK, Spinner RJ. An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves. J Neurosurg 2015; 122:1433-7. [DOI: 10.3171/2014.12.jns14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of an intraneural ganglion cyst involving a cranial nerve (V3), which was found to have a joint connection in support of an articular origin within the cranial nerves. An inferior alveolar intraneural cyst was incidentally discovered on a plain radiograph prior to edentulation. It was resected from within the mandibular canal with no joint connection perceived at surgery. Histologically, the cyst was confirmed to be an intraneural ganglion cyst. Reinterpretation of the preoperative CT scan showed the cyst arising from the temporomandibular joint. This case is consistent with the articular (synovial) theory of intraneural ganglion cysts. An anatomical explanation and potential joint connection are provided for this case as well as several other cases of intraneural cysts in the literature, and thus unifying cranial nerve involvement with accepted concepts of intraneural ganglion cyst formation and propagation.
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Affiliation(s)
- Stepan Capek
- Departments of 1Neurosurgery and
- 2International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic; and
| | - Ioannis G. Koutlas
- 3Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Rhys P. Strasia
- 4Center for Oral & Maxillofacial Surgery, Madison, Wisconsin
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Algharib A, Parekh J, Sultan A, Hopper C. A rare case of a ganglionic cyst of the TMJ – Case report and review of the literature. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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