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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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Eddelman D, Byrne R, Arvanitis LD. Inflammatory effusion of the temporomandibular joint with intracranial extension into the middle fossa: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Temporomandibular Joint Ganglion Cyst: A Unique Case of Complete Resolution Following Subtotal Excision. J Oral Maxillofac Surg 2016; 74:1783-91. [DOI: 10.1016/j.joms.2016.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/18/2022]
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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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Surgical treatment of temporomandibular disorder in a 24-year-old male patient with ganglion cyst. J Craniofac Surg 2015; 26:560-2. [PMID: 25643336 DOI: 10.1097/scs.0000000000001231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ganglion cysts are common pseudocystic masses, whereas those arising from the temporomandibular joint (TMJ) are rare entities. We report a case of ganglion cyst of the right TMJ with symptomatic bilateral TMJ internal derangement in a 24-year-old man. Disk repositioning using bone anchors and excision of the ganglion cyst were performed. A unique characteristic of inflammatory infiltrates was revealed in the specimen, and the relationship between these 2 distinct entities and probable pathogenesis of infectious involvement are discussed.
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Synovial cysts of the temporomandibular joint: an immunohistochemical characterization and literature review. Case Rep Pathol 2013; 2013:508619. [PMID: 23573446 PMCID: PMC3616358 DOI: 10.1155/2013/508619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/25/2013] [Indexed: 11/18/2022] Open
Abstract
Synovial cysts of the temporomandibular joint (TMJ) are very rare, and to date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature. In this paper, we present the clinicopathological and immunohistochemical characteristics of one such lesion affecting a 48-year-old woman, presented with a mass in the left preauricular region. We describe the usefulness of immunohistochemical analysis for recognizing the synovial lining, which allowed for clear differentiation between ganglion and synovial cysts. Immunohistochemical analyses can be used to diagnose synovial cysts with certainty; however, using at least two markers is advisable to distinguish the two existing synovial cell subtypes. Our findings indicate that synovial cysts of TMJ possess an internal lining dominated by type B (fibroblast-like) synoviocytes.
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Okochi K, Nakamura S, Tetsumura A, Honda E, Kurabayashi T. Magnetic resonance imaging of temporomandibular joint cyst. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:827-31. [DOI: 10.1016/j.oooo.2011.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 12/15/2022]
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Mumert ML, Altay T, Shelton C, Harnsberger HR, Couldwell WT. Ganglion cyst of the temporomandibular joint with intracranial extension in a patient presenting with seventh cranial nerve palsy. J Neurosurg 2012; 116:310-2. [DOI: 10.3171/2011.10.jns111247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ganglion cysts arising from the temporomandibular joint are rare entities that often present with swelling and minimal to no pain in the preauricular region. To the authors' knowledge, a temporomandibular joint ganglion cyst occurring with acute facial nerve palsy and intracranial extension has never been reported. The patient in the current case initially underwent treatment for Bell palsy and then draining of the cyst at an outside hospital with no relief of symptoms. Repeat MR imaging showed an increase in the size of the cystic, enhancing, middle fossa lesion measuring 4 cm. Resection of the lesion was undertaken using a middle fossa approach. After a satisfactory surgical decompression, the patient demonstrated a significant recovery in her facial palsy over a 3-month period of time. This case presents new clinical and radiographic findings associated with these lesions.
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Affiliation(s)
| | | | - Clough Shelton
- 2Division of Otolaryngology/Head & Neck Surgery, Department of Surgery; and
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Preauricular transcondylar approach for basal cell adenoma of parotid coexist with ganglion cyst of the ipsilateral temporomandibular joint. J Craniofac Surg 2011; 22:e23-6. [PMID: 22134312 DOI: 10.1097/scs.0b013e31822ec903] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The concurrence of 2 independent neoplasias in the ipsilateral parotid and the temporomandibular joint (TMJ) region was infrequently reported. In this article, we present a unique case characterized by the coexistence of a rare salivary gland tumor, basal cell adenoma, of the parotid gland with a ganglion cyst in the ipsilateral TMJ region. A special surgical procedure was also presented here using a modified preauricular incision and transcondylar approach for extracapsular dissection of both lesions. Previously published literature are about the traditional treatment of benign parotid tumors using partial or total parotidectomy with the preservation of facial nerve mainly via an S-shaped submandibular incision and approach. Here, for the first time, a special surgical method using preauricular transcondylar approach for this unique case of synchronous occurrence of parotid tumor and TMJ cyst is reported.
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Khachi S, Gubbels SP, Robinson RA, Hansen MR. Ganglion cyst presenting as an external auditory canal mass. Otolaryngol Head Neck Surg 2011; 144:131-2. [PMID: 21493405 DOI: 10.1177/0194599810390462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Steve Khachi
- Department of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, WI, USA
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Spinzia A, Panetta D, Russo D, Califano L. Synovial cyst of the temporomandibular joint: a case report and literature review. Int J Oral Maxillofac Surg 2011; 40:874-7. [PMID: 21470821 DOI: 10.1016/j.ijom.2011.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/11/2011] [Accepted: 02/22/2011] [Indexed: 11/19/2022]
Abstract
Synovial cysts are lesions that usually occur on the wrist, foot and knee. They are rarely involved in the region of the temporomandibular joint (TMJ), with only 10 cases reported from 1978 to 2007. The authors report a case of a synovial cyst of the TMJ in a 45-year-old woman. The patient presented with a right preauricular swelling, 1cm anterior to the tragus. A computed tomography (CT) scan showed a small oval hypodense mass of soft tissue in the right temporomandibular region with no relation to the condyle. Fine needle aspiration reported a synovial cyst of the TMJ. The patient was taken to the operating room and a preauricular approach extending to the temporal region was carried out resulting in surgical excision of the mass. The histological findings were consistent with the diagnosis of a synovial cyst. The long term clinical and radiological follow-up (after 18 months) showed no sign of recurrence. The authors suggest, in accordance with the literature, that a surgical approach should be the treatment of choice in the case of a synovial cyst of the TMJ.
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Affiliation(s)
- A Spinzia
- Department of Maxillofacial Surgery, University Federico II, Napoli, Italy.
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Deng R, Yang X, Tang E. Ganglion cyst of the temporomandibular joint. Br J Oral Maxillofac Surg 2010; 48:224-5. [DOI: 10.1016/j.bjoms.2009.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 08/17/2009] [Indexed: 12/01/2022]
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Lima SM, de Souza Maliska MC, Dimitroulis G, Modolo F, Nazareno Gil J. Painful deviation of the mandible. ACTA ACUST UNITED AC 2009; 107:749-53. [PMID: 19230727 DOI: 10.1016/j.tripleo.2009.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/25/2008] [Accepted: 01/03/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Sergio Monteiro Lima
- Department of Oral and Maxillofacial Surgery, Federal University of Santa Catarina, Florianópolis, Brazil.
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