Temporomandibular joint cyst as a preauricular mass

Bilateral synovial cysts of the temporomandibular joint

Synovial cysts very rarely affect the temporomandibular joint (TMJ). On review of the literature, there are 29 reported cases of unilateral synovial cysts of the TMJ. We present a case of bilateral synovial cysts occurring at the TMJs.

Synovial Cysts in the Temporomandibular Joint: a Case Report and Critical Review of the Literature

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.

Ganglion and Synovial Cyst of the Temporomandibular Joint: A Case Report and Literature Review

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.

Synovial cysts of the temporomandibular joint: an immunohistochemical characterization and literature review

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.

Preauricular angioleiomyoma

Preauricular masses are commonly seen in the otology clinic. Excisional biopsy is essential for diagnosis, and treatment is necessary to reduce the risk of malignancy and for cosmetic purposes. We recently treated a rare case of angioleiomyoma of the preauricular area. Angioleiomyoma is a benign tumor arising from smooth muscle within blood vessel walls. These tumors can arise anywhere in the body; however, they are usually found in the lower extremities and present as a painful mass. Angioleiomyoma of the preauricular area in an elderly person is rare, and only a few cases have been reported. Here, we report the case of an 85-year-old male patient with angioleiomyoma of the preauricular area and provide a literature review.

Synovial cyst of the temporomandibular joint: a case report and literature review

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.

Le kyste synovial de l'articulation temporomandibulaire

OBSERVATION

A 30-year-old patient presented with a left painful pre-auricular tumefaction for one year. CT-scan suggested the diagnosis of temporomandibular synovial cyst or first branchial cleft cyst. This was confirmed by surgery.

DISCUSSION

Temporomandibular synovial cysts are rare, the etiology is not documented. Revealing symptoms are those mentioned above. The common treatment is surgery.

Temporomandibular Joint Cyst Presenting as Trigeminal Neuropathy and Middle Fossa Mass: Case Report

OBJECTIVE:

We describe the case of a temporomandibular joint cyst eroding into the middle fossa, initially causing compression of the trigeminal nerve and trigeminal neuropathy, and ultimately causing destruction of the second division of the nerve with facial numbness.

CLINICAL PRESENTATION:

A 50-year-old woman with rheumatoid arthritis on prednisone developed right-sided, initially lancinating facial pain that ultimately became dull in nature in the maxillary division of the trigeminal nerve. This change in pain was associated with the development of numbness in the same distribution. The facial pain gradually resolved, but the facial numbness persisted. Imaging revealed a heterogeneously enhancing mass in the middle fossa lateral to Meckel's cave.

INTERVENTION:

During surgery, the dura was elevated, and a smooth, firm lesion with several thinly encapsulated, cystic areas containing viscous, white fluid was identified. The mass had eroded through the floor of the middle cranial fossa. The thick, fibrous capsule was freed from the bone edges and was sectioned sharply extracranially. Pathological evaluation was consistent with a cyst originating from the temporomandibular joint.

CONCLUSION:

Extracranial mass lesions involving the middle fossa structures are uncommon and typically arise from the parotid gland. This case represents the first example of a middle fossa mass originating from an abnormal temporomandibular joint and a unique cause of trigeminal neuropathy. After excision, there has been no recurrence after 2 years of follow-up.