Abstract
In this case series, we present six cases with the initial complaint of pain and/or progressive unilateral pre-auricular swelling. All patients presented at our Department of Oral and Maxillofacial surgery from January 2000 to December 2018. CT and/or MRI revealed cystic lesions with a preferred diagnosis of synovial or ganglion cyst. In four patients, the cyst was surgically removed and anatomopathological findings confirmed the diagnosis of a synovial cyst in three patients and a ganglion cyst in one case. In one patient, the cyst disappeared after puncture biopsy. The last patient did not have significant complaints and was treated conservatively. Even though recurrence of ganglion cysts in the temporomandibular joint has not been described before, we observed a recurrent ganglion cyst after complete initial surgical removal in one of our cases. This occurred 3.5 years after the initial surgery.
Due to the limited duration of follow-up in most case series, recurrence rates may be underestimated. This case series aims to raise awareness for the possible presence and recurrence of ganglion cysts and to thoroughly evaluate the symptoms before resection is considered. If a diagnosis of a synovial of ganglion cyst is suspected, a diagnostic workup should be performed. Surgical removal of the cyst is indicated in cases where the cyst is symptomatic and has an impact on daily life. Otherwise, a conservative treatment can be considered.
Highlights
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Cystic lesions of the temporomandibular joints are rare.
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A synovial cyst is more common than a ganglion cyst.
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Synovial and ganglion cysts may recur.
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Resection of the cyst does not always lead to resolution of pain.
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Spontaneous regression of small cysts is possible.
1
Introduction
Synovial and ganglion cysts are common benign cystic lesions, but they rarely occur in the temporomandibular joint (TMJ) [ ]. The cysts can be asymptomatic or cause symptoms, such as pain or pre-auricular swelling [ ]. Other possible symptoms are headache, otalgia, TMJ sounds or crepitus, malocclusion, reduced mouth opening, facial nerve palsy, dizziness or vertigo, fullness of the ear, and tinnitus [ , ]. Clinically, the two entities are difficult to distinguish. Diagnosis is made based on radiographic and mainly pathologic investigation [ ].
In this case series, we selected all patients diagnosed with synovial or ganglion cysts who presented at our Department of Oral and Maxillofacial surgery from January 2000 to December 2018 in order to evaluate the clinical characteristics and surgical outcome.
1.1
Presentation of case series
A total of 6 patients were retrieved. The case details of all cases can be found in Table 1 . A total of five patients had a synovial cyst of the TMJ and one had a proven ganglion cyst. The mean age of the six patients was 44 years. Four of them were female and two were male. The cysts occurred more often on the right side (4 of 6 patients). The most common sign during the clinical investigation was the presence of a pre-auricular swelling/nodule and pain during palpation. Other observed complaints were tinnitus and recurrent otitis. In one patient, a spontaneous atypical burning pain was present, starting at the left orbit.
| Case | Age (years) | Cyst type | Symptoms | Side cystic lesion | Duration of symptoms | Radiography | Diameter a | Treatment | Postoperative complications | Recurrence |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 46 | Synovial | Progressive swelling, pain during palpation, tinnitus | Right | 12 months | MRI | 12 mm | Surgical resection | Hypoesthesia, pre-auricular | No |
| 2 | 74 | Synovial | Pain during palpation, recurrent otitis | Right | 7 months | CT/MRI | 22 mm | Surgical resection | None | No |
| 3 | 43 | Synovial | Swelling | Right | 2 months | CT/MRI | 7 mm | Conservative | / | / |
| 4 | 26 | Synovial | Swelling, pain during palpation | Right | Recently discovered before first consultation | MRI | 4 mm | Conservative | / | / |
| 5 | 42 | Synovial | Pain (burning sensation) | Left | 5 months | MRI | 8.5 mm | Surgical resection | Worsening of pain, persisting neuropathic pain | No |
| 6 | 35 | Ganglion | Progressive swelling | Left | Years present | MRI | 14 mm | Surgical resection | None | Yes |
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