Ganglion cyst of the temporomandibular joint with intracranial extension in a patient presenting with seventh cranial nerve palsy

Case report

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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.

Abbreviation used in this paper: TMJ = temporomandibular joint.

Article Information

Address correspondence to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, University of Utah, 175 North Medical Drive East, Salt Lake City, Utah 84132. email:

Please include this information when citing this paper: published online November 25, 2011; DOI: 10.3171/2011.10.JNS111247.

© AANS, except where prohibited by US copyright law.



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    Preoperative images showing the TMJ lesion involving the condylar fossa bony wall, floor of the middle cranial fossa, and the geniculate ganglion of the facial nerve on the left. An axial bone CT image (A) shows the eroded mandibular condylar head (arrow) with a lucent defect in the medial wall of the bony condylar fossa (arrowhead). A more superior axial bone CT image (B) at the level of the geniculate fossa reveals dehiscence of the anterior bony margin (arrow) exposing the geniculate ganglion to the middle cranial fossa. An axial T2-weighted MR image (C) through the left middle cranial fossa demonstrates a mixed high- and low-signal lesion in the posterior floor of the middle cranial fossa (arrow) abutting the anterior temporal bone margin. With enhancement and fat saturation, an axial T1-weighted MR image (D) of the same region as in panel C shows the rim-enhancing low-signal lesion (arrow) in the floor of the middle cranial fossa with pathological enhancement of the geniculate ganglion (arrowhead) and adjacent components of the facial nerve.

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    Axial (A) and coronal (B) T1-weighted MR images obtained after complete removal of the lesion. No enhancing residual lesion is evident in the left middle fossa. Fat graft is visible on the lateral floor of the left middle fossa.

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    Photomicrographs of surgical specimens prepared with H & E staining. The collagenous wall of the ganglion cyst has low cellular density (A), and a small amount of hemorrhage is evident within the collagenous tissue. There is absence of a synovial cell layer on the luminal surface of the ganglion cyst (B). Original magnification × 40 (A) and × 100 (B).



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