Temporomandibular Joint Ganglion Cyst: A Unique Case of Complete Resolution Following Subtotal Excision.

Ganglion cysts of the temporomandibular joint (TMJ) are a rare entity. Most often, ganglions present in anatomic regions, such as the hand, wrist, knee, foot, or ankle. Ganglion cysts are pseudocysts characterized by a fibrous connective tissue lining that lacks synovial cells and contains a thick gelatinous material. The etiology remains unclear, but might involve myxoid degeneration or softening of the collagen and connective tissue after long-term irritation and trauma. Ganglion cysts of the TMJ most commonly present as a swelling in the preauricular region, produce limited or no pain, and often have no effect on mouth opening. Because of the infrequent involvement of ganglion cysts with the TMJ and the nonspecific clinical presentation, the diagnosis is challenging. Diagnostic imaging tools, such as computed tomography and magnetic resonance imaging, have aided in diagnosis; however, only histopathologic examination will lead to a definitive diagnosis. The precise management of ganglion cysts of the TMJ remains uncertain owing to the uncommon appearance of these lesions. Treatment has focused on surgical excision without regard for lesion size or symptoms. This seems to be due to the decreased rate of recurrence after complete excision and microscopic examination providing the best method for a definitive diagnosis. This report describes a unique case of an 88-year-old woman with a large multilocular ganglion cyst of the right TMJ that completely resolved approximately 1.5 years after subtotal cystectomy.

Surgical management of the buccal bifurcation cyst: bone grafting as a treatment adjunct to enucleation and curettage.

The buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst of unknown etiology. It typically develops on the buccal aspect of the permanent mandibular first molar and occasionally on the permanent mandibular second molar in children 4 to 14 years old. Distinct clinical findings of the BBC include involvement of a vital partially or fully erupted mandibular first or second molar, swelling in the affected mandibular molar region, delayed or altered eruption pattern of the involved tooth, and an increase in periodontal pocket depth when the affected tooth is partially erupted. Specific radiographic features include a radiolucent lesion on the buccal aspect of the tooth involving the roots to a variable extent, tilting of the involved molar so that the root apices are toward the lingual cortical plate, an intact periodontal ligament space and lamina dura, a periosteal reaction on the buccal surface, and an intact inferior border of the mandible. The histopathology of the lesion has been described as similar to a radicular or inflammatory odontogenic cyst. Most of the current literature supports simple enucleation and curettage of the cyst without extraction of the involved tooth as the treatment of choice. This report presents 3 cases of BBCs that were treated with enucleation and curettage without extraction of the involved tooth, in addition to a bone graft placed primarily or secondarily as an adjunctive treatment approach to the current therapies.