Jackson Lindsey, Poynter Jacob, Rahman Maryam, Massini Tara, Chen Si
Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, United States.
Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States.
J Neurol Surg Rep. 2025 Jun 17;86(2):e127-e132. doi: 10.1055/a-2620-3584. eCollection 2025 Apr.
Temporomandibular joint (TMJ) cysts extending through the skull base into the middle cranial fossa (MCF) are rare, with limited data on clinical progression and treatment. This study retrospectively analyzed three cases of TMJ cysts with MCF extension managed by a multidisciplinary team. Clinical presentation, imaging, surgical resection, outcomes, and a literature review are presented.
Three patients presenting with otalgia and TMJ tenderness were found to have intracranial cysts communicating with the TMJ. Two patients had been transferred with suspected intracranial abscesses; one presented for workup of headache and trigeminal neuralgia. All three demonstrated elevation of inflammatory markers. Two patients had TMJ aspiration, notable for leukocytosis and crystalline deposition, another had frank purulence. One patient demonstrated pneumocephalus within the cyst on imaging. The intracranial cysts ranged from 1.2 to 3.3 cm in maximum diameter, with their bony defects ranging from <1 to 4 mm. Two patients underwent craniotomy, cyst resection, and repair of the middle fossa defect, while the third opted for observation. Pathology of the white gelatinous fluid within the two resected growths demonstrated benign cysts.
TMJ cysts with intracranial extension, while rare, require careful differentiation from intracranial abscesses. Surgical urgency may be indicated in cases demonstrating clinical signs of infection. Additionally, TMJ cysts with intracranial extension benefit from surgical removal and skull base repair to relieve symptoms and prevent future complications.
颞下颌关节（TMJ）囊肿延伸至颅底进入中颅窝（MCF）的情况罕见，关于其临床进展和治疗的数据有限。本研究回顾性分析了由多学科团队管理的3例颞下颌关节囊肿伴中颅窝延伸的病例。介绍了临床表现、影像学检查、手术切除、治疗结果及文献综述。
3例出现耳痛和颞下颌关节压痛的患者被发现有与颞下颌关节相通的颅内囊肿。2例因疑似颅内脓肿转诊；1例因头痛和三叉神经痛前来检查。所有3例炎症标志物均升高。2例患者进行了颞下颌关节穿刺抽吸，结果显示白细胞增多和晶体沉积，另1例有明显脓液。1例患者影像学检查显示囊肿内有气颅。颅内囊肿最大直径为1.2至3.3厘米，骨质缺损范围为<1至4毫米。2例患者接受了开颅手术、囊肿切除及中颅窝缺损修复，第3例选择观察。2个切除肿物内白色胶状液体的病理检查显示为良性囊肿。
颞下颌关节囊肿伴颅内延伸虽罕见，但需要与颅内脓肿仔细鉴别。出现感染临床体征的病例可能需要手术治疗。此外，颞下颌关节囊肿伴颅内延伸通过手术切除和颅底修复可缓解症状并预防未来并发症。
