[A gouty tophus in the temporomandibular joint and on the eustachian tube].

A 76-year old female patient was suffering from a right-sided conduction-type hearing loss due to a very painful tumour in the anterior parotid region. X-ray films showed a partial destruction of the right temporomandibular joint. Since the patient had undergone a left-sided mastectomy for breast carcinoma two years previously, an operation was performed under the suspicion of a metastatic lesion. A plum-sized gouty tophus was found adjacent to the temporomandibular joint. The head of the mandible was partly destroyed, the upper pole of the parotid gland displaced and atrophic. The dorsal and medial aspect of the tophus impinged on the cartilaginous portion of the Eustachian tube. In the postoperative course, the conduction-type deafness disappeared, the pain was relieved, and the mobility of the joint almost completely restored. To our knowledge this represents the second case of a gouty tophus in the temporomandibular joint, the first one where the size of the lesion resulted in impingement of the Eustachian tube and conduction-type deafness. It is noteworthy that the patient showed no other signs or symptoms of primary gouty arthritis.