Ganglion cyst in the temporomandibular joint: A case report and discussion of surgical approaches.

Background: Ganglion cysts in the temporomandibular joint are treated by resection; however, there has been insufficient discussion regarding the appropriate approach for surgical resection. Clinical presentation: A 55-year-old man presented with a left preauricular swelling for one year. The examination revealed a moderately hard mass with a 30-mm diameter, tenderness, and restricted movement. Magnetic resonance imaging showed a cystic lesion with a 25 mm-long axis. Considering a diagnosis of temporomandibular cyst, separation of the cyst wall through a preauricular incision was attempted. However, the cyst ruptured due to strong adherence on the reverse side. Curettage followed by discectomy was performed. Histopathological diagnosis was of a ganglion cyst. Among 39 reported cases, 24 were excised via the preauricular approach, with 8 intraoperative cyst ruptures. Conclusion: The parotidectomy approach should be employed when the cyst is large, at a low position, or adherent to the surrounding tissue, in order to achieve reliable excision.