Pigmented villonodular synovitis of the temporomandibular joint – a case report

Pigmented villonodular synovitis (PVNS), also called giant cell tumor of the tendinous sheaths, have their origin in synovium. The tumor-like lesions are locally destructive. Most cases occur in the knee joint. Only very few cases of temporomandibular joint affection are reported.

A 31-year-old man was referred to our clinic for feeling pressure in the ear region and tinnitus for one year on the right side. For two weeks otorrhea and hearing impairment were present as well. The external auditory canal was swollen and coated with greasy liquid. The audiogram showed mild sensorineural hearing loss without conductive part. Diagnostic imaging was performed with the result of an osteolysis of 3 cm spreading from temporomandibular joint to outer ear canal. Dura mater of the middle cranial fossa was reached and displaced. We performed subtotal petrosectomy and revision of the zygomatic bone. The resected tissue was granulated. Because of tumor adhesion to the dura mater it could not be totally resected. Histological diagnosis of the reference laboratory described an osteolytic tissue containing giant cells. Therefore the most likely diagnosis was a giant cell tumor of the tendinous sheaths developing in the temporomadibular joint. Follow-up examination after six months was clinically unremarkable. MRI showed no destructive growth.

Tumors originating in the temporomadibular joint may lead to symptoms typical for chronic otitis because of their close location to external auditory canal and middle ear. In case of untypical combination of symptoms preoperative imaging should be mandatory for surgical planning.

Publication History

Publication Date:
18 April 2018 (online)