Periarticular Cysts Of The Temporomandibular Joint Are More Frequently Synovial Than Ganglion

Publication date: Available online 28 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): J. Partridge, N. Cipriani, W.C. Faquin, S.K. Chuang, D.A. Keith, E. Lahey
PurposeDifferentiating between ganglion and synovial cysts by standard histology is difficult, leading to inaccurate statements on frequency for each of these periarticular lesions. The purpose of this study is to use immunohistochemical (IHC) analysis to 1) calculate the accuracy of the histological diagnoses, 2) determine the frequency of ganglion and synovial cysts of the temporomandibular joint (TMJ) and 3) compare the frequency of these lesions in the TMJ compared to the extracranial skeleton in patients treated at Massachusetts General Hospital (MGH).Materials and MethodsThis is a retrospective cohort study of all patients undergoing treatment of TMJ cysts at MGH between 2001 and 2013. IHC analysis of tissue samples for each patient was completed and compared to original histological diagnoses. Categorical variables including age, gender and sidedness were recorded. A natural language search of the Department of Pathology database determined the frequency of extracranial periarticular cysts during the same timeframe.ResultsThirteen patients met the inclusion criteria. Eleven cysts were synovial and two were ganglion based on histology. IHC analysis identified two false positive synovial cyst diagnoses resulting in 100% sensitivity and 50% specificity for the original histological assessment and a percent error of 22%. Of the periarticular TMJ lesions, 69% were synovial cysts while 31% were ganglion. The frequency of TMJ versus extracranial ganglion cysts is 0.24%, and the frequency of TMJ versus extracranial synovial cysts is 0.60% based on a total of 3,176 extracranial cysts (1506 synovial; 1670 ganglion).ConclusionThis study represents the largest single-institution experience with periarticular cysts of the TMJ and contrary to previous reports, TMJ cysts appear to be more frequently synovial than ganglion. IHC can be used to overcome the relatively poor specificity of histological diagnosis of synovial cysts.



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