2025 Poster Presentations
P090: TENOSYNOVIAL GIANT CELL TUMOR OF THE TEMPOROMANDIBULAR JOINT WITH SKULL BASE EROSION: MULTIDISCIPLINARY MANAGEMENT OF A RARE CASE AND REVIEW OF THE LITERATURE
Marc Gelernter; Daniel Sharbel, MD; Kenneth J Byrd, MD; Martin Rutkowski, MD; Marshall F Newman, DMD; Mohammad Seyyedi, MD; M. Salman Ali, MD; Medical College of Georgia at Augusta University
Introduction: Tenosynovial giant cell tumors (TGCT) of the temporomandibular joint (TMJ) with skull base involvement are rare. This case report focuses on the multidisciplinary management of a TGCT with skull base involvement in a dentate 24 year-old female.
Methods: This is a single institution retrospective review of a single case of complex TGCT of the TMJ.
Results: The patient presented with purulent right sided otorrhea, episodic otalgia, and headaches for 1 year. Physical examination revealed right sided facial edema and swelling. Magnetic resonance imaging revealed T2-heterogeneously intense 4.1 x 4.4 x 4.6 destructive lesion of the right TMJ with central necrosis and erosion of the glenoid fossa. Pathology from core needle biopsy showed chondroid metaplasia and dystrophic calcification staining positive for clusterin and negative for desmin and H3K36M.
To address both the intracranial and extracranial tumor components, a multidisciplinary surgical approach involving head and neck surgery, neurosurgery, otology, and oral and maxillofacial surgery was needed. The recommended treatment included right temporal craniotomy, segmental mandibulectomy, resection and reconstruction of the bony ear canal, free tissue transfer, and maxillomandibular fixation. Soft tissue reconstruction of the resection defect was performed using an adipofascial left radial forearm free flap. Following adjuvant radiation, the patient was able to return to a regular diet without weight loss.
Conclusion: Our case highlights the importance of multidisciplinary planning in the event of total resection of the TMJ, glenoid fossa and resulting skull base defect. Adequate occlusal rehabilitation with maintenance of normal diet and quality of life can be achieved with reconstruction using soft tissue alone.