Article
We would like to share a case of a central giant cell tumour of the condyle that presented initially as temporomandibular dysfunction.
A 90-year-old female patient was initially referred to the department of maxillofacial surgery for the treatment of her temporomandibular joint (TMJ) dysfunction. She presented with a history of clicking and radiation of pain from the right TMJ to the right temple. Clinical examination revealed some tenderness in the right TMJ and muscles of mastication, with no restriction of mouth opening. At presentation, the patient admitted that her symptoms were slowly beginning to resolve. The decision was made to treat her symptoms conservatively. Due to the COVID-19 pandemic crisis, the patient was triaged for a telephone consultation. The patient reported that although her symptoms were improving, she was still experiencing pain from her TMJ. She was reassured and a further clinical review was organized for imaging.
While the patient was waiting to be seen by the maxillofacial surgery unit, she had a fall and progressively became unwell.
A CT scan and MRI revealed a semi-cystic mass lesion, possibly centred upon the right TMJ arising from the condyle itself, and eroding the base of skull with an extension into the cranial fossa.
An ultrasound-guided fine-needle aspiration (USGFNA) demonstrated an intra-osseous lesion and features most in keeping with a central giant cell tumour.
Haematological investigation tests, including calcium, thyroid function and parathyroid hormone, were requested to exclude Brown's tumour of hyperparathyroidism, but were all reported to be in the normal range.
The findings were discussed in the weekly head and neck multidisciplinary team (MDT) meeting, and a decision was then made to refer the patient to the palliative care team for the best supportive care and adequate pain relief.
Central giant cell tumours are benign bone tumours that are rarely seen in the jaw. According to the literature review, they account for 4–7% of all primary bone tumours. CGCT is most commonly seen in the mandible rather than in maxilla. Only a few cases have been reported arising from the mandibular condyle with extension to the ramus of the mandible. CGCT presenting as TMJD is very rare.
CGCT of the mandible usually presents as pain, swelling and tender mass. The treatment of choice is surgical removal followed by regular review to monitor the recurrence.
If the symptoms do not resolve or improve, prompt referral to a specialist unit should be considered for appropriate imaging for patents who have been treated conservatively for TMJD in primary care. An early diagnosis will not only prevent the patient having extensive surgery, but also improve the quality of the life of the patient.