A 48-year-old man was admitted at the Department of #ENT for an acute spinning type of dizziness lasting a week. An otolaryngologists first impression was vestibular neuritis, and magnetic resonance imaging (MRI) was performed for further evaluation. The MRI revealed chronic otomastoiditis and a cystic mass in the left pre-auricular region. The otolaryngologist prescribed medications for vestibular neuritis. Because the otolaryngologist and a radiologist regarded the patients preauricular mass to be a simple subcutaneous benign mass, the patient was also referred to the CranioMaxilloFacial Department for mass removal. Preoperatively, the patient had no typical symptoms and signs such as malocclusion, trismus, a clicking sound, or TMJ tenderness except for the mild swelling at the preauricular area. Physical examination revealed a 1-cm round, slightly mobile mass in front of the right tragus. As the junior author regarded the mass to be a simple subcutaneous cyst such as a lipoma or an epidermal cyst, he performed a surgical excision of the tumor under local anesthesia. The surgeon injected local anesthetics (2% lidocaine with 1:80,000 epinephrine) very superficially into the subcutaneous layer. Then, he made a direct vertical small incision in front of the right tragus over the protruding mass and performed dissection with a pair of blunt Metzenbaum scissors. During dissection around the mass, he inadvertently found that the mass penetrated into the depth of the temporalis fascia, and he started to use a nerve stimulator. After retraction of the superficial temporal vessels anteriorly with the skin flap, with the aid of a nerve stimulator, the surgeon made an oblique incision parallel to the frontal branch of the facial nerve, through a superficial layer of the temporalis fascia above the zygomatic arch. Then, he inserted the periosteal elevator beneath the superficial layer of the temporalis fascia and stripped the periosteum off the lateral zygomatic arch. Dissection was carried out inferiorly to expose the capsule of the TMJ. Intraoperatively, a cystic mass sized 10 mm in diameter was found. Its surface was soft, round, and translucent. The cystic mass was filled with a jelly-like material and connected with the lateral surface of the TMJ capsule by a short, narrow stalk. The tumor was successfully extirpated without injury to the facial nerves. Histopathologic examination confirmed a ganglion cyst. There was no sign of recurrence 8 months postoperatively, and the patients symptom of dizziness disappeared. #Maxillofacial #Craniofacial
Posted on: Mon, 17 Nov 2014 20:54:53 +0000
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