側頭下窩を占拠する巨大な結節性偽痛風の1例

• Published in: 日本口腔外科学会雑誌 Vol. 63; no. 10; pp. 517 - 522
• Main Authors: 大矢, 亮一, 秋森, 俊行, 平島, 惣一, 中村, 昭一, 於保, 耕太郎, 宮脇, 昭彦
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.10.2017
• Subjects: ピロリン酸カルシウム結晶沈着症; 側頭下窩; 結節性偽痛風; 顎関節
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.63.517

We report a case of large tophaceous pseudogout occupying the infratemporal fossa arising in the temporomandibular joint (TMJ). A 62-year-old woman was referred to our hospital with a chief complaint of pain in the right TMJ when she opened her mouth. She had diffuse swelling with mild tenderness in the right preauricular and the right buccal mucosal regions. Contrast-enhanced computed tomography revealed a 54-mm calcified mass-like lesion in the major axis occupying the infratemporal fossa. Compressive bone resorption in the condylar head, inner mandibular ramus, and the base of the skull, which was in contact with the mass, were also seen. Clinically, a masticator space tumor was suspected, and a biopsy of the mass was performed from the buccal mucosa region. The biopsy specimen revealed deposits of calcium pyrophosphate dehydrate (CPPD) crystals, and tophaceous pseudogout was thus diagnosed. With the patient under general anesthesia, an operation was performed from a preauricular and temporal approach as well as an intraoral approach to divide and remove the mass as much as possible. Although part of the mass remained, clinical symptoms disappeared after surgery. Three years 7 months postoperatively, the patient has not had any symptoms.