A 47-year-old woman came to our service 3 months after finding a tumor in the left preauricular region.
The patient reported that the lesion was sudden onset and progressive growth.
The patient complained of pain in the temporal, cervical and left periocular regions.
Among the medical history, only essential hypertension under treatment with angiotensin converting enzyme inhibitors should be highlighted, without other relevant systemic alterations.
Physical examination revealed a nodule of approximately 1.5 cm in diameter in the left preauricular region.
The localization is soft, mobile and slightly sensitive to touch.
The maximum mouth opening is 45 mm and there is articular clicking in both.
The rest of the head and neck examination is anodyne.
Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cystic lesion measuring 1.8 × 1.7 × 1.4 cm adjacent to the upper edge of the parotid gland.
The MRI shows a closed layer dependent on the left TMJ, with the position of the articular meniscus and displacement of the mandibular condyle with open and normal mouth.
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A needle aspiration was performed and the whole sample was informed as a proteinaceous material and histiocytes, compatible with cystic lesion.
The obtained findings are carried out surgical treatment through a preauricular approach, identifying the trunk of the facial nerve and its respective branches.
After dissection of the facial nerve, it was decided to perform a superficial parotidectomy of the upper portion to find multiple adhesions to the lesion, isolating the synovial cyst above the frontal branch of the facial nerve.
Later on, it was visualized that communicates the cyst with the temporomandibular joint, causing its ligation and subsequent resection.
The wound was sutured by planes.
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The surgical specimen was fixed with 10% formaldehyde.
Histological sections stained with hematoxylin and eosin revealed a multilocular cystic lesion.
To establish with certainty the presence of synoviocytes in the cyst lining, an immunohistochemical analysis was performed to confirm its existence.
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During the outpatient follow-up of the patient after 9 months of evolution has not shown postoperative complications or signs of recurrence.
