Gout of the temporomandibular joint: a a differential diagnosis of preauricular swelling

Gout arthropathy is a metabolic disease which first leads to elevated uric acid levels and to the deposition of urate crystals in the tissue. The sole manifestation in the head and neck area, in this case in the temporomandibular joint, is very rare, but should be included in the differential diagnosis of preauricular swelling. The case presented here shows an atypical destruction of the temporomandibular joint with the formation of defects in the base of the skull with histologically confirmed urate crystal arthtopathy.

A 68-year-old woman presented to our polyclinic with pain in the left temporomandibular joint that had existed for 3 years, preauricular swelling and progredient hearing impairment. Clinically, there was an obstruction of the external auditory canal covered by non-irritated skin and a swelling in the left parotid region. CT showed a process starting from the left temporomandibular joint, destroying the temporomandibular joint and the socket with the formation of defects in the skull base. The tissue samples from the external auditory canal confirmed the gouty tophus histologically. Laboratory tests showed a uric acid level of 6.1 mg / dl.

Due to the extent of the findings, it was decided against an operative procedure. The acute pain symptoms were treated with an anti-inflammatory analgesic with a non-steroidal anti-inflammatory drug. In addition, long-term therapy with a xanthine oxidase inhibitor under close laboratory control and a low-purine diet was initiated.

Despite the increasing prevalence of gout, the manifestation in the temporomandibular joint is a rare and relevant differential diagnosis of a pre-auricular swelling, which has so far only been described sporadically in the literature.

Publication History

Article published online:
24 May 2022