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80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

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Large gouty tophus of the infratemporal fossa – a rare differential diagnosis of a skull base tumor

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  • corresponding author Ingo Ott - Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-, Hals- und plastische Gesichtschirurgie, Klinikum Darmstadt, Germany
  • Tobias Waller - Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-, Hals- und plastische Gesichtschirurgie, Klinikum Darmstadt, Germany
  • M. Gartenschläger - Institut für Diagnostische und Interventionelle Radiologie, Klinikum Darmstadt, Germany
  • S. Schmeck - Institut für Pathologie, Klinikum Darmstadt, Germany
  • Gerald Baier - Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-, Hals- und plastische Gesichtschirurgie, Klinikum Darmstadt, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno110

doi: 10.3205/09hno110, urn:nbn:de:0183-09hno1108

Published: July 22, 2009

© 2009 Ott et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: In most cases gout is a hereditary, metabolic disorder. It leads to crystalline uric acid deposits in the distal joints with acute, very painful monarthritis and chronic joint destruction in the long run. Gouty manifestations in the ORL-region are quite rare.

Patient: A 75-year-old male presented with a blunt, painless swelling of the parotid region. This lesion had developed over years and enlarged gradually. There were no further symptoms in addition to occasional “cracking sounds” while chewing. Clinical examination revealed a slightly diminished jaw opening. A typical history of gout was denied.

Results: Blood testing showed no pathological parameters. Radiologic imaging could find a lesion of 4 cm in diameter surrounding the head of the mandibular joint and extending into the infratemporal fossa. Its expansive growth has led to a circumscribed arrosion of the bony skull base with the dural lining being intact. After negative fine needle aspiration cytology only operative exploration was able to confirm the diagnosis histologically.

Discussion: Presenting an atypical lesion deriving from the mandibular joint gout is described as a disease also being relevant for the ORL-specialist. Difficulties in differential diagnosis will be explained and a recommendation for an adequate therapeutic management in such a critical localisation will be suggested.