TMJ lesions beyond the joint: compartment patterns and misclassification rates

In 270 temporomandibular joint (TMJ) cases, extra-articular spread most often involved deep neck spaces (52), temporal bone (44), and central skull base (42). In cases with reported differentials, misclassification was 79% for temporal bone and 75% for facial bone.

• Pigmented villonodular synovitis/tenosynovial giant cell tumor predominated in temporal bone, deep neck, and multicompartment disease; synovial chondromatosis was most common with skull base extension.
• Radiologic misdiagnosis led to six unnecessary parotidectomies and five cases of delayed diagnosis or avoidable morbidity.
• Primary limitation: inherent biases of case report and case series literature, including variable reporting of imaging features and follow-up.

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