Intra-cranial pathology masked by temporomandibular disorder

Pain in the orofacial region can arise from a distant site. The symptoms of non-temporomandibular disorders, including intra-cranial lesions, may mimic or be masked by symptoms of temporomandibular disorders, and thus not be detected.

We describe a case of a patient who presented with temporomandibular disorder masking the underlying intra-cranial pathology.

A 45-year-old Caucasian female presented initially with bilateral temporomandibular disorders. The symptoms in the left TMJ indicated a surgical exploration. Unfortunately the symptoms persist in both joints and a diagnostics arthroscopy and arthrocentesis followed by intra-articular morphine injection was performed. The images from the arthroscopy confirmed that both joints are pathology free. In the immediate postoperative phase, the patient reported weakness of the right oculomotor and trochlear nerves as well as vertigo.

The MRI scan report showed high signals in the right temporal lobe and cavernous sinus; the diagnosis of a 'cavernoma' was reached.

The clinician must be aware of this diagnosis and maintain a high level of suspicion when the patient fails to respond to treatment or develop unusual postoperative complications.