Ganglion of the temporomandibular joint.

falls into the third category of CMC patients. However , longitudinal studies by Valdimarsson et al.4 suggest that some patients may move between Types III and IV and that these two groups could belong to a spectrum, the position of the patient within this spectrum being determined by factors such as fungal virulence or antigenic load. The management of patients with CMC involves both the identification and correction of any underlying systemic factors and the control of the fungal infection with antifungal agents. However, the can-didal organisms present in CMC often develop resistance to topical nystatin.5 Intravenous ampho-tericin has been used in the treatment of CMC but is limited because of its toxic renal effects. More recently, the imidazoles have been used. Clotrim-azole has been successful in a few reported cases,6'7 however, its effectiveness can be lessened by its ability to induce the production of liver enzymes that metabolise the drug at an enhanced rate. Mi-conazole is poorly absorbed from the gastrointes-tinal tract and systemic treatment requires that the drug be given intravenously, which may give rise to severe pruritis and thrombophlebitis.* Topical application of miconazole gel has been used successfully to treat oral lesions in CMC9 Of the newer imidazoles, ketoconazole has been the most useful as it is well absorbed orally and drug resistance and enhanced metabolism have not been described. However, cases of fatal hepatotoxicity have been reported and this limits its use to the most severe cases.'O Methods to improve the immunological status of patients have been reviewed by Porter and Scully' and have included transfer factor, thymosin, leva-misole, transplantation of bone marrow or fetal thymic tissue, plasmapheresis and infusion of leu-kocytes. However, further trials need to be carried out before their more generalized use because the clinical and immunologic improvement often has been only transient. A new approach to the use of anti-fungal agents in infants with persistent oral candidosis. A ganglion is a cystic enlargement of the syno-vium, also known as synovial cyst. It commonly occurs on the wrist, but is sometimes found on the dorsal surface of the foot, or close to the ankle or knee.' However, a ganglion associated with the temporomandibular joint (TMJ) is very rare, with only six cases having been reported.2-7 This lesion of the TMJ is very difficult to diagnose correctly before surgical exploration, because of its rare occurrence and because there are no definitive means of differentiating …