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Murahashi M, Ntege EH, Higa M, Maruyama N, Kawano T, Shimizu Y, Nakamura H. Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis. BMC Oral Health 2022; 22:662. [PMID: 36587200 PMCID: PMC9805689 DOI: 10.1186/s12903-022-02695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. CASE PRESENTATION We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. CONCLUSIONS Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.
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Affiliation(s)
- Makoto Murahashi
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Edward Hosea Ntege
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan ,grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Masaru Higa
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Toshihiro Kawano
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Yusuke Shimizu
- grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Hiroyuki Nakamura
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
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Satyanarayan P, Roy ID, Issar Y, Tomar K, Jakka S. Comparative Evaluation of Success in Cases of Synovial Chondromatosis of Temporomandibular Joint Treated with Temporomandibular Joint Arthroscopy: A Case Series. J Maxillofac Oral Surg 2022; 21:1227-1232. [PMID: 36896077 PMCID: PMC9989087 DOI: 10.1007/s12663-021-01640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022] Open
Abstract
Introduction Synovial chondromatosis of the temporomandibular joint (TMJ) is characterized by the formation of multiple nodules of cartilage with varying sizes due to metaplastic development of the synovial membrane. Aetiology revolves with primary lesion, and pathogenesis is still unknown with multiple factors, which includes low-grade trauma or internal derangement. This condition remains undiagnosed and leads to therapeutic challenges from clinical manifestations which are non-specific and needs various tools to diagnose with combination of radiologic and histopathological examination. Materials and Method We report a case series of five cases which were diagnosed as cases of TMD of the temporomandibular joint. Diagnostic arthroscopy including lysis and lavage with Ringers lactate, hyaluronic acid was carried out. Intra-operative findings were suggestive of synovial chondromatosis. Sample taken for histopathological examination confirmed the diagnosis of synovial chondromatosis of TMJ. Postoperative status of mouth opening and pain was assessed at 15 days, one month, 3 months, 6 months and one year during the review to evaluate the success of arthroscopy of TMJ. Results All patients reported success with the modality of arthroscopy lysis and lavage at 12 months of follow-up with improvement at every follow-up visit in terms of range of motion and reduction of pain score on VAS. Hence, arthroscopy with lysis and lavage came out to be a promising alternative for open joint surgery in cases of synovial chondromatosis of the TMJ with same outcomes in relieving patients who complain of reduced maximum inter-incisal opening and pain. Conclusion Thus, arthroscopic procedures can be considered an alternative and effective modality for successful management of cases of synovial chondromatosis of temporomandibular joint.
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Affiliation(s)
- P. Satyanarayan
- Division of Oral and Maxillofacial Surgery, AFMC, Solapur road, Pune, Maharashtra 411040 India
| | - I. D. Roy
- Department of Dental Surgery & Oral Health Sciences, AFMC, Pune, India
| | - Yuvraj Issar
- Division of Oral and Maxillofacial Surgery, AFMC, Solapur road, Pune, Maharashtra 411040 India
- Department of Dental Surgery & Oral Health Sciences, AFMC, Pune, India
| | - Kapil Tomar
- Division of Oral and Maxillofacial Surgery, AFMC, Solapur road, Pune, Maharashtra 411040 India
| | - Sabareesh Jakka
- Division of Oral and Maxillofacial Surgery, AFMC, Solapur road, Pune, Maharashtra 411040 India
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Fukutani T, Toratani S, Kanda T, Matsui K, Yamasaki S, Sumi K, Ogawa I, Yanamoto S. Two Cases of Temporomandibular Synovial Chondromatosis Associated with Gli1 Gene Mutation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084702. [PMID: 35457572 PMCID: PMC9030668 DOI: 10.3390/ijerph19084702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023]
Abstract
Synovial chondromatosis (SC) is a rare benign disease involving multifocal generation of ectopic cartilage in the synovial tissue. Herein, we report two cases of SC in the temporomandibular joint: a 38-year-old woman (patient 1) and 39-year-old woman (patient 2). Both patients had trismus, jaw joint noises, and jaw-opening pain in the temporomandibular joint. Cone-beam computed tomography (CT) and magnetic resonance imaging (MRI) in patient 1 showed multiple calcified loose bodies around the right mandibular condyle. In addition, CT and MRI in patient 2 showed multiple calcified loose bodies around the left mandibular condyle and temporal bone perforation. Following establishing a diagnosis of SC, both patients underwent tumor resection via open surgery. In immunohistochemical examinations of the resected tissues, tumor cells showed intense nuclear staining with labeled anti-Gli1 antibody. Gene sequencing revealed that both patients had a homozygous mutation in the Gli1 gene (rs2228226 G>C). In conclusion, we suggest that the Gli1 gene (rs2228226 G>C) may be involved in the etiology of SC.
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Affiliation(s)
- Taeko Fukutani
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (S.T.); (S.Y.); (K.S.); (S.Y.)
- Correspondence: ; Tel.: +81-(0)-82-257-5667
| | - Shigeaki Toratani
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (S.T.); (S.Y.); (K.S.); (S.Y.)
| | - Taku Kanda
- Department of Oral and Maxillofacial Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan; (T.K.); (K.M.)
| | - Kensaku Matsui
- Department of Oral and Maxillofacial Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan; (T.K.); (K.M.)
| | - Sachiko Yamasaki
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (S.T.); (S.Y.); (K.S.); (S.Y.)
| | - Kensaku Sumi
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (S.T.); (S.Y.); (K.S.); (S.Y.)
| | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima 734-8553, Japan;
| | - Souichi Yanamoto
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (S.T.); (S.Y.); (K.S.); (S.Y.)
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Abstract
Clinically, radiologically, and pathologically, chondroid neoplasms of the skull can be diagnostically challenging due to overlapping features in each of these domains. Compounding the problem for the pathologist, there is also significant morphologic, immunophenotypic, and molecular genetic overlap between benign and malignant cartilaginous lesions, and the majority of these lesions are encountered quite rarely in routine surgical pathology practice. Each of these factors contribute to the diagnostic difficulty posed by these lesions, highlighting the importance of radiologic-pathologic correlation in the diagnosis. This review is intended to provide an update for surgical pathologists on some of the most commonly encountered chondroid neoplasms in the skull, and includes the following lesions: chondromyxoid fibroma, synovial chondromatosis, chondrosarcoma and variants, and chordoma and variants. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.
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Ear and Temporal Bone: Cartilaginous and Osseous Pathologies. Head Neck Pathol 2018; 12:378-391. [PMID: 30069840 PMCID: PMC6081291 DOI: 10.1007/s12105-018-0949-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/29/2022]
Abstract
Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.
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Romano A, Lo Faro C, Salzano G, Dell’aversana Orabona G, Petrocelli M, Corvino R, Vaira LA, Iaconetta G, Califano L. Synovial chondromatosis of temporomandibular joint spreading into the cranial space. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Synovial chondromatosis of the temporomandibular joint with intracranial extension—report of two cases. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Recurrent synovial chondromatosis of the temporomandibular joint: report of two cases. Br J Oral Maxillofac Surg 2017; 55:965-967. [PMID: 28964665 DOI: 10.1016/j.bjoms.2017.08.367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
Abstract
Synovial chondromatosis is the most common tumour-like lesion that is found in the temporomandibular joint (TMJ). Although it is benign and self-limiting, it can recur. We retrospectively reviewed 274 cases that were treated in our department from 2001-16 and found two recurrences, the radiological, surgical, histopathological, and follow-up results of which we report here. The reasons for their recurrence were analysed and elucidated.
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Selvi F, Messina J, Faquin WC, Keith DA. Relapsing Polychondritis Concomitant With Synovial Chondromatosis of the Temporomandibular Joint. J Oral Maxillofac Surg 2016; 74:2207-2215. [PMID: 27292528 DOI: 10.1016/j.joms.2016.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Relapsing polychondritis (RP) is a rare, multisystem autoimmune disease characterized by inflammation, structural damage, and impaired function of cartilaginous tissues throughout the body. In the craniofacial region, this rare disease has been reported to affect structures of the ear and nose; however, reports of temporomandibular joint (TMJ) involvement are scarce. A second uncommon disorder of cartilage is synovial chondromatosis (SC), a progressive and proliferative disorder of the synovial membrane associated with the formation of variably sized cartilaginous and calcified loose bodies, often causing dysfunction of the joints and enlargement of the joint capsule. It commonly affects the larger joints; TMJ involvement is uncommon. We present the case of a 45-year-old woman with previously diagnosed RP in whom right TMJ pathology subsequently developed, undergoing arthroscopy and biopsy followed by arthroplasty, which was proved to be SC, likely due to her autoimmune disease. To our knowledge, this is the first case describing concomitant SC of the TMJ presumably from pre-existing RP.
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Affiliation(s)
- Firat Selvi
- Chief Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; Associate Professor of Oral Surgery, Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Justin Messina
- Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - William C Faquin
- Associate Professor of Pathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A Keith
- Clinical Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine; Attending Oral and Maxillofacial Surgeon, Massachusetts General Hospital, Boston, MA.
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Pau M, Bicsák A, Reinbacher KE, Feichtinger M, Kärcher H. Surgical treatment of synovial chondromatosis of the temporomandibular joint with erosion of the skull base: a case report and review of the literature. Int J Oral Maxillofac Surg 2013; 43:600-5. [PMID: 24314559 DOI: 10.1016/j.ijom.2013.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/13/2013] [Accepted: 10/16/2013] [Indexed: 12/11/2022]
Abstract
Synovial chondromatosis (SC) is a rare metaplastic disease of the larger joints. It is rarely observed in smaller joints, especially in the temporomandibular joint (TMJ). This disease is considered to be metaplastic and shows no malignant tendencies, but can become locally aggressive, erode the cranial base, and even spread intracranially. To date, nine cases of spread into the intracranial space have been reported in the literature; however, the disease remained extradural in all cases. The authors present a review of the literature and report the case of a 70-year-old man with SC of the right TMJ that had eroded the cranial base, reaching the dura mater; a large intracranial mass was not present. The disease was considered to be stage 3 according to Milgram's classification. The patient was treated surgically, the tumour mass was removed, reconstruction of the cranial base was performed using titanium mesh, and the joint was reconstructed with a temporal muscle interposition flap. Diagnostic images and intraoperative photographs are also presented.
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Affiliation(s)
- M Pau
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria.
| | - A Bicsák
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | - K E Reinbacher
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | - M Feichtinger
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | - H Kärcher
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria
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Yoshida H, Tsuji K, Oshiro N, Wato M, Morita S. Preliminary report of Ki-67 reactivity in synovial chondromatosis of the temporomandibular joint: An immunohistochemical study. J Craniomaxillofac Surg 2013; 41:473-5. [DOI: 10.1016/j.jcms.2011.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/07/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022] Open
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Matsumura Y, Nomura J, Nakanishi K, Yanase S, Kato H, Tagawa T. Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout). Dentomaxillofac Radiol 2013; 41:703-7. [PMID: 23166363 DOI: 10.1259/dmfr/24183821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report describes a very rare case of synovial chondromatosis with deposition of calcium pyrophosphate dihydrate (CPPD) crystals (pseudogout) in the temporomandibular joint (TMJ) of a 46-year-old male patient. Synovial chondromatosis is a non-neoplastic disease characterized by metaplasia of the connective tissue leading to chondrogenesis in the synovial membrane. Pseudogout is an inflammatory disease of the joints caused by the deposition of CPPD, producing similar symptoms to those observed in gout but not hyperuricaemia. Both diseases commonly affect the knee, hip and elbow joints, but rarely affect the TMJ.
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Affiliation(s)
- Y Matsumura
- Department of Oral and Maxillofacial Surgery, Division of Reparative and Regenerative Medicine, Institute of Medical Science, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu, Mie 514-8507, Japan.
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Three case reports of synovial chondromatosis of temporomandibular joint: histopathologic analyses of minute cartilaginous loose bodies from joint lavage fluid and comparison with phase II and III cases. J Oral Maxillofac Surg 2011; 70:2099-105. [PMID: 22177806 DOI: 10.1016/j.joms.2011.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 12/21/2022]
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Varol A, Sencimen M, Gulses A, Altug HA, Dumlu A, Kurt B. Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint. Cranio 2011; 29:313-7. [PMID: 22128672 DOI: 10.1179/crn.2011.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.
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Shah SB, Ramanojam S, Gadre PK, Gadre KS. Synovial chondromatosis of temporomandibular joint: journey through 25 decades and a case report. J Oral Maxillofac Surg 2011; 69:2795-814. [PMID: 21470750 DOI: 10.1016/j.joms.2010.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 12/28/2010] [Indexed: 02/03/2023]
Affiliation(s)
- Shishir B Shah
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India.
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Guarda-Nardini L, Piccotti F, Ferronato G, Manfredini D. Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review. Int J Oral Maxillofac Surg 2010; 39:745-55. [PMID: 20434884 DOI: 10.1016/j.ijom.2010.03.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 02/09/2010] [Accepted: 03/26/2010] [Indexed: 02/07/2023]
Abstract
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease characterized by the presence of calcified loose bodies within the joint, and few systematically gathered data are available about its epidemiology. The aim of this paper was to describe a case of SC of the TMJ, and to carry out a systematic review of the literature on epidemiology over the past decade. A case of a 53-year-old female with the classical triad of signs and symptoms of SC (pain, swelling, restricted mouth opening) is described. A systematic search in the National Library of Medicine's PubMed Database was performed. 155 cases were described in 103 publications. Most dealt with single case reports. Females are affected more than males with a 2.5:1 ratio and the mean age of patients was about 46 years. Late diagnosis is common and in most cases more than 2 years elapsed between symptom onset and surgical intervention. Open TMJ surgery is the treatment of choice, since less invasive techniques, such as arthroscopy, allowed complete removal of the loose bodies only in about half of cases. A single recurrence was described, confirming the benign nature of the disease.
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Sato J, Notani KI, Goto J, Shindoh M, Kitagawa Y. Synovial chondromatosis of the temporomandibular joint accompanied by loose bodies in both the superior and inferior joint compartments: case report. Int J Oral Maxillofac Surg 2010; 39:86-8. [DOI: 10.1016/j.ijom.2009.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 05/30/2009] [Accepted: 07/21/2009] [Indexed: 11/26/2022]
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Ida M, Yoshitake H, Okoch K, Tetsumura A, Ohbayashi N, Amagasa T, Omura K, Okada N, Kurabayashi T. An investigation of magnetic resonance imaging features in 14 patients with synovial chondromatosis of the temporomandibular joint. Dentomaxillofac Radiol 2008; 37:213-9. [PMID: 18460574 DOI: 10.1259/dmfr/95185114] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To show the characteristic MRI features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). METHODS All patients with histologically proven SC of the TMJ who underwent MRI at our clinic were examined. In 14 patients (male-to-female ratio, 2:12; average age 46+/-14 years), clinical and conventional radiographic findings were reviewed. In addition, the MRI findings of articular disc and condyle position, shape and signal intensity of the joint spaces, and bone changes of surrounding structures were analysed. RESULTS The main symptoms were pain (in 93% of the patients) and limitation of mouth opening (64%). Two cases showed typical multiple calcifications around the TMJ on conventional radiography. On MRI, the disc position was normal in 12 (86%) patients and the condyle was inferiorly displaced in 9 (64%) patients. 11 (79%) patients showed enlargement of the joint space, with either a "dumbbell" shape or bulging. SC in the upper compartment showed various degrees of bone changes of the articular eminence and fossa. SC in the lower compartment showed concavity or hypertrophy of the condyle. The severity of the bone changes progressed with duration of symptoms. CONCLUSIONS About 0.3% of the patients complaining of TMJ pain and dysfunction were found to have SC. There was great variation in the MRI features of the TMJs with SC. More severe destruction of surrounding bone structures with features resembling a tumour were found in patients with a longer duration of symptoms.
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Affiliation(s)
- M Ida
- Oral and Maxillofacial Radiology, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo 1138549, Japan.
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Yokota N, Inenaga C, Tokuyama T, Nishizawa S, Miura K, Namba H. Synovial chondromatosis of the temporomandibular joint with intracranial extension. Neurol Med Chir (Tokyo) 2008; 48:266-70. [PMID: 18574334 DOI: 10.2176/nmc.48.266] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 52-year-old man presented with an extremely rare case of synovial chondromatosis in the temporomandibular joint (TMJ) with extension into the middle cranial fossa manifesting as swelling and exacerbation of pain. He had a long history of right TMJ disorders. Computed tomography and magnetic resonance imaging showed a mass in the right TMJ with extension into the intracranial part through the destroyed temporal skull base. The preoperative diagnosis was chondrosarcoma or osteosarcoma. The patient underwent surgery via combined trans-zygomatic temporal skull base and pre-auricular approaches and the mass was totally removed. Histological examination found an enormous number of closely packed loose bodies of various sizes, consisting of hyaline chondrocytes. The histological diagnosis was synovial chondromatosis. This rare lesion is difficult to discriminate from chondrosarcoma, so total removal is essential for correct diagnosis and cure.
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Affiliation(s)
- Naoki Yokota
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
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Lieger O, Zix J, Stauffer-Brauch EJ, Iizuka T. Synovial Chondromatosis of the Temporomandibular Joint With Cranial Extension: A Case Report and Literature Review. J Oral Maxillofac Surg 2007; 65:2073-80. [PMID: 17884541 DOI: 10.1016/j.joms.2006.04.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 12/15/2005] [Accepted: 04/05/2006] [Indexed: 10/22/2022]
Affiliation(s)
- Olivier Lieger
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland.
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Xu WH, Ma XC, Guo CB, Yi B, Bao SD. Synovial chondromatosis of the temporomandibular joint with middle cranial fossa extension. Int J Oral Maxillofac Surg 2007; 36:652-5. [PMID: 17368853 DOI: 10.1016/j.ijom.2007.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 10/26/2006] [Accepted: 01/23/2007] [Indexed: 11/18/2022]
Abstract
Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.
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Affiliation(s)
- W-H Xu
- Center for TMD & Orofacial Pain, School of Stomatology, Peking University, Beijing 100081, PR China
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Li B, Long X, Cheng Y, Yang X, Li X, Cai H. Ultrasonographic and arthrographic diagnoses of synovial chondromatosis. Dentomaxillofac Radiol 2007; 36:175-9. [PMID: 17463104 DOI: 10.1259/dmfr/32238405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Synovial chondromatosis (SC) is rare in the temporomandibular joint (TMJ). Plain radiographs, CT, MRI and arthrography of the TMJ have been used for the diagnosis of SC. The purpose of this paper is to present ultrasonographic and arthrographic diagnoses of a case of SC of the TMJ.
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Affiliation(s)
- B Li
- Department of Radiology, College and Hospital of Stomatology, Wuhan University, Key Laboratory for Oral Biomedical Engineering, Ministry of Education, Wuhan, PR China
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Huh JK, Park JY, Lee S, Lee SH, Choi SW. Synovial chondromatosis of the temporomandibular joint with condylar extension. ACTA ACUST UNITED AC 2006; 101:e83-8. [PMID: 16731380 DOI: 10.1016/j.tripleo.2005.10.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 10/04/2005] [Accepted: 10/24/2005] [Indexed: 10/24/2022]
Abstract
Synovial chondromatosis is a benign disease that rarely affects the temporomandibular joint (TMJ). It can be seen commonly in the superior joint space and presents with various signs and symptoms according to the stage of progression. Sometimes it presents as a large swelling in the preauricular area with or without cranial extension, and the clinical and radiographic findings may be misdiagnosed as other benign or malignant diseases of TMJ. Therefore, we report an uncommon case of synovial chondromatosis presenting as a large preauricular mass arising from the inferior joint space of the TMJ with bony resorption of the mandibular condyle, which mimicked osteochondroma.
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Affiliation(s)
- Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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26
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Ardekian L, Faquin W, Troulis MJ, Kaban LB, August M. Synovial Chondromatosis of the Temporomandibular Joint: Report and Analysis of Eleven Cases. J Oral Maxillofac Surg 2005; 63:941-7. [PMID: 16003619 DOI: 10.1016/j.joms.2005.03.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Synovial chondromatosis (SC) is a benign monoarticular condition that is uncommon in the temporomandibular joint (TMJ). The purpose of this article is to present 11 additional cases of SC of the TMJ and discuss newer modes of imaging, diagnostic approaches, treatment options, and follow-up data. METHODS Medical records of 11 patients with SC treated within our department from 1991 to the present were reviewed. Demographic data, etiology, clinical presentation, diagnostic evaluation, treatment, and follow-up information were collected. Previously reported cases (both TMJ and others) from 1988 to present were identified for comparison and the literature reviewed. RESULTS There were 8 females and 3 males with an average age of 54 years. Pain and preauricular swelling were the most common presenting clinical complaints. Etiologic factors (parafunction, inflammatory joint disease) were found in 7 of 11 cases. Plain radiographs showed joint calcifications in only 2 of 11 cases. Computed tomography identified calcifications in 3 of 6. Magnetic resonance imaging clearly demonstrated the mass and its extension in 10 of 10 cases. Fine needle aspiration was diagnostic in 4 of 9. All patients were treated with an open arthrotomy. Meniscectomy was required in 7 of 11. Average follow-up was 5.2 years with no recurrences reported. CONCLUSION The current case series of SC shows a female predilection with age and presenting complaints similar to those previously reported. A traumatic etiology was not identified, although a weak association is reported in the literature. The superiority of magnetic resonance imaging for both diagnosis and evaluation of extension of disease is shown. In a subset of cases, fine needle aspiration is useful for confirming the clinicoradiographic impression. Complete removal of involved tissue is associated with an excellent prognosis.
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Sarlani E, Nikitakis NG, Papadimitriou JC, Ord RA. Synchronous occurrence of ipsilateral synovial chondromatosis of the temporomandibular joint and pleomorphic adenoma of the parotid gland. ACTA ACUST UNITED AC 2004; 98:69-75. [PMID: 15243473 DOI: 10.1016/j.tripleo.2003.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a unique case characterized by true coexistence of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) with a salivary gland tumor, specifically pleomorphic adenoma, of the ipsilateral parotid gland. The possibility that the condition was the result of a single pathologic entity, ie, SC with extracapsular involvement or pleomorphic adenoma affecting the TMJ, received strong consideration. Nonetheless, careful assessment of the clinical, radiographic, MRI, and surgical findings strongly suggested the synchronous occurrence of 2 separate pathologic processes, despite their close proximity. Further, histopathologic examination confirmed the presence of both SC of the TMJ and pleomorphic adenoma of the superficial lobe of the ipsilateral parotid gland. Previous reports have pointed out the possibility of misdiagnosing extracapsular spread of SC as a salivary gland tumor. Vice versa, it has been noted that parotid gland tumors, especially malignant, may cause TMJ symptoms similar to those of SC. However, to the best of our knowledge, this is the first time that true synchronous occurrence of ipsilateral SC and pleomorphic adenoma, or parotid tumor of any kind, is reported.
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Affiliation(s)
- Eleni Sarlani
- Department of Biomedical Sciences, Brotman Facial Pain Center, Dental School, University of Maryland, 666 W. Baltimore Street, Room 2-A-15, Baltimore, MD 21201-1586, USA.
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Fujita S, Yoshida H, Tojyo I, Wada T, Murakami K, Iizuka T. Synovial chondromatosis of the temporomandibular joint: clinical and immunohistopathological considerations. Br J Oral Maxillofac Surg 2004; 42:259-60. [PMID: 15121276 DOI: 10.1016/j.bjoms.2004.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2004] [Indexed: 11/28/2022]
Abstract
A histopathological study of 30 cases of synovial osteochondromatosis found that the process followed a temporal sequence characterised by three phases: (I) active intrasynovial disease only; (II) transitional lesions with both active intrasynovial proliferation and free loose bodies; and (III) many free osteochondral bodies with no demonstrable intrasynovial disease [J. Bone Joint Surg. 59 (1977) 792]. We present five cases of synovial chondromatosis of the temporpmandibular joint (TMJ) which we studied by immunohistochemical methods of for transforming growth factor beta (TGFbeta) and tenascin.
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Affiliation(s)
- S Fujita
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Kimiidera 811-1, Wakayama-city, 641-8509 Wakayama, Japan.
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Shibuya T, Kino K, Yoshida S, Amagasa T. Arthroscopic removal of nodules of synovial chondromatosis of the temporomandibular joint. Cranio 2002; 20:304-6. [PMID: 12403189 DOI: 10.1080/08869634.2002.11746223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this report we describe a new method for removing nodules of TMJ synovial chondromatosis using arthroscopic surgery instead of open surgery. We used two steps during arthroscopy. In the first, we lavaged the cavity with sterile saline. In the next step, the second cannula was replaced with ethmoid forceps. Under arthroscopic guidance through the first cannula, all loose bodies were removed using the forceps. Since the loose bodies are not fragmented during this procedure, the time needed for removal is shortened. Based on this experience, we suggest the use of ethmoid forceps should be considered as an alternative procedure when nodules are unable to pass through the cannula by lavage with sterile saline.
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Affiliation(s)
- Tomoaki Shibuya
- Dept. of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Japan
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Aydin MA, Kurtay A, Celebioglu S. A case of synovial chondromatosis of the TMJ: treatment based on stage of the disease. J Craniofac Surg 2002; 13:670-5. [PMID: 12218796 DOI: 10.1097/00001665-200209000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A patient with synovial chondromatosis of the temporomandibular joint extending to the preauricular skin, parotid, and infratemporal fossa was operated and followed with a stable remnant, for 2 years postoperatively. In light of literature and what the authors have learned from this case, the authors emphasize stage of the disease as a risk factor for recurrence. The long history of symptoms, calcified and conglomerated radiological appearance of the lesion, and extensive involvement of the joint and periarticular area of this case indicate a late-stage disease in which the metaplastic activity dwindles. For late stages, the authors suggest a conservative approach that will only provide symptom relief and prevent secondary joint deformity to avoid potential complications and morbidities of a more extensive surgery.
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Affiliation(s)
- Mustafa Asim Aydin
- SSK Egitim Hastanesi Plastik ve Rekonstruktif Cerrahi Klinigi Dişkapi, Ankara, Turkey.
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von Lindern JJ, Theuerkauf I, Niederhagen B, Bergé S, Appel T, Reich RH. Synovial chondromatosis of the temporomandibular joint: clinical, diagnostic, and histomorphologic findings. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:31-8. [PMID: 12193890 DOI: 10.1067/moe.2002.123498] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage.
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Affiliation(s)
- Jens J von Lindern
- Department of Oral and Maxillofacial Surgery, University of Bonn, Sigmund Freud Strasse 25, D-53105 Bonn, Germany.
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Klenoff JR, Lowlicht RA, Lesnik T, Sasaki CT. Mandibular and temporomandibular joint arthropathy in the differential diagnosis of the parotid mass. Laryngoscope 2001; 111:2162-5. [PMID: 11802017 DOI: 10.1097/00005537-200112000-00016] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass. STUDY DESIGN We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland. CONCLUSIONS Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.
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Affiliation(s)
- J R Klenoff
- Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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Gay-Escoda C, Valmaseda-Castellón E, Alaejos-Algarra C, Vázquez-Rodriguez E. Condylar hyperplasia associated to synovial chondromatosis of the temporomandibular joint: a case report. Cranio 2001; 19:91-5. [PMID: 11842870 DOI: 10.1080/08869634.2001.11746157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Condylar hyperplasia is a slowly developing malformation of the mandible, with elongation of the mandibular neck, that generally results in facial asymmetry. Synovial chondromatosis is a benign chronic disorder characterized by the formation of multiple small nodules of hyaline cartilage as a result of metaplasia of the synovial connective tissue. It affects mostly the large joints, particularly the knee, hip, elbow and ankle. The temporomandibular joint (TMJ) is rarely affected. The case of a 42-year-old male with a history of left preauricular pain and swelling and deviation of the mandible to the left upon opening the mouth is presented. Computed tomography disclosed hyperplasia of the left condyle with loose radiopaque bodies within the joint cavity. The left TMJ was subject to open surgery, which included resection of four loose bodies and a remodeling condylectomy. The histopathological study confirmed the diagnosis of condylar hyperplasia and chondromatosis of the left TMJ.
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Affiliation(s)
- C Gay-Escoda
- Dental School of the University of Barcelona, Spain
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Yildiz ST, Demir A, Kaya A. Synovial chondromatosis of the temporomandibular joint extending to temporalis, masticator, and parotid spaces. J Comput Assist Tomogr 2001; 25:126-9. [PMID: 11176307 DOI: 10.1097/00004728-200101000-00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Synovial chondromatosis of the temporomandibular joint (TMJ) is very rare. We report a case of synovial chondromatosis of the TMJ with extraarticular extension that was diagnosed with MRI and CT. Histopathologic evaluation indicated that this case was synovial chondromatosis in intermediate phase.
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Affiliation(s)
- S T Yildiz
- Guney Medical Imaging Center, Antalya, Turkey
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35
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Shibuya T, Kino K, Okada N, Amagasa T. Synovial chondromatosis of the left temporomandibular joint superficially resembling chondrosarcoma: a case report. Cranio 2000; 18:286-8. [PMID: 11202849 DOI: 10.1080/08869634.2000.11746143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 25 year-old woman was referred to the clinic complaining of pain in the left temporomandibular joint (TMJ) and trismus. According to the x-ray images, a solitary mass was observed in the anterior pouch of the lower joint cavity. The mass was removed by means of a synovectomy and a diskectomy. Upon light microscopic examination, the tissue removed showed high cellular activity. As a differential diagnosis, we had to consider the possibility of chondrosarcoma based on the histopathological features; however, since no invasive nor metastatic finding was recognized, we made a diagnosis of synovial chondromatosis despite its rare existence. Although there has been no sign of recurrence at present, we plan to carefully follow up with the patient.
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Affiliation(s)
- T Shibuya
- Div. of Maxillofacial and Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo, Japan
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36
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Batheja NO, Wang BY, Springfield D, Hermann G, Lee G, Burstein DE, Klein MJ. Fine-needle aspiration diagnosis of synovial chondromatosis of the tibiofibular joint. Ann Diagn Pathol 2000; 4:77-80. [PMID: 10760320 DOI: 10.1016/s1092-9134(00)90015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of synovial chondromatosis of the tibiofibular joint in a 25-year-old woman that was diagnosed by fine-needle aspiration (FNA). The patient presented with pain in the left knee and a mass in the popliteal fossa. Synovial chondromatosis usually presents with joint symptoms and is often associated with intra-articular loose bodies, whereas presentation as a soft tissue mass is unusual and may raise the clinical suspicion of malignant neoplasm. The diagnosis is commonly confirmed by histopathologic examination of biopsy or excision of the specimen. To the best of our knowledge, this is the first case of synovial chondromatosis of a large joint successfully diagnosed by FNA. Two cases of synovial chondromatosis of the temporomandibular joint have been reported in which the diagnosis was suspected on the basis of FNA. In both these cases, the final diagnosis was established by histopathology of the excised specimens.
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Affiliation(s)
- N O Batheja
- Departments of Pathology, The Mount Sinai Medical Center, The Mount Sinai Medical School, New York, USA
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38
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Karlis V, Glickman RS, Zaslow M. Synovial chondromatosis of the temporomandibular joint with intracranial extension. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:664-6. [PMID: 9868721 DOI: 10.1016/s1079-2104(98)90200-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An unusual case of synovial chondromatosis of the temporomandibular joint with intracranial extension, which resulted in complete dehiscence of the floor of the middle cranial fossa, is reported. An overview of the current literature and a discussion of the diagnosis and surgical management of synovial chondromatosis are presented.
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Affiliation(s)
- V Karlis
- New York University College of Dentistry, Dept. of Oral and Maxillofacial Surgery, New York, New York 10010, USA
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39
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Louis PJ, West WF, Tilley MS, Waite PD, Cuzalina LA. A case report. Chondromatosis of the temporomandibular joint. J Am Dent Assoc 1998; 129:1010-3. [PMID: 9685766 DOI: 10.14219/jada.archive.1998.0355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Synovial chondromatosis is a rare pathological condition that usually affects large joints but can affect the temporomandibular joint. The disease typically manifests itself with signs and symptoms similar to internal derangement. The disease is characterized by free-floating or attached cartilaginous bodies in the joint space. In this article, the authors present a case of synovial chondromatosis and discuss its pathological process. They also discuss diagnostic approaches and current treatment.
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Affiliation(s)
- P J Louis
- University of Alabama at Birmingham, School of Dentistry, Department of Oral and Maxillofacial Surgery 35294-0007, USA
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40
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Lucas JH, Quinn P, Foote J, Baker S, Bruno J. Recurrent synovial chondromatosis treated with meniscectomy and synovectomy. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:253-8. [PMID: 9377187 DOI: 10.1016/s1079-2104(97)90339-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Synovial chondromatosis is a rare benign intraarticular metaplasia of synovium. This process may result in the production of detached particles of highly cellular cartilage in the involved joint spaces. It is most often reported in the larger joints of the body including the knee, hip, elbow, and ankle. Since Axhausen in 1993 reported the first case affecting the temporomandibular joint, several articles have been listed in the literature regarding the presentation, diagnosis, and management of this form of an arthropathy. This is a case of a recurrent synovial chondromatosis that was approached with a meniscectomy and a complete synovectomy.
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Affiliation(s)
- J H Lucas
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania Medical Center, Philadelphia, USA
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41
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Miyamoto H, Sakashita H, Miyata M, Kurita K. Arthroscopic diagnosis and treatment of temporomandibular joint synovial chondromatosis: report of a case. J Oral Maxillofac Surg 1996; 54:629-31. [PMID: 8632250 DOI: 10.1016/s0278-2391(96)90648-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- H Miyamoto
- Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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42
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Abstract
Recent advances in imaging technology have greatly contributed to the understanding of diseases of the temporomandibular joint (TMJ). MRI is now the modality of choice in the evaluation of TMJ-related symptoms. This article describes normal anatomy and MRI characteristics of diseases affecting the TMJ including internal derangement, inflammation, and tumors.
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Affiliation(s)
- V M Rao
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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43
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Fanibunda KB, Moore UJ, Soames JV. Bilateral osteochondral loose bodies of the temporomandibular joints with unilateral enlargement of condyle. Br J Oral Maxillofac Surg 1994; 32:248-50. [PMID: 7524648 DOI: 10.1016/0266-4356(94)90210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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44
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Mendonca-Caridad JJ, Schwartz HC. Synovial chondromatosis of the temporomandibular joint: arthroscopic diagnosis and treatment of a case. J Oral Maxillofac Surg 1994; 52:624-5. [PMID: 8189302 DOI: 10.1016/0278-2391(94)90102-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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45
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Wise DP, Ruskin JD. Arthroscopic diagnosis and treatment of temporomandibular joint synovial chondromatosis: report of a case. J Oral Maxillofac Surg 1994; 52:90-3. [PMID: 8263652 DOI: 10.1016/0278-2391(94)90023-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D P Wise
- Department of Oral and Maxillofacial Surgery, University of Nebraska Medical Center, Omaha
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46
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Moses JJ, Hosaka H. Arthroscopic punch for definitive diagnosis of synovial chondromatosis of the temporomandibular joint. Case report and pathology review. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:12-7. [PMID: 8419865 DOI: 10.1016/0030-4220(93)90398-n] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Synovial chondromatosis is characterized as a benign monoarticular condition with metaplastic cartilaginous nodules that develop within the synovial membrane of articulating joints. In addition to a pathology literature review, this article describes an unusual case of temporomandibular synovial chondromatosis that was sufficiently expansile to displace the condyle, which created not only a posterior occlusal apertognathia, but unusual articular bony fossa and eminentia erosions. An arthroscopic approach for definitive diagnostic punch biopsy and surgical approach is described and presented along with preoperative computerized tomograph, magnetic resonance imaging, and tomographic diagnostic images, as well as 3-year follow-up clinical and radiographic findings. Most interestingly, the arthroscopic examination and biopsy proved to be the most useful method to establish a definitive diagnosis of synovial membrane chondromatosis within the temporomandibular joint region for this patient.
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Affiliation(s)
- J J Moses
- Pacific Clinical Research Foundation, Encinitas, CA 92024
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Quinn PD, Stanton DC, Foote JW. Synovial chondromatosis with cranial extension. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 73:398-402. [PMID: 1374170 DOI: 10.1016/0030-4220(92)90313-f] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Synovial chondromatosis is a benign arthropathy characterized by metaplasia in synovial membranes that can produce detached particles of cartilage. It occurs most often in the knee, hip, and elbow but has been reported in the temporomandibular joint. This is a rare presentation of synovial chondromatosis with glenoid fossa erosion and cranial extension.
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Affiliation(s)
- P D Quinn
- Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia
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Milchgrub S, Mulhollan T, Vuitch MF, Wheatherall PT. Case report 692: Synovial chondrometaplasia of the 1st costovertebral joint. Skeletal Radiol 1992; 21:45-8. [PMID: 1546336 DOI: 10.1007/bf00243094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synovial chondrometaplasia, also known as synovial chondromatosis, is a rare disease affecting the synovial membrane and characterized by a nodular proliferation of metaplastic cartilage. It most commonly involves large joints such as the knee, hip, and elbow, but its presence in unusual locations such as small joints and the temporomandibular joint has been described. To our knowledge, this is the first case report of synovial chondrometaplasia involving the costovertebral joint in a patient with a previous injury to that area.
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Affiliation(s)
- S Milchgrub
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072
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Deahl ST, Ruprecht A. Asymptomatic, radiologically detected chondrometaplasia in the temporomandibular joint. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 72:371-4. [PMID: 1923429 DOI: 10.1016/0030-4220(91)90235-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Asymptomatic loose bodies were detected in the temporomandibular joint of a 62-year-old woman during an examination before comprehensive dental care. The radiologic interpretation was synovial chondrometaplasia (synovial osteochondromatosis). A histologic diagnosis was not obtained, because surgery was unwarranted in view of the lack of symptoms and the benign differential diagnosis. Review of the literature revealed 62 reported cases of temporomandibular joint chondrometaplasia, all of which included one or more of the following: swelling, pain, joint noise, and limited mandibular movement. These reports have described this entity as a rare lesion, but the rate of reports has increased, perhaps because of greater practitioner awareness and increased sensitivity of diagnostic tests.
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Affiliation(s)
- S T Deahl
- Department of Oral Pathology, Radiology and Medicine, University of Iowa
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Deboise A, Roche Y. Synovial chondromatosis of the temporomandibular joint possibly secondary to trauma. A case report. Int J Oral Maxillofac Surg 1991; 20:90-2. [PMID: 2051055 DOI: 10.1016/s0901-5027(05)80714-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A histologically confirmed case of synovial chondromatosis of the temporomandibular joint associated with a glenoid fossa callus is described. The lesion appeared 6 years after trauma to the chin. Conservative surgical treatment without excision of the synovial membrane or meniscus but including arthroplasty of both the eminence and the lateral side of the glenoid fossa was successful. The possible role of trauma in the etiology of synovial chondromatosis is discussed.
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Affiliation(s)
- A Deboise
- Department of Oral and Maxillofacial Surgery, Hôpital Saint-Louis, Paris, France
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