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Vladimír M, Vasilis V, Dušan H, Robert P, Michal B, René F. TMJ synovial chondromatosis - an evaluation of 37 patients. Oral Maxillofac Surg 2024:10.1007/s10006-024-01273-8. [PMID: 38937389 DOI: 10.1007/s10006-024-01273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE The authors evaluated a cohort of 37 patients with histologically verified synovial chondromatosis (SC) between 2013 and 2022. METHODS The cohort consisted of 37 patients (26 women, 11 men). 36 patients had unilateral involvement, while one patient had bilateral involvement. The average age of the patients was 54.77 years. The authors used the Milgram histopathological classification. They evaluated SC localisation, clinical symptoms, diagnostics and treatment (including recurrence incidence) in this cohort. RESULTS In 31 patients (83.7%) SC affected only the upper joint space in one patient (2.7%) the lower space, and in five patients (13.6%) both spaces. 12 patients (32%) were Milgram Stage 1 (presence of synovial metaplasia without loose bodies), eight patients (22%) were Stage 2 (presence of synovial changes, loose bodies), and 17 patients (46%) were Stage 3 (presence of loose bodies, no synovial changes). Pain was the dominant clinical symptom (32 patients, 86.4%). Treatment consisted of arthroscopy and open surgery. Two patients underwent primary reconstruction and total TMJ replacement. Treatment was successful in 89.2% of cases (33 patients), with four (10.8%) patients suffering recurrence. CONCLUSION As this patient cohort shows, pain was the dominant symptom in patients with SC. Magnetic resonance imaging is fundamental in the diagnosis of SC, demonstrating pathological findings even in patients for whom an initial X-ray was negative. These were mainly patients with Milgram Stages 1 and 2 without calcification, loose bodies or pathological changes of the bone structures. This is why the authors recommend MRI for any patient experiencing pain for more than three months, and if this reveals an effusion, joint distension or intraarticular soft tissue mass, they will always indicate arthroscopy. Thorough follow-up of patients is recommended, although SC recurrence is not very frequent. The authors recommend follow-up one, three and six months after surgery, and then annually for the first five years after surgery. They recommend follow-up MRI one, two and five years after surgery.
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Affiliation(s)
- Machoň Vladimír
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic
| | - Vlachopulos Vasilis
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic
| | - Hirjak Dušan
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic
| | - Plachý Robert
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic
| | - Beňo Michal
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic.
| | - Foltán René
- Department Oral Maxillofacial Surgery, Faculty Hospital Prague Prague, Charles University, Prague U Nemocnice 2 str, Prague 2, Staré Město, 128 08, Czech Republic
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De Nordenflycht D, Matus G, Aravena JP, Toloza H. Osteochondritis dissecans of the temporomandibular joint: a scoping review. Oral Maxillofac Surg 2024; 28:29-38. [PMID: 36631710 DOI: 10.1007/s10006-022-01134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
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Affiliation(s)
- Diego De Nordenflycht
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile.
| | | | | | - Héctor Toloza
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile
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Gonzalez LV, López JP, Orjuela MP, Mejía M, Gallo-Orjuela DM, Granizo López RM. Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review. J Craniomaxillofac Surg 2023; 51:551-559. [PMID: 37562984 DOI: 10.1016/j.jcms.2023.07.008] [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: 10/08/2022] [Revised: 02/26/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21-81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.
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Affiliation(s)
- Luis Vicente Gonzalez
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana. Bogotá, Colombia
| | - Juan Pablo López
- Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá Colombia; Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia.
| | - María Paula Orjuela
- Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia
| | - Manuel Mejía
- Biomedical Engineer, Escuela Colombiana de Carreras Industriales, Bogotá, Colombia
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Sembronio S, Raccampo L, Tel A, Di Cosola M, Troise S, Dell’Aversana Orabona G, Robiony M. The Role of Temporomandibular Joint Arthroscopy for Diagnosis and Surgical Management of Synovial Chondromatosis. Diagnostics (Basel) 2023; 13:2837. [PMID: 37685375 PMCID: PMC10486883 DOI: 10.3390/diagnostics13172837] [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: 07/16/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE We report the experience of our maxillo-facial surgery unit into the diagnostic and the therapeutic role of arthroscopy of temporomandibular joint (TMJ) synovial chondromatosis (SC). MATERIALS AND METHODS A series of sixteen patients with an imaging, arthroscopical, and histological diagnosis of SC treated with arthroscopy was selected. The surgeries were conducted in the Department of Maxillo-facial surgery, Academic hospital of Udine, from January 2016 to December 2022. Medical history, clinical examination, imaging, arthroscopical, and histological characteristics were recorded and then reviewed and discussed. RESULTS Clinical improvement, both in pain and in maximum incisal opening (MIO), were noticed in whole patients. Histologically, according to Milgram's classification, the sample was fairly homogeneous. Arthroscopic treatment was successful in 87.5% of the patients. Only two cases of SC relapse were registered and were then submitted to open surgery to perform a total sinovectomy. The data collected were used to develop an SC classification proposal based on clinical, radiological (magnetic resonance imaging), arthroscopical, and histopathological characteristics. CONCLUSIONS TMJ arthroscopy must be considered the first line of treatment for SC, leaving open surgery to relapses cases and those cases with extraarticular extension. A univocal classification is essential to best stage and prognostically characterise this pathology.
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Affiliation(s)
- Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Stefania Troise
- Maxillofacial Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Dell’Aversana Orabona
- Maxillofacial Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
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Cini MA, Avelino MD, Machado JGLA, Junior RLDR, Santos AD. Chondromatosis of the temporomandibular joint as a cause of reflex otalgia. Braz J Otorhinolaryngol 2023; 89:101284. [PMID: 37421832 PMCID: PMC10344662 DOI: 10.1016/j.bjorl.2023.101284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
| | | | | | | | - Alan Dos Santos
- Universidade do Oeste Paulista (UNOESTE), Guarujá, SP, Brazil
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Burris B, Guastaldi FPS, Hadad H, Faquin WC, McCain JP. Arthroscopic management of synovial chondromatosis with skull base perforation: A case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e1-e10. [PMID: 36828757 DOI: 10.1016/j.oooo.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a synovial membrane disease characterized by the formation of cartilaginous nodules (CN), that may erode the skull base. Historically, cases with skull base involvement have been treated with open surgery. We report a case of TMJ SC with skull base perforation treated and repaired via minimally invasive TMJ arthroscopy and describe the advanced endoscopic operative maneuvers performed. CASE REPORT A 34-year-old male presented with a 4-year history of malocclusion and right TMJ arthralgia. Clinical examination demonstrated malocclusion and direct pressure loading pain. Advanced imaging revealed glenoid fossa erosion and numerous homogenous hypointense lesions within an effusion. The initial surgical plan included diagnostic TMJ arthroscopy followed by conversion to open arthroplasty. Endoscopic operative maneuvers allowed for the accomplishment of the surgical goals, completely arthroscopically. Histopathology confirmed SC, and the patient remains on observation, with relief of symptoms. CONCLUSION Advanced arthroscopy is a viable treatment option for select cases of TMJ SC with skull base involvement that allowed for access to the joint space, retrieval of biopsy specimens and CN, and repair of the skull defect.
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Affiliation(s)
- Briana Burris
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - Fernando P S Guastaldi
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - Henrique Hadad
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - William C Faquin
- Massachusetts Eye and Ear Infirmary, Divisions of Head and Neck Pathology and Cytopathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph P McCain
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA.
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Riechelmann F, Hackl W, Schmitz K, Henninger B, Keiler A. Primäre synoviale Chondromatose. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Zusammenfassung
Hintergrund
Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden.
Methoden
Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt.
Ergebnisse
Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird.
Schlussfolgerung
Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.
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A Case of Synovial Chondromatosis of Temporomandibular Joint with Numerous Loose Bodies. Case Rep Dent 2021; 2021:5927215. [PMID: 34931148 PMCID: PMC8684526 DOI: 10.1155/2021/5927215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.
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Diagnosis of Synovial Chondromatosis of Temporomandibular Joint: Case Report and Literature Review. Healthcare (Basel) 2021; 9:healthcare9050601. [PMID: 34069926 PMCID: PMC8157565 DOI: 10.3390/healthcare9050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
Synovial chondromatosis is a non-cancerous tumor characterized by the formation of multiple nodules of cartilage due to metaplastic development of the synovial membrane. Etiology can be a primary lesion, of which pathogenesis remains unknown, or low-grade trauma or internal disorders. This pathology can long remain undiagnosed and leads to therapeutic wandering, especially since clinical manifestations are non-specific. Symptoms may mimic temporomandibular disorders and dental orthopantomogram does not always show intra-articular calcified bodies. Cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are tests of choice for the diagnosis of this pathology. This case report describes the clinical manifestations, diagnosis and management of a case of synovial chondromatosis involving the temporomandibular joint, in a 21-year-old woman who was initially treated for two years for a common temporo-mandibular disorder. The evidence gathered during the medical interview and clinical examination led us to suspect synovial chondromatosis of the temporomandibular joint. Prescription of a CBCT and MRI confirmed the diagnosis of her temporomandibular joint disorder and led to a successful arthroplasty.
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Zhao W, Ruan Y, Zhang W, Yang F. Synovial chondromatosis of the temporomandibular joint with 400 loose bodies: a case report and literature review. J Int Med Res 2021; 49:3000605211000526. [PMID: 33752510 PMCID: PMC7995452 DOI: 10.1177/03000605211000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.
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Affiliation(s)
- Wenyan Zhao
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Yan Ruan
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Wentao Zhang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Fan Yang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
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Qiao YM, Wang Y, Li R. [Clinical analysis of arthroscopy used in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:209-214. [PMID: 33834677 DOI: 10.7518/hxkq.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the value of arthroscopy in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint (TMJSC). METHODS The cases of 16 patients preliminarily diagnosed with TMJSC by magnetic resonance imaging (MRI) from July 2011 to December 2018 were analyzed retrospectively. If the diagnosis was confirmed by arthroscopy, the opening operation was performed. The preoperative MRI, arthroscopy and opening operation, postoperative pathology and postoperative MRI of confirmed cases were analyzed, and clinical follow-up was performed to evaluate the curative effect of open surgery. The degree of mouth opening and visual analogue scale (VAS) scores for pain pre-operation and during follow-up of the confirmed cases were analyzed by t-test. RESULTS Fourteen cases of TMJSC were diagnosed by arthroscopy, consistent with the postoperative pathological diagnosis. Postoperative MRI examination showed that articular cavity lesions basically disappeared. Ten patients with synovial chondromatosis were followed-up (follow-up rate, 71.4%) from 6 months to 7 years and 8 months (average follow-up time, 17.6 months); no recurrence was found, and clinical symptoms improved by varying degrees. Before operation and at follow-up, t-test results of opening degree difference were t=7.757, P<0.05; t-test results of VAS were t=-3.274, P<0.05. CONCLUSIONS Arthroscopy is essential in the diagnosis and treatment of TMJ synovial chondromatosis.
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Affiliation(s)
- Yong-Ming Qiao
- Dept. of Oral and Maxilloficial Surgery, the Stomatology Center of the First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Oral Health Management and Cancer Prevention Medicine, Zhengzhou 450052, China
| | - Ying Wang
- Dept. of Oral and Maxilloficial Surgery, the Stomatology Center of the First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Oral Health Management and Cancer Prevention Medicine, Zhengzhou 450052, China
| | - Rui Li
- Dept. of Oral and Maxilloficial Surgery, the Stomatology Center of the First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Oral Health Management and Cancer Prevention Medicine, Zhengzhou 450052, China
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Magdieva KM, Ermolin VI, Visaitova ZY, Romanovsky MA. [A case report of extensive intracapsular synovial chondromatosis of the temporomandibular joint]. STOMATOLOGIIA 2021; 100:92-96. [PMID: 34953196 DOI: 10.17116/stomat202110006192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The article reports a patient with an unusually large synovial chondromatosis of the temporomandibular joint. In this clinical case, the extremely rare sizes of chondral bodies are given, because of which it was required to expand the standard access to the TMJ with the isolation of the trunk and branches of the facial nerve.
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Affiliation(s)
- Kh M Magdieva
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
| | - Z Yu Visaitova
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
| | - M A Romanovsky
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
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de Almeida D, de Souza PSAP, de Mendonça LP, Verner FS, Devito KL. Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations. Imaging Sci Dent 2020; 50:99-104. [PMID: 32601584 PMCID: PMC7314601 DOI: 10.5624/isd.2020.50.2.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to use cone-beam computed tomography (CBCT) images to determine the prevalence of calcifications in the temporomandibular joint (TMJ) and to evaluate any associations between the presence of such calcifications and degenerative bone alterations of the TMJ, sex, or age. Materials and Methods In this retrospective study, 1,058 CBCT exams were analyzed, and data regarding the presence and quantity of calcifications, the affected side, any degenerative alterations of the condyle, sex, and age were collected. To evaluate associations between the presence of calcifications and sex or age, the Fisher exact test or the Spearman correlation coefficient, respectively, was used. To assess the association between the presence of calcifications and joint bone alterations, the chi-square and Fisher exact tests were used. The significance level adopted was 5% (P<0.05). Results Twenty-eight patients (2.7%) presented with TMJ calcifications, including 23 women (82.1%) and 5 men (17.9%). Significant correlations were found between the presence of calcifications and age (P<0.05) and between the presence of calcifications and the presence of condylar alterations (P<0.05), with 73.2% of patients with bone alterations having TMJ calcifications. Conclusion It may be concluded that, although rare (with a prevalence of only 2.7%), intra-articular calcifications are associated with both degenerative bone alterations and age.
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Affiliation(s)
- Daniela de Almeida
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Luana Pereira de Mendonça
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Karina Lopes Devito
- Department of Dental Clinic, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Gross AJ, Houston KR, Hudson JW, McCoy JM. A Multidisciplinary Approach to Synovial Chondromatosis of the Temporomandibular Joint With Cranial Base Involvement: A Brief Review of the Literature and Case Report. J Oral Maxillofac Surg 2020; 78:1759-1765. [PMID: 32544471 DOI: 10.1016/j.joms.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
Synovial chondromatosis (SC) is an infrequent, benign condition of unknown etiology affecting the synovium within articular joints. Often considered a metaplastic process, multiple cartilaginous nodules develop in the confines of the synovial membrane. In time, these cartilage nodules develop into fragments, sometimes detaching from the synovium and, thus, become loose in an adjacent synovial cavity. The temporomandibular joint (TMJ) is an unusual site of involvement, with the extracapsular compromise of the cranial base exceedingly rare. A 68-year-old woman presented with a tender mass to the left TMJ that later proved to be SC. Computed tomography illustrated a rare extension of the lesion into the middle cranial fossa. The multidisciplinary effort to remove the mass in its entirety included both oral and maxillofacial surgical and neurosurgical teams. We have reviewed the presentation, diagnosis, surgical treatment, and outcomes of the present case, with diagnostic images and photomicrographs of the lesion included. We also briefly reviewed the reported studies.
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Affiliation(s)
- Andrew J Gross
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Kyle R Houston
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - John-Wallace Hudson
- Professor, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
| | - J Michael McCoy
- Professor, Departments of Pathology, Oral and Maxillofacial Surgery, and Radiology, University of Tennessee Medical Center, Knoxville, TN
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Where to Stand with Stromal Cells and Chronic Synovitis in Rheumatoid Arthritis? Cells 2019; 8:cells8101257. [PMID: 31618926 PMCID: PMC6829866 DOI: 10.3390/cells8101257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
The synovium exercises its main function in joint homeostasis through the secretion of factors (such as lubricin and hyaluronic acid) that are critical for the joint lubrication and function. The main synovium cell components are fibroblast-like synoviocytes, mesenchymal stromal/stem cells and macrophage-like synovial cells. In the synovium, cells of mesenchymal origin modulate local inflammation and fibrosis, and interact with different fibroblast subtypes and with resident macrophages. In pathologic conditions, such as rheumatoid arthritis, fibroblast-like synoviocytes proliferate abnormally, recruit mesenchymal stem cells from subchondral bone marrow, and influence immune cell activity through epigenetic and metabolic adaptations. The resulting synovial hyperplasia leads to secondary cartilage destruction, joint swelling, and pain. In the present review, we summarize recent findings on the molecular signature and the roles of stromal cells during synovial pannus formation and rheumatoid arthritis progression.
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