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Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery. Head Neck Pathol 2015; 9:525-9. [PMID: 25912648 PMCID: PMC4651936 DOI: 10.1007/s12105-015-0626-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 04/01/2015] [Indexed: 01/17/2023]
Abstract
Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up features of this lesion are also discussed. To our knowledge, this is the second report of SC of the TMJ in Brazil.
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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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Lee D, Shin J, Kwak J, Kim J, Kim SJ, Kim MR. The synovial chondromatosis of the temporomandibular joints: review of the 4 cases. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.2.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Donghyun Lee
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jungsub Shin
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Juhee Kwak
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jinwoo Kim
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sun-Jong Kim
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myung-Rae Kim
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
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Umstadt HE, Kusch B. [Joint loose bodies in the mandible. Diagnostic criteria and pathways for therapy planning]. ACTA ACUST UNITED AC 2003; 7:330-4. [PMID: 14648247 DOI: 10.1007/s10006-003-0500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination.
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Affiliation(s)
- H E Umstadt
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Philipps-Universität Marburg.
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Holmlund AB, Eriksson L, Reinholt FP. Synovial chondromatosis of the temporomandibular joint: clinical, surgical and histological aspects. Int J Oral Maxillofac Surg 2003; 32:143-7. [PMID: 12729773 DOI: 10.1054/ijom.2002.0300] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nine patients with histologically confirmed unilateral synovial chondromatosis of the temporomandibular joint were treated surgically with extirpation of loose bodies and partial synovectomy. In six of them the histological material was available for a systematic examination. The results of treatment were evaluated clinically and with MRI after a follow-up ranging between 1 and 17 years. Our findings suggest that synovial chondromatosis of the temporomandibular affects only the synovial lining of the upper compartment. The histological appearance is that of a benign chronic inflammation varying in severity and with metaplastic activity. The most specific clinical sign of synovial chondromatosis is swelling over the joint. Distension of the lateral capsule and fluid in the joint on the MRI are very suggestive of this diagnosis. Loose bodies also indicate synovial chondromatosis, but they are not always detected on the preoperative MRI. The surgical treatment should be conservative and include thorough removal of the loose bodies and partial synovectomy in areas with marked inflammation.
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Affiliation(s)
- A B Holmlund
- Department of Oral and Maxillofacial Surgery, Karolinska Institutet, Box 4064, SE-141 04 Huddinge, Sweden.
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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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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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8
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Petito AR, Bennett J, Assael LA, Carlotti AE. Synovial chondromatosis of the temporomandibular joint: varying presentation in 4 cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:758-64. [PMID: 11113823 DOI: 10.1067/moe.2000.107533] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Synovial chondromatosis is a rare condition in which cartilage is formed in the synovial membrane of a joint. The manifestations of this benign neoplastic process can mimic many common temporomandibular joint and parotid diseases. Four cases of synovial chondromatosis are presented. In each case, atypical presentation, coexisting joint disease, or both caused diagnostic confusion. The histories and physical examinations were initially consistent with more common joint diseases in each case. Imaging provided some insight into diagnosis and was a definitive indication for surgical treatment. Treatment by subtotal synovectomy and by removal of chondromatous nodules were undertaken in each case. No patient in our series has had recurrence of disease or symptoms after surgical treatment.
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Affiliation(s)
- A R Petito
- Brown University School of Medicine, Warwick, RI, USA
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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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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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Kessler P, Hardt N, Kuttenberger J. [Synovial chondromatosis of the temporomandibular joint with invasion into the middle cranial fossa]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 1997; 1:353-5. [PMID: 9490222 DOI: 10.1007/bf03043583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach.
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Affiliation(s)
- P Kessler
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Kantonsspital Luzern
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Plath T, Dallenbach H, Ohnesorge I, Hoffmeister B. [Synovial chondromatosis (chondrometaplasia). Contribution to the differential diagnosis of temporomandibular joint diseases]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 1997; 1:349-52. [PMID: 9490221 DOI: 10.1007/bf03043582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Nonphysiologic overstrain of any cause should be diagnosed and corrected.
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Affiliation(s)
- T Plath
- Klinik für Kieferchirurgie und Plastische Gesichtschirurgie, Klinikum Benjamin Franklin, Freie Universtität Berlin
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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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