Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease) of the temporomandibular joint: A case report

Prevalence of chondrocalcinosis in the temporomandibular joint in patients with chondrocalcinosis of the knee or wrist

OBJECTIVE

The aim of this study was to investigate the prevalence of TMJ chondrocalcinosis on head CT scans in patients with chondrocalcinosis of the knee or wrist.

METHODS AND MATERIALS

227 patients with radiological evidence of calcifications on knee or wrist radiographs had a head CT scan obtained for unrelated purposes. CT scans were retrospectively reviewed for the presence of temporomandibular crystal deposition. Prevalence, bilaterality, age and gender distribution were determined.

RESULTS

41 of 227 (18%) of patients had TMJ chondrocalcinosis. TMJ chondrocalcinosis was more common in females (17%) than males (1%). It was more commonly unilateral (68%) than bilateral (32%).

CONCLUSION

In patients with peripheral calcific disease, the TMJ is more commonly involved than previously reported and this is more common in females compared to males.

Imaging Approach to Temporomandibular Joint Disorders

Internal derangement is the most common temporomandibular joint disorder. Degenerative osteoarthritis and trauma are next in frequency. Less common pathology includes rheumatoid arthritis, synovial chondromatosis, calcium pyrophosphate dehydrate deposition disease, pigmented villonodular synovitis, tumors, infection, and osteonecrosis. We provide a systematic approach to facilitate interpretation based on major anatomic structures: disc-attachments, joint space, condyle, and lateral pterygoid muscle. Relevant graphic anatomy and state of the art imaging are discussed in correlation with current clinical and therapeutic highlights of pathologic entities affecting the joint.

Tophaceous pseudogout of the temporomandibular joint: a series of 3 cases

OBJECTIVE

We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ).

STUDY DESIGN

Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening.

RESULTS

Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a "neoplastic lesion" in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as "tophaceous pseudogout."

CONCLUSION

Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with "neoplasm-like" lesions clinically and radiographically.

Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout)

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.