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Morishima H, Nogami S, Igarashi A, Imoto K, Saito S, Chiba M, Kumamoto H, Takahashi T, Yamauchi K. A case of tenosynovial giant cell tumor secondary to synovial chondromatosis in the temporomandibular joint. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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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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Lee JC, Huang HY. Soft Tissue Special Issue: Giant Cell-Rich Lesions of the Head and Neck Region. Head Neck Pathol 2020; 14:97-108. [PMID: 31950466 PMCID: PMC7021864 DOI: 10.1007/s12105-019-01086-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
Giant cell-rich lesions represent a heterogeneous group of tumors and non-neoplastic lesions, usually arising in bone, which harbor varying number of reactive osteoclastic-type multinucleate giant cells as a common feature. Among these entities, some are confined to the head and neck region (e.g., central giant cell granuloma and mimicking lesions, i.e., peripheral giant cell granuloma and cherubism) or show a relative predilection for this region (e.g., aneurysmal bone cyst and brown tumor of hyperparathyroidism), while others are rare but associated with distinct underlying disease (e.g., giant cell tumor of bone) or histology (e.g., tenosynovial giant cell tumor of the temporomandibular joint and phosphaturic mesenchymal tumor of the jaws) when occurring in the head and neck. Collectively, these lesions pose great challenge in the pathologic diagnosis, which often requires combinatory assessment from the clinical, histopathologic, and/or molecular aspects. This review provides a summary of pertinent clinical and pathologic features and an update of recent molecular and genetic findings of these entities. The considerations in differential diagnosis as well as the effects of the emerging therapeutic RANKL-antagonizing antibody denosumab will also be addressed.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833 Taiwan
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Wang JG, Liu J, He B, Gao L, Zhang L, Liu J. Diffuse Tenosynovial Giant Cell Tumor Around the Temporomandibular Joint: An Entity With Special Radiologic and Pathologic Features. J Oral Maxillofac Surg 2019; 77:1022.e1-1022.e39. [PMID: 30796908 DOI: 10.1016/j.joms.2019.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Diffuse tenosynovial giant cell tumor (TGCT) of the temporomandibular joint (TMJ) is rare. The aim of the present study was to summarize the clinical, radiologic, and pathologic features of this tumor. MATERIALS AND METHODS Nine cases of TGCT in the TMJ region were examined. All available radiologic and pathologic documents were carefully reviewed. These cases were grouped into 3 types according to the radiologic features: bone-centered type, intraosseous type, and soft tissue type. Cases reported in the literature were reviewed to better summarize the clinical characteristics. RESULTS TGCTs in the TMJ region showed some special radiologic and pathologic features. Radiologically, the lesion could be centered in the craniofacial bone or centered in the surrounding soft tissue. Four cases were categorized as the bone-centered type, 1 was categorized as the intraosseous type, and 4 were categorized as the soft tissue type. Pathologically, epithelioid mononuclear cells with abundant eosinophilic cytoplasm and eccentric nuclei were observed in all cases. Chondroid metaplasia was noted in 8 cases. Some areas were similar to giant cell reparative granuloma and chondroblastoma. All patients who underwent complete tumor resection showed no evidence of recurrence at follow-up. Of the 93 reported cases, only 5 developed postoperative recurrence and distant metastasis. CONCLUSION TGCTs of the TMJ region share similar radiologic and pathologic features as other tumors, which indicates the TGCT might be a special entity within a spectrum of diseases.
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Affiliation(s)
- Ji-Gang Wang
- Associate Chief Physician and Postdoctoral Research Fellow, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingwei Liu
- Resident, Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Bing He
- Resident, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Gao
- Attending Doctor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Professor, Medical Systems Biological Center for Complex Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jihua Liu
- Professor, Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Holtmann H, Böttinger T, Kübler NR, Singh DD, Sproll CK, Sander K, Langie R, Schrader F, Lommen J. Intra- and extracapsular synovial chondromatosis of the temporomandibular joint: Rare case and review of the literature. SAGE Open Med Case Rep 2018; 6:2050313X18775307. [PMID: 29796269 PMCID: PMC5954576 DOI: 10.1177/2050313x18775307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/16/2018] [Indexed: 12/05/2022] Open
Abstract
Synovial chondromatosis is a benign disease which most commonly appears in large joints and only rarely affects the temporomandibular joint. The diagnosis is quite difficult due to the fact that a large swelling in the preauricular area and the radiographic findings may be misdiagnosed as other benign or malignant diseases. We report an unusual case of intra- and extracapsular chondromatosis of 25 osteochondral loose bodies in the right temporomandibular joint.
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Affiliation(s)
- Henrik Holtmann
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Böttinger
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Norbert R Kübler
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Daman D Singh
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christoph K Sproll
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Karoline Sander
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Renan Langie
- Santa Casa de Misericórdia de Porto Alegre (SCMPA), Avenida Independência, Porto Alegre, Brazil
| | - Felix Schrader
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
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Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension. J Craniofac Surg 2016; 26:e115-8. [PMID: 25699525 DOI: 10.1097/scs.0000000000001341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pigmented villonodular synovitis is an uncommon benign tumor-like proliferative lesion with an undetermined origin. Involvement of the temporomandibular joint is uncommon. Although pigmented villonodular synovitis is a benign lesion, it can grow with an aggressive pattern, and it extends extra-articularly in most of the reported cases, about one-third of them exhibiting intracranial involvement. The authors reported an additional case of a 47-year-old woman with intracranial extension, who had a history of joint pain and trismus. The preoperative diagnosis was made with arthroscopy. The lesion was completely excised via preauricular approach and condylotomy. The bone defect was covered by the pedicled temporalis myofascial fat flap. The patient has been symptom-free for 40 months postoperatively.
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Damodar D, Chan N, Kokot N. Pigmented villonodular synovitis of the temporomandibular joint: Case report and review of the literature. Head Neck 2015; 37:E194-9. [DOI: 10.1002/hed.24056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/22/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dhanur Damodar
- Department of Otolaryngology; University of Southern California, Keck School of Medicine; Los Angeles California
| | - Nadia Chan
- Department of Otolaryngology; University of Southern California, Keck School of Medicine; Los Angeles California
| | - Niels Kokot
- Department of Otolaryngology; University of Southern California, Keck School of Medicine; Los Angeles California
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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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Joshi K, Huang B, Scanga L, Buchman C, Chera BS. Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint. Am J Otolaryngol 2015; 36:106-13. [PMID: 25459320 DOI: 10.1016/j.amjoto.2014.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ. METHODS We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT. RESULTS 71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled. CONCLUSIONS PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.
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Affiliation(s)
| | - Benjamin Huang
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Lori Scanga
- Department of Pathology, University of North Carolina, Chapel Hill, NC
| | - Craig Buchman
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina, Chapel Hill, NC
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Linebeger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Safaee M, Oh T, Sun MZ, Parsa AT, McDermott MW, El-Sayed IH, Bloch O. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review. Head Neck 2014; 37:1213-24. [PMID: 24764167 DOI: 10.1002/hed.23717] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/15/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. METHODS Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. RESULTS Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. CONCLUSION PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Michael W McDermott
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Ivan H El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Pina S, Fernandez M, Maya S, Garcia RA, Noor A, Pawha PS, Som PM. Recurrent temporal bone tenosynovial giant cell tumor with chondroid metaplasia: the use of imaging to assess recurrence. Neuroradiol J 2014; 27:97-101. [PMID: 24571839 DOI: 10.15274/nrj-2014-10011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/14/2013] [Indexed: 11/12/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a benign proliferative lesion of unclear etiology. It is predominantly monoarticular and involves the synovium of the joint, tendon sheath, and bursa. TGCT of the temporomandibular joint (TMJ) is rare and aggressive resulting in destruction of surrounding structures. The diagnosis may be suggested by imaging, mainly by the MR features and PET/CT, and confirmed by histopathology. We describe the case of a 50-year-old man who presented with right-sided hearing loss, tinnitus and TMJ pain. Pathology revealed tenosynovial giant cell tumor with chondroid metaplasia. Six years later he developed a recurrence, which was documented to our knowledge for the first time with CT, MR and FDG PET/CT imaging.
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Affiliation(s)
- Sofia Pina
- Department of Neuroradiology, Hospital Santo António - CHP; Porto, Portugal -
| | - Maria Fernandez
- Department of Radiology, Virgen de la Salud Hospital; Toledo, Spain
| | - Silvia Maya
- Department of Radiology, Valencia Clinical University Hospital; Valencia, Spain
| | - Roberto A Garcia
- Department of Pathology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Ali Noor
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Puneet S Pawha
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Peter M Som
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
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Okada K, Yamaguchi T, Minowa K, Totsuka Y, Shindoh M, Inoue N. A case of pigmented villonodular synovitis, with few clinical symptoms, arising from the temporomandibular joint. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Matsumoto K, Sato T, Iwanari S, Kameoka S, Oki H, Komiyama K, Honda K. The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis. Dentomaxillofac Radiol 2012; 42:15388284. [PMID: 22282505 DOI: 10.1259/dmfr/15388284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ.
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Affiliation(s)
- K Matsumoto
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Nihon University, Tokyo, Japan.
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Cai XY, Yang C, Chen MJ, Jiang B, Zhou Q, Jin JM, Yun B, Chen ZZ. Arthroscopic management for synovial chondromatosis of the temporomandibular joint: a retrospective review of 33 cases. J Oral Maxillofac Surg 2011; 70:2106-13. [PMID: 22177814 DOI: 10.1016/j.joms.2011.09.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 09/24/2011] [Accepted: 09/27/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE To present clinical, radiologic, and arthroscopic results of patients with synovial chondromatosis of the temporomandibular joint; to introduce a technique for removal of loose bodies in different areas; and to summarize the indications of therapeutic arthroscopy according to the magnetic resonance imaging (MRI) features. PATIENTS AND METHODS From April 2001 to April 2010, 33 consecutive patients underwent arthroscopy. Their demographics, clinical manifestations, imaging studies, arthroscopic findings, treatments, and outcomes were reviewed. RESULTS The predominant symptoms were pain, limitation of mouth opening, and joint sounds. Obvious joint effusion was shown on MRI in 21 of 33 patients. Mass lesions were shown on MRI in 29 of 33 cases. The presence of loose bodies was shown in 31 cases under an arthroscope. Synovial hyperplasia was noted in 12 patients. Bony erosion of the articular surface was discovered in 11 patients. Thirty-two patients underwent therapeutic arthroscopy. Smaller loose bodies were commonly removed with joint lavage or biopsy forceps in 24 patients. Fragmentation with forceps or a wider additional incision was applied to remove larger loose bodies in 7 patients. Debridement was applied to remove intrasynovial lesions in 7 patients. Coblation was used to remove the hyperplastic synovium in 10 of 32 patients. Eight patients were lost to follow-up. The mean follow-up period was 38 months. No recurrence was suspected clinically and radiologically. CONCLUSIONS Therapeutic arthroscopy was appropriate for patients with separate mass lesions and no extra-articular extension. Surgical treatment comprised thorough removal of loose bodies and affected synovial tissues.
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Affiliation(s)
- Xie-Yi Cai
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Pigmented villonodular synovitis of the temporomandibular joint: a case report and the literature review. Int J Oral Maxillofac Surg 2011; 40:1314-22. [DOI: 10.1016/j.ijom.2011.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/23/2011] [Accepted: 03/02/2011] [Indexed: 11/23/2022]
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Chen MJ, Yang C, Cai XY, Jiang B, Qiu YT, Zhang XH. Synovial chondromatosis in the inferior compartment of the temporomandibular joint: different stages with different treatments. J Oral Maxillofac Surg 2011; 70:e32-8. [PMID: 22033448 DOI: 10.1016/j.joms.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To discuss a new classification and the treatment principles of synovial chondromatosis (SC) in the inferior compartment of the temporomandibular joint (TMJ). PATIENTS AND METHODS Five cases of SC in the inferior compartment were treated in an open manner between January 2008 and May 2011. Each case had different clinical and radiologic aspects and was treated with different surgical therapies. SC in the inferior compartment of the TMJ is classified into 3 stages. All patients were evaluated by computed tomography, magnetic resonance imaging, and clinical manifestations preoperatively and postoperatively. RESULTS There were 3 kinds of manifestation modes from radiologic findings. Case 1 was in stage 1, in which multiple loose bodies are noted without bony erosion. This patient was treated by removal of loose bodies and affected synovium. Case 2 was in stage 2, in which multiple calcified nodules were conglutinated to the condyle; the condyle was enlarged with pressure erosions. This patient was treated by condylectomy and reconstruction with costochondral graft. Case 3, case 4, and case 5 were all in stage 3, in which the condyle was destroyed as a result of pressure erosions or by direct bony invasion of the mass and the inferior surface of the disc was involved. These patients were treated by condylectomy together with discectomy, as well as reconstruction with costochondral graft and pedicled deep temporal fascial fat flap. No recurrence occurred. The height of the ramus and the occlusion were maintained in the same condition as preoperatively. CONCLUSIONS Our new classification of SC in the inferior compartment of the TMJ can better guide clinical treatment.
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Affiliation(s)
- Min-jie Chen
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Wong JJS, Phal PM, Wiesenfeld D. Pigmented villonodular synovitis of the temporomandibular joint: a radiologic diagnosis and case report. J Oral Maxillofac Surg 2011; 70:126-34. [PMID: 21783297 DOI: 10.1016/j.joms.2011.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Jaclyn J S Wong
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Pigmented villonodular synovitis of the temporomandibular joint: case report and review of the literature. ACTA ACUST UNITED AC 2011; 111:e17-28. [PMID: 21310347 DOI: 10.1016/j.tripleo.2010.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/31/2010] [Accepted: 11/26/2010] [Indexed: 02/06/2023]
Abstract
Pigmented villonodular synovitis (PVNS) is an aggressive proliferative lesion that usually involves the synovial tissues of big joints. To date, there are ∼52 cases of PVNS affecting the temporomandibular joint reported in the English-language literature, about one-third of them exhibiting intracranial involvement. We herein describe an additional case of PVNS of the temporomandibular joint with skull base invasion affecting a 26-year-old male patient and discuss its clinicopathologic features considering previously published cases. Histopathology and imaging evaluation are important for the diagnosis of PVNS, which should be included in the differential diagnosis of preauricular aggressive swellings.
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19
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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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20
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Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint. Int J Oral Maxillofac Surg 2011; 40:150-4. [DOI: 10.1016/j.ijom.2010.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/05/2010] [Accepted: 09/13/2010] [Indexed: 11/23/2022]
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Cai XY, Yang C, Chen MJ, Jiang B, Wang BL. Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint. Int J Oral Maxillofac Surg 2010; 39:1236-9. [DOI: 10.1016/j.ijom.2010.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/10/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
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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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