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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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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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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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Morales RJ, Cabrales RA. Synovial chondromatosis affecting the temporomandibular joint: A case report and literature review. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Endoscopically assisted fixation of the custom-made total temporomandibular joint prosthesis in TMJ Yang's system through a modified preauricular approach. Int J Oral Maxillofac Surg 2019; 49:224-229. [PMID: 31272900 DOI: 10.1016/j.ijom.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/26/2019] [Accepted: 06/04/2019] [Indexed: 11/20/2022]
Abstract
This article describes the experience with the endoscopically assisted fixation of the customized total temporomandibular joint (TMJ) prosthesis in TMJ Yang's system only through a modified preauricular approach. Twenty patients (23 joints) treated with the custom-made total TMJ prosthesis were retrospectively recruited. An endoscopically assisted technique was used through a modified preauricular approach to fix the mandibular component for all these patients. These reconstructions were evaluated by surgical records, clinical examinations, and radiographic observations. All patients had successful fixation of the prosthesis. No patient had permanent weakness of the facial nerve and malocclusion or any other severe complications. The mean operative time was 111 min per joint (range, 85-133 min). The average surgical bleeding was 195 ml per side. The mean follow-up period was 16.2 months (range, 5-32 months). The mean scores were 8.3 for surgical satisfaction and 9.2 for scar healing evaluation. All patients experienced positive clinical outcomes, with a mean 75.2% reduction in pain and 53.7% increase in mouth opening with significant differences (P<0.05). The endoscopically assisted TMJ reconstruction with the customized prosthesis in TMJ Yang's system through the modified preauricular approach could produce good aesthetic and functional results.
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Lee LM, Zhu YM, Zhang DD, Deng YQ, Gu Y. Synovial Chondromatosis of the Temporomandibular Joint: A clinical and arthroscopic study of 16 cases. J Craniomaxillofac Surg 2019; 47:607-610. [PMID: 30799132 DOI: 10.1016/j.jcms.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/08/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Present and overview the clinical finding, management and arthroscopic study of Synovial Chondromatosis (SC) cases in Temporomandibular Joint (TMJ) treated by our team. STUDY DESIGN During year 2008-2018, 16 TMJ SC cases were treated and reviewed. The clinical manifestations, radiographic data, arthroscopic study and pathologic findings were recorded and analyzed. RESULTS Average age of first visit was 32.68. The ratio of male/female was 2/14, right/left was 7/9. The most common symptoms were pain, continuous crepitus and limited mouth opening (LMO). All cases were examined by computed tomography (CT) and magnetic resonance imaging (MRI) preoperative and proved by pathology postoperative. The diagnostic rates of CT and MRI were 12.5% and 93.75% respectively. 1 case could not be detected by both, but by arthroscopy. Particles in all cases occurred in the upper joint cavity and were all removed by arthroscopic technique. No recurrence was found after 3 years follow-up. CONCLUSIONS MRI and arthroscopic technique could be the first choice in the diagnosis and treatment of SC. Most cases were in stage 3 of the disease at the first visit. Low recurrence rate may be attributed to the improvement of intra-articular environment after surgery. Larger sample sizes are needed for further study.
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Affiliation(s)
- Lee Mui Lee
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Yao Min Zhu
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Dan Di Zhang
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Yong Qiang Deng
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Ying Gu
- Graduate Institution, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou City, Guangdong Province, 511436, People's Republic of China.
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Liu X, Huang Z, Zhu W, Liang P, Tao Q. Clinical and Imaging Findings of Temporomandibular Joint Synovial Chondromatosis: An Analysis of 10 Cases and Literature Review. J Oral Maxillofac Surg 2016; 74:2159-2168. [DOI: 10.1016/j.joms.2016.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 01/04/2023]
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Removal of a Solitary Synovial Chondromatosis of the Temporomandibular Joint Using Arthroscopy. J Craniofac Surg 2016; 27:967-9. [PMID: 27244213 DOI: 10.1097/scs.0000000000002612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of synovial chrondromatosis of temporomandibular joint (TMJ) requires a combined assessment consisting of clinical, radiologic, and histopathologic examinations. The purpose of this study is to report in 1 patient the removal of a single large cartilaginous nodule floating in the upper joint compartment using arthroscopy. A 30-year-old woman was referred to our department complaining about pain in preauricular area and restricted mouth opening. Imaging of magnetic resonance reveals anterior disc displacement and right joint effusion. Arthroscopy of TMJ was performed for diagnosis and treatment. During the arthroscopy a large loose body was identified and removed with a biopsy forceps; lavage was conducted with ringer solution. Hyaluronic acid was injected in TMJ at surgery, 1 and 3 months after surgery. Postoperative magnetic resonance imaging showed articular disc on position and no effusion. The patient was followed up of 1 year without sign and symptoms. Arthroscopic procedure of TMJ was effective in diagnosis and removal of a solitary loose body of synovial chrondromatosis. Viscosupplementation appers to offer benefits in controlling pain and functional improvements.
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Abstract
A rapidly progressing calcified mass was found in the left sinus tarsi in a 12-year-old female after a trivial ankle sprain. The lesion mimicked an aggressive lesion clinically and radiographically. Ultrasound-guided biopsy confirmed the diagnosis of a synovial chondroma. Excision of the tumor and partial synovectomy were performed. The histologic diagnosis was a solitary synovial osteochondroma. The condition had not recurred after a follow-up period of 12 months.
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Affiliation(s)
- Tun Hing Lui
- Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territory, Hong Kong SAR, China.
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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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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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