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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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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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Jenzer AC, Trotta R, Hechler BL, Powers DB. Synovial chondromatosis: a case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:276-283. [PMID: 37321929 DOI: 10.1016/j.oooo.2023.02.006] [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: 12/25/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy of the joint to remove the cartilaginous and osteocartilaginous nodules. The second is a 63-year-old male who was evaluated and treated for synovial chondromatosis of the right TMJ with the removal of extracapsular masses and an arthrotomy with intra-joint removal of nodules. Six-year radiographic follow-up demonstrated no recurrence of the pathology in his case. The cases are reviewed in this article, along with a current review of the literature.
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Affiliation(s)
- Andrew C Jenzer
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
| | - Benjamin L Hechler
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
| | - David B Powers
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
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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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Song Z, Yuan S, Liu J, Bakker AD, Klein-Nulend J, Pathak JL, Zhang Q. Temporomandibular joint synovial chondromatosis: An analysis of 7 cases and literature review. Sci Prog 2022; 105:368504221115232. [PMID: 35850569 PMCID: PMC10358552 DOI: 10.1177/00368504221115232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). METHODS Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint", and found 181 cases. RESULTS There was no specific difference in the symptoms of SC in the TMJ in different Milgram's stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram's stage. CONCLUSIONS The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.
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Affiliation(s)
- Zhiqiang Song
- Guangdong Engineering Research Center of Oral Restoration and Reonstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, China
| | - Shanshan Yuan
- Guangdong Engineering Research Center of Oral Restoration and Reonstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, China
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Junjie Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Astrid D. Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Janak L. Pathak
- Guangdong Engineering Research Center of Oral Restoration and Reonstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, China
| | - Qingbin Zhang
- Guangdong Engineering Research Center of Oral Restoration and Reonstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, China
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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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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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Imaging features of synovial chondromatosis of the temporomandibular joint: a report of 34 cases. Clin Radiol 2021; 76:627.e1-627.e11. [PMID: 33762137 DOI: 10.1016/j.crad.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023]
Abstract
AIM To investigate the imaging features of synovial chondromatosis of the temporomandibular joint (TMJ), which is a rare benign arthropathy with cartilaginous proliferation. MATERIALS AND METHODS Computed tomography and magnetic resonance imaging examinations of 34 patients with histopathologically confirmed primary synovial chondromatosis of the TMJ were reviewed retrospectively. Imaging features including the lesion epicentre, destruction/sclerosis of surrounding bone, calcification, periosteal reaction, osteophyte, lesion size, and joint space dimensions were assessed. RESULTS Thirty-one of thirty-four patients (91.2%) showed the superior joint space as the lesion epicentre. For the mandibular condyle, more than one-third of patients (14/34; 41.2%) showed no destruction, and more than half of patients (19/34; 55.9%) showed no sclerosis. Conversely, >70% of patients showed destruction and sclerosis of the articular eminence/glenoid fossa, while >80% of patients (28/34; 82.4%) presented with various calcifications, including the ring-and-arc (9/34; 26.5%) and popcorn (13/34; 38.2%) types. The mean joint space on the affected side was significantly larger than that of the unaffected side (p<0.001). More than three-fourths of patients (76.9%) experienced no interval increase in lesion size during an average of 1.6 years of follow-up. CONCLUSION Synovial chondromatosis of the TMJ demonstrated several imaging features, including the lesion centre being located in the superior joint space, resultant articular eminence/glenoid fossa-oriented bone changes, ring-and-arc and popcorn calcification, joint space widening, and self-limiting growth. These imaging features may be helpful in differentiating synovial chondromatosis from other lesions of the TMJ.
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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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Liu X, Wan S, Abdelrehem A, Chen M, Yang C. Benign temporomandibular joint tumours with extension to infratemporal fossa and skull base: condyle preserving approach. Int J Oral Maxillofac Surg 2020; 49:867-873. [PMID: 32044186 DOI: 10.1016/j.ijom.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/11/2019] [Accepted: 12/24/2019] [Indexed: 11/28/2022]
Abstract
This article introduces a modified surgical approach combining condylotomy with posterior disc attachment release for the resection of large non-malignant masses located in the infratemporal fossa and involving the skull base. This retrospective study included 14 patients treated at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University between January 2010 and December 2016. Clinical evaluations (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiological findings (magnetic resonance imaging (MRI) and computed tomography (CT)) were collected pre- and postoperatively. All patients had satisfactory surgical exposure and complete resection of the neoplasms. During an average follow-up of 54.8 months, no clinical or radiographic signs of recurrence were reported. MIO increased from 28mm preoperatively to 35.4mm postoperatively (P<0.001). The pain VAS score changed from 5.4 preoperatively to 0.7 postoperatively (P<0.001). Neural function was normal for all patients. Postoperative MRI and CT scans showed a satisfactory disc position and condyle morphology, with no resorption. Three-dimensional reconstruction of the postoperative CT scan also demonstrated healing of the skull base defects. The modified surgical approach combining condylotomy with posterior disc attachment release is suitable for the removal of large non-malignant masses involving the infratemporal fossa and skull base.
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Affiliation(s)
- X Liu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - S Wan
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - A Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - C Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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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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Nath P, Menon S. Synovial Chondromatosis of the Temporomandibular Joint. J Maxillofac Oral Surg 2019; 19:230-234. [PMID: 32346232 DOI: 10.1007/s12663-019-01194-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/31/2019] [Indexed: 12/16/2022] Open
Abstract
Synovial chondromatosis is a rare condition characterized by the presence of loose cartilaginous bodies, due to the abnormal proliferation of synovial membrane. However, its manifestation in the temporomandibular joint is a rare finding, occurring predominantly in females. This case report describes the clinical features, diagnosis and management of a case of synovial chondromatosis.
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Affiliation(s)
| | - Suresh Menon
- Vydehi Institute of Dental Sciences, Bangalore, India
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Brabyn PJ, Capote A, Muñoz-Guerra MF, Zylberberg I, Rodríguez-Campo FJ, Naval-Gías L. Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review. J Maxillofac Oral Surg 2018; 17:401-409. [PMID: 30344377 DOI: 10.1007/s12663-018-1102-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/12/2018] [Indexed: 12/19/2022] Open
Abstract
Aim Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopy for the treatment of SC of the temporomandibular joint (TMJ). Materials and Methods A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out. Results Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgical treatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period. Conclusions Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3 mm or without extra-articular extension.
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Affiliation(s)
- Philip James Brabyn
- 1Resident of Oral and Maxillofacial Department, Hospital Universitario La Princesa, C/Diego de León 62, 28006 Madrid, Spain
| | - Ana Capote
- 2Staff Surgeon of Oral and Maxillofacial Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Ian Zylberberg
- 1Resident of Oral and Maxillofacial Department, Hospital Universitario La Princesa, C/Diego de León 62, 28006 Madrid, Spain
| | | | - Luis Naval-Gías
- 3Head of Oral and Maxillofacial Department, Hospital Universitario La Princesa, Madrid, Spain
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