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Spallaccia F, De Tomaso S, Picotti A, Vellone V. The role of PETRA MRI sequences in the diagnosis of chondromatosis of the temporomandibular joint with erosion of the glenoid fossa. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00183-8. [PMID: 38969534 DOI: 10.1016/j.ijom.2024.06.002] [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: 01/17/2024] [Revised: 05/11/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024]
Abstract
Synovial chondromatosis is a benign condition characterised by the presence of small cartilaginous nodules in the joint; its aetiology is unknown. Only a few cases of temporomandibular chondromatosis are described in the literature. In some cases, the synovial chondromatosis can erode the adjacent bone structures, such as the glenoid fossa, middle cranial fossa, and internal carotid canal. In these cases, besides MRI, the gold standard to verify the erosion of the glenoid fossa is a computed tomography scan. The aim of this study is to report the use of MRI with PETRA (pointwise encoding time reduction with radial acquisition) sequences for the diagnosis and follow-up of temporomandibular joint chondromatosis with suspected erosion of the glenoid fossa.
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Affiliation(s)
- F Spallaccia
- Department of Maxillofacial Surgery, "S. Maria" Hospital, Terni, Italy
| | - S De Tomaso
- Department of Maxillofacial Surgery, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - A Picotti
- Radiological Center Picotti Algeri, Grosseto, Italy
| | - V Vellone
- Department of Maxillofacial Surgery, "S. Maria" Hospital, Terni, Italy.
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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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Zhang Y, Yu F, Long X, Fang W. Imaging features of temporomandibular joint synovial chondromatosis with associated osseous degenerative changes. Int J Oral Maxillofac Surg 2024; 53:311-318. [PMID: 37840000 DOI: 10.1016/j.ijom.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).
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Affiliation(s)
- Y Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - F Yu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - X Long
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - W Fang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
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Kuliński W. Physical Procedure in Temporomandibular Joint Dysfunctions. Clinical Study. ACTA BALNEOLOGICA 2022. [DOI: 10.36740/abal202206101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aim: Temporomandibular joint dysfunction is a common and difficult clinical problem. To present the use of physical therapy in patients with temporomandibular joint dysfunctions.
Materials and Methods: The paper presents the etiopathogenesis and clinical presentation of temporomandibular joint dysfunctions as well as patient cases and describes physical therapy in joint dysfunction, including the methods and equipment used to perform the procedures.
Conclusion: The paper stresses the importance of physical therapy in the treatment of temporomandibular joint dysfunctions. Physical therapy is a crucial part of treatment in patients with temporomandibular joint dysfunctions.
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Affiliation(s)
- Włodzisław Kuliński
- Department of Rehabilitation, Military Institute of Medicine, Warsaw, Poland
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Chandran Kana Veettil A, Mariyappa Shantha A, Timmasandra Ashwathappa D, Sailaja Choudary A, Lingaiah U. Assessment of thickness of roof of the glenoid fossa in dentate, edentulous, and partially edentulous subjects using cone beam computed tomography (CBCT) - a retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e279-e284. [PMID: 35545193 DOI: 10.1016/j.jormas.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Studies have inferred a direct association between Temporomandibular joint disorders (TMD) and the integrity of the structures associated with it such as the Glenoid fossa thereby necessitating the requirement to measure the thickness of this oft ignored entity. This study was carried out to assess the thickness of the glenoid fossa roof in dentulous, edentulous, and partially edentulous subjects using archival Cone beam computed tomography (CBCT) images. METHOD Analysis of CBCT data of 120 joints from 60 adult subjects without signs and symptoms of TMD was carried out. The scans were grouped based on the dental status as dentulous, edentulous, and partially edentulous and additionally into two sets as those below and above 40 years of age. The distance between the superior and inferior cortices of the glenoid fossa was measured indicating the thickness of the roof of the glenoid fossa in the coronal and sagittal planes, by three independent observers. Analysis of Variance (ANOVA) and Tukey's post hoc test were used to compare the association between the mean thickness of the glenoid fossa and the dentition status. A p ≤ 0.05 was considered to be significant. RESULTS There was no significant association between the mean thickness of the glenoid fossa and the dentition of the study participants of all three groups, when assessed by the three observers, except the mean thickness on the right side in the sagittal section as measured by one observer. A thicker fossa was observed in edentulous subjects when compared to dentulous participants, and the difference was statistically significant (p = 0.035). CONCLUSION The thickness of the roof of the glenoid fossa demonstrated no association with the dental status of the study participants and no age or sex related differences were noted.
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Affiliation(s)
| | | | | | | | - Upasana Lingaiah
- V S Dental College and Hospital, Rajiv Gandhi University of Health Sciences, Bangalore, India
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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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Zhao W, Ruan Y, Zhang W, Yang F. Synovial chondromatosis of the temporomandibular joint with 400 loose bodies: a case report and literature review. J Int Med Res 2021; 49:3000605211000526. [PMID: 33752510 PMCID: PMC7995452 DOI: 10.1177/03000605211000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.
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Affiliation(s)
- Wenyan Zhao
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Yan Ruan
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Wentao Zhang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Fan Yang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
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de Almeida D, de Souza PSAP, de Mendonça LP, Verner FS, Devito KL. Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations. Imaging Sci Dent 2020; 50:99-104. [PMID: 32601584 PMCID: PMC7314601 DOI: 10.5624/isd.2020.50.2.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to use cone-beam computed tomography (CBCT) images to determine the prevalence of calcifications in the temporomandibular joint (TMJ) and to evaluate any associations between the presence of such calcifications and degenerative bone alterations of the TMJ, sex, or age. Materials and Methods In this retrospective study, 1,058 CBCT exams were analyzed, and data regarding the presence and quantity of calcifications, the affected side, any degenerative alterations of the condyle, sex, and age were collected. To evaluate associations between the presence of calcifications and sex or age, the Fisher exact test or the Spearman correlation coefficient, respectively, was used. To assess the association between the presence of calcifications and joint bone alterations, the chi-square and Fisher exact tests were used. The significance level adopted was 5% (P<0.05). Results Twenty-eight patients (2.7%) presented with TMJ calcifications, including 23 women (82.1%) and 5 men (17.9%). Significant correlations were found between the presence of calcifications and age (P<0.05) and between the presence of calcifications and the presence of condylar alterations (P<0.05), with 73.2% of patients with bone alterations having TMJ calcifications. Conclusion It may be concluded that, although rare (with a prevalence of only 2.7%), intra-articular calcifications are associated with both degenerative bone alterations and age.
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Affiliation(s)
- Daniela de Almeida
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Luana Pereira de Mendonça
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Karina Lopes Devito
- Department of Dental Clinic, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Gross AJ, Houston KR, Hudson JW, McCoy JM. A Multidisciplinary Approach to Synovial Chondromatosis of the Temporomandibular Joint With Cranial Base Involvement: A Brief Review of the Literature and Case Report. J Oral Maxillofac Surg 2020; 78:1759-1765. [PMID: 32544471 DOI: 10.1016/j.joms.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
Synovial chondromatosis (SC) is an infrequent, benign condition of unknown etiology affecting the synovium within articular joints. Often considered a metaplastic process, multiple cartilaginous nodules develop in the confines of the synovial membrane. In time, these cartilage nodules develop into fragments, sometimes detaching from the synovium and, thus, become loose in an adjacent synovial cavity. The temporomandibular joint (TMJ) is an unusual site of involvement, with the extracapsular compromise of the cranial base exceedingly rare. A 68-year-old woman presented with a tender mass to the left TMJ that later proved to be SC. Computed tomography illustrated a rare extension of the lesion into the middle cranial fossa. The multidisciplinary effort to remove the mass in its entirety included both oral and maxillofacial surgical and neurosurgical teams. We have reviewed the presentation, diagnosis, surgical treatment, and outcomes of the present case, with diagnostic images and photomicrographs of the lesion included. We also briefly reviewed the reported studies.
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Affiliation(s)
- Andrew J Gross
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Kyle R Houston
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - John-Wallace Hudson
- Professor, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
| | - J Michael McCoy
- Professor, Departments of Pathology, Oral and Maxillofacial Surgery, and Radiology, University of Tennessee Medical Center, Knoxville, TN
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