Arthroscopic observation and treatment of synovial chondromatosis of the temporomandibular joint. Report of a case and review of the literature

TMJ synovial chondromatosis - an evaluation of 37 patients

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.

Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review

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.

The Role of Temporomandibular Joint Arthroscopy for Diagnosis and Surgical Management of Synovial Chondromatosis

OBJECTIVE

We report the experience of our maxillo-facial surgery unit into the diagnostic and the therapeutic role of arthroscopy of temporomandibular joint (TMJ) synovial chondromatosis (SC).

MATERIALS AND METHODS

A series of sixteen patients with an imaging, arthroscopical, and histological diagnosis of SC treated with arthroscopy was selected. The surgeries were conducted in the Department of Maxillo-facial surgery, Academic hospital of Udine, from January 2016 to December 2022. Medical history, clinical examination, imaging, arthroscopical, and histological characteristics were recorded and then reviewed and discussed.

RESULTS

Clinical improvement, both in pain and in maximum incisal opening (MIO), were noticed in whole patients. Histologically, according to Milgram's classification, the sample was fairly homogeneous. Arthroscopic treatment was successful in 87.5% of the patients. Only two cases of SC relapse were registered and were then submitted to open surgery to perform a total sinovectomy. The data collected were used to develop an SC classification proposal based on clinical, radiological (magnetic resonance imaging), arthroscopical, and histopathological characteristics.

CONCLUSIONS

TMJ arthroscopy must be considered the first line of treatment for SC, leaving open surgery to relapses cases and those cases with extraarticular extension. A univocal classification is essential to best stage and prognostically characterise this pathology.

Arthroscopic management of synovial chondromatosis with skull base perforation: A case report and literature review

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.

Comparative Evaluation of Success in Cases of Synovial Chondromatosis of Temporomandibular Joint Treated with Temporomandibular Joint Arthroscopy: A Case Series

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.

Synovial Chondromatosis of the Temporomandibular Joint: A clinical and arthroscopic study of 16 cases

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.

Diagnostic accuracy of synovial chondromatosis of the temporomandibular joint on magnetic resonance imaging

The purpose of this study was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for synovial chondromatosis (SC) of the temporomandibular joint (TMJ). In this study, 1415 patients (2109 joints) with temporomandibular joint disorders were collected between January 2012 and January 2017. All patients had a preoperative MRI examination and were treated by either arthroscopy or open surgery. On reviewing all MRI images, the number of "positive", "suspicious", and "negative" cases was collected afterwards, then the number of reported SC cases in operative data was recorded. The SPSS software was used to process all collected data. The kappa coefficient and ROC curve (AUC-index) with sensitivity and specificity were calculated to evaluate the consistency between MRI and arthroscopy/open surgery. Compared to 156 joints with SC detected by arthroscopy and open surgery, the results of MRI examination showed "positive" in 117 joints, and "negative" in 1938 joints. The number of "true positive", and "true negative" cases was 95, and 1897 respectively. The AUC-index was 0.86 (0.82-0.90) with a kappa coefficient of 0.74 (P < 0.05). In conclusion, the incidence of synovial chondromatosis diagnosed on MRI was in accordance with the arthroscopic and open surgery. Therefore, being a relatively non-invasive tool, MRI could be recommended as an effective diagnostic modality for SC.

Intra- and extracapsular synovial chondromatosis of the temporomandibular joint: Rare case and review of the literature

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.

Open surgery assisted with arthroscopy to treat synovial chondromatosis of the temporomandibular joint

Open surgery and arthroscopy for the treatment of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) have their advantages and disadvantages. The aim of this study was to report the application and results of the combined use of these two methods in the treatment of SC and the indications for use. A total of 36 patients with magnetic resonance imaging (MRI) confirmation of SC, treated from 2010 to 2015, were included. Patients with tumours in the upper articular cavity and with the extended margin of the medial groove still in-between the medial crest of the condyle and infratemporal space on coronal MRI were selected to undergo open surgery with the assistance of arthroscopy to clear the loose bodies and affected synovium. All 36 patients first went through open surgery. Subsequent arthroscopy examinations indicated the presence of loose bodies in the medial groove in 14 patients (in the anterior or posterior recess), which were removed using a cup-shaped clamp. Thirty-three of the patients were followed up for an average of 33.3 months; there was no recurrence in these patients. This technique has the benefits of the complete elimination of diseased tissues with a minimal osteotomy and a short surgical duration.

[Chondromatose of the temporomandibular joint: Multicentric study and clarification from 14 cases]

INTRODUCTION

The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease.

MATERIAL AND METHODS

We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant.

RESULTS

Fourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90-47.38) (41 for women [σ = 14.74; IC95: 33.28-48.72] and 35 years for men [σ = 5.66, IC95: 27.16-42.84]). Average age at surgery was 40.86 (σ = 14.18; IC95: 33.43-48.28). There was no predominance of side; 57.14 % of the patients had a joint syndrome, 57.14 % a tumor syndrome, 28.57 % had pain and 14.29 % had headaches. Panoramic X-ray was informative in 3 cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10 years later.

DISCUSSION

Chondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.

Removal of a Solitary Synovial Chondromatosis of the Temporomandibular Joint Using Arthroscopy

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.

Arthroscopic surgery for removal of 112 loose bodies of synovial chondromatosis of the temporomandibular joint

We present a new case of unilateral synovial chondromatosis of the temporomandibular joint, including diagnostic images, the treatment performed, and histologic analysis. In this report, we describe a case of temporomandibular joint synovial chondromatosis treated only through arthroscopy to remove 112 loose bodies completely.

Rationale of arthroscopic surgery of the temporomandibular joint

Arthroscopic surgery has been widely used for treatment of temporomandibular joint (TMJ) internal derangements and diseases for the last 40 years. Although 626 articles have been hit by Pubmed search in terms of "TMJ arthroscopic surgery", this review article is described based on distinguished publishing works and on my experiences with TMJ arthroscopic surgery and related research with an aim to analyse the rationale of arthroscopic surgeries of the temporomandibular joint. With arthrocentesis emerging as an alternative, less invasive, treatment for internal derangement with closed lock, the primary indication of arthroscopic surgery seems to be somewhat limited. However, the value of endoscopic inspection and surgery has its position for both patient and physician with its long-term reliable results.

Arthroscopic management for synovial chondromatosis of the temporomandibular joint: a retrospective review of 33 cases

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.

Temporomandibular joint synovial chondromatosis with a traumatic etiology

Synovial chondromatosis (SC) is a metaplastic disorder characterized by the formation of cartilaginous nodules inside the articular space. SC is uncommon in the temporomandibular joint (TMJ). A few reports suggest a correlation between a traumatic episode and the development of SC. The authors describe the diagnosis, treatment and follow-up of a patient with unilateral SC of the left TMJ in conjunction with bony resorption on the mandibular condyle and a clear traumatic etiology. They review and comment on previous reports in the literature.

Bilateral synovial chondromatosis of the temporomandibular joint

PURPOSE

To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data.

PATIENTS AND METHODS

A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ.

RESULTS

SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy.

CONCLUSION

SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint

OBJECTIVES

Our aim was to study the clinical and radiologic findings of synovial chondromatosis (SC) affecting the temporomandibular joint (TMJ) and provide references for diagnosis and treatment.

STUDY DESIGN

Twenty patients confirmed as SC histopathologically were included in the investigation. Nineteen cases were treated with arthrotomy and 1 case with arthroscopy. The clinical manifestations, radiographic findings, histopathologic features, surgical treatment, and differential diagnosis were combined to study this disease. The SC features of TMJ on magnetic resonance (MR) images were summarized on proton density-weighted (PD) and T2-weighted images.

RESULTS

Synovial chondromatosis of TMJ occurred more often in women and on the right. Symptoms included preauricular pain, swelling, limitation of mouth opening, crepitations, and deviation on opening. The detection rate of calcified loose bodies was 30% on conventional radiographs and 53.3% on computerized tomography. Multiple small ring-like or tubular signals could be seen on PD and T2-weighted MR images. SC mainly affected the superior joint space; it could involve the inferior space when a perforated or deformed disc was present. SC could extend into intracranial fossa, infratemporal fossa, and lateral pytergoid muscle.

CONCLUSIONS

The characteristic ring-like signals could be found on MR images of the patients with SC of TMJ. This lesion should be differentially diagnosed with TMJ disorders and preauricular masses. Considering its recurrence and the different behavior of SC in different patients, various treatment strategies should be considered.

Synovial Chondromatosis of the Temporomandibular Joint: Report and Analysis of Eleven Cases

PURPOSE

Synovial chondromatosis (SC) is a benign monoarticular condition that is uncommon in the temporomandibular joint (TMJ). The purpose of this article is to present 11 additional cases of SC of the TMJ and discuss newer modes of imaging, diagnostic approaches, treatment options, and follow-up data.

METHODS

Medical records of 11 patients with SC treated within our department from 1991 to the present were reviewed. Demographic data, etiology, clinical presentation, diagnostic evaluation, treatment, and follow-up information were collected. Previously reported cases (both TMJ and others) from 1988 to present were identified for comparison and the literature reviewed.

RESULTS

There were 8 females and 3 males with an average age of 54 years. Pain and preauricular swelling were the most common presenting clinical complaints. Etiologic factors (parafunction, inflammatory joint disease) were found in 7 of 11 cases. Plain radiographs showed joint calcifications in only 2 of 11 cases. Computed tomography identified calcifications in 3 of 6. Magnetic resonance imaging clearly demonstrated the mass and its extension in 10 of 10 cases. Fine needle aspiration was diagnostic in 4 of 9. All patients were treated with an open arthrotomy. Meniscectomy was required in 7 of 11. Average follow-up was 5.2 years with no recurrences reported.

CONCLUSION

The current case series of SC shows a female predilection with age and presenting complaints similar to those previously reported. A traumatic etiology was not identified, although a weak association is reported in the literature. The superiority of magnetic resonance imaging for both diagnosis and evaluation of extension of disease is shown. In a subset of cases, fine needle aspiration is useful for confirming the clinicoradiographic impression. Complete removal of involved tissue is associated with an excellent prognosis.

Arthroscopic removal of nodules of synovial chondromatosis of the temporomandibular joint

In this report we describe a new method for removing nodules of TMJ synovial chondromatosis using arthroscopic surgery instead of open surgery. We used two steps during arthroscopy. In the first, we lavaged the cavity with sterile saline. In the next step, the second cannula was replaced with ethmoid forceps. Under arthroscopic guidance through the first cannula, all loose bodies were removed using the forceps. Since the loose bodies are not fragmented during this procedure, the time needed for removal is shortened. Based on this experience, we suggest the use of ethmoid forceps should be considered as an alternative procedure when nodules are unable to pass through the cannula by lavage with sterile saline.

Synovial chondromatosis of the temporomandibular joint: clinical, diagnostic, and histomorphologic findings

Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage.

Principles of computer-assisted arthroscopy of the temporomandibular joint with optoelectronic tracking technology

PURPOSE

This preliminary clinical study evaluated the applicability, accuracy, and benefits of computer-assisted arthroscopy of the temporomandibular joint (TMJ) with optoelectronic tracking technology.

MATERIALS AND METHODS

A hybrid of reality and virtual reality is built as a composite-reality environment by extracting 3-dimensional anatomical structures through use of computed tomography, magnetic resonance imaging, radiography, and other types of imaging procedures commonly used in clinical praxis. These various independent sources of imaging data of a particular patient can be combined with and complemented by complex graphic simulations. Intraoperatively they are merged with online position data of surgical instruments inside the patient's TMJ. This hybrid model of detailed anatomical structures, guidelines, and real-time instrument positions allows the surgeon to accurately plan the arthroscopic intervention as well as to navigate effectively intraoperatively.

RESULTS

In the first 10 cases of computer-assisted TMJ arthroscopy, composite reality environment technology permitted the online visualization of TMJ structures, puncture sites, instrument positions, and virtual pathways in relation to anatomical landmarks with high spatial accuracy (minimum, 0.0 mm; maximum, 2.5 mm; mean, 1.4 mm; SD, 0.6 mm) and high temporal resolution (100 ms). Past, present, and possible future instrument positions can be displayed. The application of computer-assisted arthroscopy caused little immobility for either surgeon or patient.

CONCLUSION

Even experienced surgeons profit from improved precision in the handling of the arthroscope; thus this technology was found to be particularly useful in degenerative temporomandibular disorders and for triangulation procedures.

Condylar hyperplasia associated to synovial chondromatosis of the temporomandibular joint: a case report

Condylar hyperplasia is a slowly developing malformation of the mandible, with elongation of the mandibular neck, that generally results in facial asymmetry. Synovial chondromatosis is a benign chronic disorder characterized by the formation of multiple small nodules of hyaline cartilage as a result of metaplasia of the synovial connective tissue. It affects mostly the large joints, particularly the knee, hip, elbow and ankle. The temporomandibular joint (TMJ) is rarely affected. The case of a 42-year-old male with a history of left preauricular pain and swelling and deviation of the mandible to the left upon opening the mouth is presented. Computed tomography disclosed hyperplasia of the left condyle with loose radiopaque bodies within the joint cavity. The left TMJ was subject to open surgery, which included resection of four loose bodies and a remodeling condylectomy. The histopathological study confirmed the diagnosis of condylar hyperplasia and chondromatosis of the left TMJ.

Synovial chondromatosis of the temporomandibular joint: varying presentation in 4 cases

Synovial chondromatosis is a rare condition in which cartilage is formed in the synovial membrane of a joint. The manifestations of this benign neoplastic process can mimic many common temporomandibular joint and parotid diseases. Four cases of synovial chondromatosis are presented. In each case, atypical presentation, coexisting joint disease, or both caused diagnostic confusion. The histories and physical examinations were initially consistent with more common joint diseases in each case. Imaging provided some insight into diagnosis and was a definitive indication for surgical treatment. Treatment by subtotal synovectomy and by removal of chondromatous nodules were undertaken in each case. No patient in our series has had recurrence of disease or symptoms after surgical treatment.

Synovial chondromatosis of the temporomandibular joint with intracranial extension

We present a rare case of synovial chondromatosis of the left temporomandibular joint with intracranial extension and review the relevant literature. This is the sixth published report of such a skull base tumour. We discuss imaging characteristics and the differential diagnosis with regards to a curative surgical resection.

A case report. Chondromatosis of the temporomandibular joint

Synovial chondromatosis is a rare pathological condition that usually affects large joints but can affect the temporomandibular joint. The disease typically manifests itself with signs and symptoms similar to internal derangement. The disease is characterized by free-floating or attached cartilaginous bodies in the joint space. In this article, the authors present a case of synovial chondromatosis and discuss its pathological process. They also discuss diagnostic approaches and current treatment.

Synovial chondromatosis of the temporomandibular joint: the effect of interleukin-1 on loose-body-derived cells

OBJECTIVE

The purpose of this study was to investigate the effect of interleukin-1 on cells from loose bodies of synovial chondromatosis of the temporomandibular joint.

STUDY DESIGN

The cells were isolated from uncalcified loose bodies in a case of synovial chondromatosis of the temporomandibular joint and cultured in alpha-MEM medium containing 10% fetal bovine serum. The cells were treated with or without interleukin-1alpha and then stained with toluidine blue. Their conditioned media were analyzed with gelatin zymography to detect matrix-degrading proteinase(s).

RESULTS

The cells from loose bodies produced toluidine-blue-stained matrix. When the cells were treated with 100 ng/ml of interleukin-1alpha for 3 days, toluidine-blue-stained matrix was strikingly reduced. Gelatin zymography revealed that interleukin-1alpha-treated cells released 62-kDa gelatinase.

CONCLUSIONS

Interleukin-1alpha may lead loose-body-derived cells to degrade the cartilaginous matrix of loose bodies in synovial chondromatosis of the temporomandibular joint.

Primary synovial chondromatosis of the temporomandibular joint with suspected traumatic etiology. Report of a case

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease that is characterized by the development of nodules of cartilage within the synovial connective tissues of articulating joints. Reports of extracapsular TMJ SC are rare. A case is presented of primary SC of the TMJ with extension to the pterygoid plates, with a suspected traumatic etiology. The differences between primary and secondary SC are discussed.

[Synovial chondromatosis of the temporomandibular joint with invasion into the middle cranial fossa]

Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach.

[Synovial chondromatosis (chondrometaplasia). Contribution to the differential diagnosis of temporomandibular joint diseases]

A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Nonphysiologic overstrain of any cause should be diagnosed and corrected.

Recurrent synovial chondromatosis treated with meniscectomy and synovectomy

Synovial chondromatosis is a rare benign intraarticular metaplasia of synovium. This process may result in the production of detached particles of highly cellular cartilage in the involved joint spaces. It is most often reported in the larger joints of the body including the knee, hip, elbow, and ankle. Since Axhausen in 1993 reported the first case affecting the temporomandibular joint, several articles have been listed in the literature regarding the presentation, diagnosis, and management of this form of an arthropathy. This is a case of a recurrent synovial chondromatosis that was approached with a meniscectomy and a complete synovectomy.

Loose bodies in the temporomandibular joint. The advantages of arthroscopy

Loose bodies are a rare cause of temporomandibular joint symptoms. Their main source is synovial chondromatosis. We report on clinical findings, diagnostic methods, treatment choices and outcome following the removal of loose bodies in 10 patients. Seven patients were evaluated and treated by means of arthroscopy, while in three patients open arthrotomy was performed. In five patients, no diagnostic imaging technique had demonstrated the presence of loose bodies prior to arthroscopy. In six patients, histology revealed synovial chondromatosis. In four patients, osteochondral fragments alone were found. Until now, the recommended treatment of choice for the removal of all loose bodies and of affected synovial tissue required open arthrotomy. We conclude that the advantages of arthroscopy consist in locating loose bodies that are not detectable radiologically and in reducing operative trauma.

Diagnostic accuracy of TMJ arthroscopy in correlation to histological findings

From 1987-1993, 356 arthroscopic examinations of the temporomandibular joint were performed on 295 patients. During 69 examinations, biopsies were obtained to correlate arthroscopic findings with histology. In the overall group, histology confirmed in 78.9% the arthroscopic findings. Correlation was better in joints with degenerative changes (81.5%) than in those with a synovitic/hyperaemic appearance (61.5%). Chondroid metaplasia, detritus synovitis and synovial chondromatosis were additional diagnoses given by histological examination. In 11 joints, open arthrotomy was performed after arthroscopy with biopsy was carried out. The excised tissue was also investigated microscopically and correlates to the biopsy-result. Because no different pathological changes were found, it is concluded that biopsies performed during arthroscopy of the temporomandibular joint are representative for histological investigation. An additional perforation for introducing the biopsy forceps is not necessary, because results obtained with different techniques appeared to be equally accurate.

Arthroscopic punch for definitive diagnosis of synovial chondromatosis of the temporomandibular joint. Case report and pathology review

Synovial chondromatosis is characterized as a benign monoarticular condition with metaplastic cartilaginous nodules that develop within the synovial membrane of articulating joints. In addition to a pathology literature review, this article describes an unusual case of temporomandibular synovial chondromatosis that was sufficiently expansile to displace the condyle, which created not only a posterior occlusal apertognathia, but unusual articular bony fossa and eminentia erosions. An arthroscopic approach for definitive diagnostic punch biopsy and surgical approach is described and presented along with preoperative computerized tomograph, magnetic resonance imaging, and tomographic diagnostic images, as well as 3-year follow-up clinical and radiographic findings. Most interestingly, the arthroscopic examination and biopsy proved to be the most useful method to establish a definitive diagnosis of synovial membrane chondromatosis within the temporomandibular joint region for this patient.

Synovial chondromatosis with cranial extension

Synovial chondromatosis is a benign arthropathy characterized by metaplasia in synovial membranes that can produce detached particles of cartilage. It occurs most often in the knee, hip, and elbow but has been reported in the temporomandibular joint. This is a rare presentation of synovial chondromatosis with glenoid fossa erosion and cranial extension.

Synovial chondromatosis of the temporomandibular joint. Report of a case

A case of synovial chondromatosis of the temporomandibular joint is reported in which initial clinical and radiographic data indicated disk derangement. Magnetic resonance imaging revealed distention and thickening of the lateral capsule but could not delineate the numerous loose bodies found at arthrotomy. The literature is reviewed, and diagnosis and surgical therapy are discussed.

Asymptomatic, radiologically detected chondrometaplasia in the temporomandibular joint

Asymptomatic loose bodies were detected in the temporomandibular joint of a 62-year-old woman during an examination before comprehensive dental care. The radiologic interpretation was synovial chondrometaplasia (synovial osteochondromatosis). A histologic diagnosis was not obtained, because surgery was unwarranted in view of the lack of symptoms and the benign differential diagnosis. Review of the literature revealed 62 reported cases of temporomandibular joint chondrometaplasia, all of which included one or more of the following: swelling, pain, joint noise, and limited mandibular movement. These reports have described this entity as a rare lesion, but the rate of reports has increased, perhaps because of greater practitioner awareness and increased sensitivity of diagnostic tests.