Synovial chondromatosis of the temporomandibular joint. Review of the literature and case report

Relative risk of positional and dynamic temporomandibular disc abnormality for osteoarthritis-magnetic resonance imaging study

Dynamic articular disc abnormality (wR, with reduction; woR, without reduction) is well known as the risk factor for temporomandibular joint osteoarthritis (TMJOA). However, there are few speculations on the potential risk of positional disc abnormalities for TMJOA. The purpose of this study was to investigate the relative risk of positional abnormality and dynamic abnormality of the temporomandibular disc for OA after the three-dimensional interpretation of all the sagittal and coronal planes of magnetic resonance (MR) data in a large dataset of consecutive subjects. Experimental samples consisted of images of 1356 TMJs of patients. A diagnosis of disc state was established in each TMJ utilising a 1.5T MR imaging scanner. A binary logistic regression analysis was performed to identify the significant associations between the outcome (dependent variable: the presence of OA) and the predictors (covariates: age, sex, dynamic disc state [the presence of woR], and 5 categories of the positional disc state [NA, no abnormality; SW, sideways; pADD, partial anterior; cADD, complete anterior; PDD, posterior]). Based on the result of the binary logistic regression analysis, the presence of woR showed an odds ratio of 14.1 (P < .05). In addition, compared with the joints NA, those with SW and cADD showed odds ratios of 5.62 and 10.88, respectively (P < .05). Despite the limitations of the study, in the positional disc abnormalities, sideways disc displacement and complete anterior disc displacement could be associated with the occurrence of TMJOA. All the coronal and sagittal MR images should be evaluated to assess intra-articular joint disorders accurately.

Temporomandibular joint synovial chondromatosis extending to the temporal bone: a report of two cases

Synovial chondromatosis is a rare benign lesion originating from the synovial membrane. It presents as adhesive or non-adhesive intra-articular cartilaginous loose bodies. Although the causes of synovial chondromatosis have not been fully elucidated, inflammation, external injury, or excessive use of joints have been suggested as possible causes. Synovial chondromatosis has been reported to occur most frequently at large joints that bear weights, with a rare occurrence at the temporomandibular joint (TMJ). When synovial chondromatosis develops at TMJ, clinical symptoms, including pain, joint sounds, and mouth opening may common. Moreover, synovial chondromatosis rarely spreads to the mandibular condyle, glenoid cavity, or articular eminence of TMJ. The goal of this study was to discuss the methods of surgery and other possible considerations by reviewing cases of patients who underwent surgery for synovial chondromatosis that extended to the temporal bone.

Nosocomial oral myiasis in ICU patients: occurrence of three sequential cases

Myiasis is the infestation of living vertebrates or humans tissues by dipterous larvae. The oral cavity is rarely affected by this infestation and the circumstances which can lead to oral myiasis include persistent mouth opening together with poor hygiene. Such infestations have been reported mainly in developing countries such as in Asia. Although rare, nosocomial myiasis must be noted carefully, especially in case of hospitalized patients. This report describes three cases of nosocomial oral myiasis in hospitalized patients in ICU (intensive care unit) in Tabriz, North West of Iran.

The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis

Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ.

Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.

Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease characterized by the presence of calcified loose bodies within the joint, and few systematically gathered data are available about its epidemiology. The aim of this paper was to describe a case of SC of the TMJ, and to carry out a systematic review of the literature on epidemiology over the past decade. A case of a 53-year-old female with the classical triad of signs and symptoms of SC (pain, swelling, restricted mouth opening) is described. A systematic search in the National Library of Medicine's PubMed Database was performed. 155 cases were described in 103 publications. Most dealt with single case reports. Females are affected more than males with a 2.5:1 ratio and the mean age of patients was about 46 years. Late diagnosis is common and in most cases more than 2 years elapsed between symptom onset and surgical intervention. Open TMJ surgery is the treatment of choice, since less invasive techniques, such as arthroscopy, allowed complete removal of the loose bodies only in about half of cases. A single recurrence was described, confirming the benign nature of the disease.

A case of recurrence of synovial chondromatosis of the temporomandibular joint

This is a case study of a patient with recurrent synovial chondromatosis. It shows some relevant images. It also provides possibilities for why this patient may have had a recurrence and how this was managed.

Synovial chondromatosis of the temporomandibular joint with middle cranial fossa extension

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.

Synovial Chondromatosis of the Temporomandibular Joint With Skull Base Extension

Synovial chondromatosis is a benign pathologic lesion that is considered to be a metaplastic process. This disease is rarely encountered in the temporomandibular joint (TMJ). In this article, a 72-year-old patient with synovial chondromatosis of the TMJ extending to the infratemporal fossa is presented and the literature is reviewed.

Malocclusion associated with osteocartilaginous loose bodies of the temporomandibular joint

BACKGROUND

The authors review the literature regarding osteocartilaginous loose bodies (that is, secondary synovial chondrometaplasia or secondary synovial chondromatosis) in the temporomandibular joint (TMJ), present a case report and stress the importance of early diagnosis.

CASE DESCRIPTION

A 57-year-old woman was referred to an orthodontist with a chief complaint of bite changes that took place over several years as the patient intermittently experienced TMJ problems. The authors noted radiopacities around the right TMJ space on a panoramic radiograph. They referred the patient to an oral and maxillofacial surgeon for treatment.

CLINICAL IMPLICATIONS

Asymmetrical occlusal changes in a nongrowing adult with progressive shifts from Class I to Class III malocclusion unilaterally may indicate a space-occupying lesion in the TMJ space on the affected side.

A case of synovial chondromatosis of the TMJ: treatment based on stage of the disease

A patient with synovial chondromatosis of the temporomandibular joint extending to the preauricular skin, parotid, and infratemporal fossa was operated and followed with a stable remnant, for 2 years postoperatively. In light of literature and what the authors have learned from this case, the authors emphasize stage of the disease as a risk factor for recurrence. The long history of symptoms, calcified and conglomerated radiological appearance of the lesion, and extensive involvement of the joint and periarticular area of this case indicate a late-stage disease in which the metaplastic activity dwindles. For late stages, the authors suggest a conservative approach that will only provide symptom relief and prevent secondary joint deformity to avoid potential complications and morbidities of a more extensive surgery.

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.

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 left temporomandibular joint superficially resembling chondrosarcoma: a case report

A 25 year-old woman was referred to the clinic complaining of pain in the left temporomandibular joint (TMJ) and trismus. According to the x-ray images, a solitary mass was observed in the anterior pouch of the lower joint cavity. The mass was removed by means of a synovectomy and a diskectomy. Upon light microscopic examination, the tissue removed showed high cellular activity. As a differential diagnosis, we had to consider the possibility of chondrosarcoma based on the histopathological features; however, since no invasive nor metastatic finding was recognized, we made a diagnosis of synovial chondromatosis despite its rare existence. Although there has been no sign of recurrence at present, we plan to carefully follow up with the patient.

Synovial chondromatosis of the temporomandibular joint with intracranial extension

An unusual case of synovial chondromatosis of the temporomandibular joint with intracranial extension, which resulted in complete dehiscence of the floor of the middle cranial fossa, is reported. An overview of the current literature and a discussion of the diagnosis and surgical management of synovial chondromatosis are presented.

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.

Transforming growth factor and tenascin in synovial chondromatosis of the temporomandibular joint. Report of a case

Synovial chondromatosis (SC) is an uncommon, benign condition of unknown etiology. A case of SC of the temporomandibular joint (TMJ) with the immunohistochemical findings of transforming growth factor-beta (TGF) and tenascin (TN) is reported. The roles of TGF and TN in SC of TMJ are discussed.

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.

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.

Synovial chondromatosis of the temporomandibular joint

A case report of synovial chondromatosis of the temporomandibular joint is presented in which the limitations of clinical findings, needle biopsy, standard radiography and computer assisted tomography were exposed and the importance of clinico-pathology consultation reaffirmed.

The diagnostic value of computed tomography in temporomandibular joint synovial chondromatosis

Synovial chondromatosis of the temporomandibular joint was diagnosed and location of dens particles was assessed by means of computed tomography. Based upon the data collected, the joint was operated conservatively and most of the calcifications were removed leaving the patient symptom free. The importance of an accurate preoperative diagnosis of synovial chondromatosis by use of CT scan is stressed in view of numerous unnecessary condylectomies and parotidectomies reported in the literature.

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

Synovial chondromatosis of the TMJ is a rare disorder of unknown etiology that may be neoplastic or hyperplastic in nature. A histopathologically confirmed case, the first to be identified and treated by arthroscopy, is presented. Removal of the affected synovial tissue and of loose particles was accomplished arthroscopically, a relatively non-invasive alternative to open arthrotomy.