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

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.

Scanning electoronmicroscopical analysis of the loose bodies of synovial chondoromatosis in temporomandibular joint

The aim of this study is to reveal the morphological property about the loose bodies (LBs) of temporomandibular joint (TMJ) by scanning electron microscope (SEM). We obtained specimens from two female cases of released loose body by surgical operation. These specimens were fixed by soaking in a mixture of 5% glutaraldehyde or 4% formaldehyde for one week. They were cut into half pieces. These specimens were observed at an accelerating voltage of 3 kV under a SEM (JSM-5500, JEOL, Tokyo). In the electron microscopic findings, it seems to be separated into two different parts as inside part and outside part. On the inside part, collagen fibers were running very densely in the same direction in an orderly neatly manner. Whereas, we observed waved collagen fibers running irregularly with many spaces on the outside part. Outside part seems to be porous pattern compared with inside part. It might be that the surface and outside part included many active fibroblasts. As results, it seems that the LBs might develop in a multi-layer style, in which fibrous tissues were piled up loosely around the inside part. The proliferating activity of LBs grows from the inside to outside of SC in TMJ.

Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review

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.

[Synovial chondromatosis in the temporomandibular joint: analysis of 5 cases]

Five patients with synovial chondromatosis in the temporomandibular joint were treated in our hospital between August, 2011 and August, 2014. All the patients underwent preoperative imaging examinations for clinical diagnosis and determining the involvement of the lesions. Surgeries were performed and the lesions were confirmed as synovial chondromatosis by pathological diagnosis. The clinical manifestations, imaging features, diagnosis and treatment results were analyzed. All the 5 patients had pain in the joint region, 3 had limited mouth opening, and 3 had swelling in the joint region. X-ray film showed widening of the joint space in all the 5 cases and radiographic findings showed space-occupying lesions in the intra-articular space. Open joint surgeries was performed and completed successfully in all the cases. The postoperative imaging showed no residual lesions in the surgical area. As a rare clinical entity, synovial chondromatosis in the temporomandibular joint was poorly documented without specific clinical manifestations. The diagnosis of synovial chondromatosis relies on imaging, arthroscopic and pathological findings. Corpus liberum is an important feature of the disease occurring frequently in the joint cavity. Surgical intervention is the primary choice for treatment of synovial chondromatosis in the temporomandibular joint, in which the corpus liberum and the affected synovial membrane shall be removed after joint incision.

Chondromatosis of the Temporomandibular Joint as a Consequence of Persistent Long-Lasting Joint Dysfunction: Late Diagnosis of a Rare Occurrence

The authors present a rare patient of right synovial chondromatosis (SC) of the temporomandibular joint in which diagnosis was late and delay led to SC extension to the cranial base. Synovial chondromatosis is a rare benign disorder characterized by multiple cartilaginous free-floating nodules originated from the synovial membrane of large articular joints of the body. Differential diagnosis is with neoplasm and radical surgical removal is essential. The patient came to the authors' observation complaining about long-lasting temporomandibular joint dysfunction. The patient already underwent either functional or medical therapy in times without any improvement. Clinical examination showed limited mouth opening and swelling of the right preauricolar region with no signs of facial nerve palsy and without paresthesia or hearing loss. No history of recent trauma was recorded. Magnetic resonance imaging showed a mucous-like hyperintense mass with small hypointense spots inside. A preoperative computed tomography scan was performed and showed a mass extending from the superior aspect of the temporomandibular joint to the glenoid fossa, which was partially eroded. The patient underwent either open joint surgery or arthroscopy of the superior joint space and a large number of chondrocytes were removed. No complications were recorded postoperatively and the patient completely recovered after 6 months. Histology confirmed the diagnosis of synovial condromatosys of the right temporomandibular joint.

Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery

Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up features of this lesion are also discussed. To our knowledge, this is the second report of SC of the TMJ in Brazil.

Synovial chondromatosis in the inferior compartment of the temporomandibular joint: different stages with different treatments

PURPOSE

To discuss a new classification and the treatment principles of synovial chondromatosis (SC) in the inferior compartment of the temporomandibular joint (TMJ).

PATIENTS AND METHODS

Five cases of SC in the inferior compartment were treated in an open manner between January 2008 and May 2011. Each case had different clinical and radiologic aspects and was treated with different surgical therapies. SC in the inferior compartment of the TMJ is classified into 3 stages. All patients were evaluated by computed tomography, magnetic resonance imaging, and clinical manifestations preoperatively and postoperatively.

RESULTS

There were 3 kinds of manifestation modes from radiologic findings. Case 1 was in stage 1, in which multiple loose bodies are noted without bony erosion. This patient was treated by removal of loose bodies and affected synovium. Case 2 was in stage 2, in which multiple calcified nodules were conglutinated to the condyle; the condyle was enlarged with pressure erosions. This patient was treated by condylectomy and reconstruction with costochondral graft. Case 3, case 4, and case 5 were all in stage 3, in which the condyle was destroyed as a result of pressure erosions or by direct bony invasion of the mass and the inferior surface of the disc was involved. These patients were treated by condylectomy together with discectomy, as well as reconstruction with costochondral graft and pedicled deep temporal fascial fat flap. No recurrence occurred. The height of the ramus and the occlusion were maintained in the same condition as preoperatively.

CONCLUSIONS

Our new classification of SC in the inferior compartment of the TMJ can better guide clinical treatment.

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.

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.

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.

Ultrasonographic and arthrographic diagnoses of synovial chondromatosis

Synovial chondromatosis (SC) is rare in the temporomandibular joint (TMJ). Plain radiographs, CT, MRI and arthrography of the TMJ have been used for the diagnosis of SC. The purpose of this paper is to present ultrasonographic and arthrographic diagnoses of a case of SC of the TMJ.

Temporomandibular joint osteochondritis dissecans: case report

BACKGROUND

Osteochondritis dissecans is a process in which segment(s) of cartilage separate from an articular surface. It is most often reported in the larger joints of the body, including the knee, elbow, hip, wrist, and ankle. Involvement of the temporomandibular joint (TMJ) is exceedingly rare.

OBJECTIVES

To describe a probable case of osteochondritis dissecans and discuss the differential diagnosis for this condition.

STUDY DESIGN

In addition to clinical examination the patient was imaged using panoramic radiography, computed tomography and magnetic resonance imaging.

RESULTS

Panoramic radiography showed separation of 2 rounded fragments superior to the right mandibular condyle. These were more precisely located using 3-dimensional computerized tomographic reconstructions. Magnetic resonance imaging demonstrated the right condyle as having low signal intensity area on T1-weighted images and a heterogeneous signal on T2-weighted images, with low signal dominance. No abnormality was apparent in the left TMJ.

CONCLUSIONS

The patient was treated nonsurgically with a splint, occlusal adjustment, physiotherapy, and nonsteroidal antiinflammatory medications. Maximum mouth opening has increased from 24 mm to 39 mm 6 months following initiation of treatment, and pain has subsided.

Synovial chondromatosis of the temporomandibular joint with condylar extension

Synovial chondromatosis is a benign disease that rarely affects the temporomandibular joint (TMJ). It can be seen commonly in the superior joint space and presents with various signs and symptoms according to the stage of progression. Sometimes it presents as a large swelling in the preauricular area with or without cranial extension, and the clinical and radiographic findings may be misdiagnosed as other benign or malignant diseases of TMJ. Therefore, we report an uncommon case of synovial chondromatosis presenting as a large preauricular mass arising from the inferior joint space of the TMJ with bony resorption of the mandibular condyle, which mimicked osteochondroma.

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.

Synchronous occurrence of ipsilateral synovial chondromatosis of the temporomandibular joint and pleomorphic adenoma of the parotid gland

We present a unique case characterized by true coexistence of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) with a salivary gland tumor, specifically pleomorphic adenoma, of the ipsilateral parotid gland. The possibility that the condition was the result of a single pathologic entity, ie, SC with extracapsular involvement or pleomorphic adenoma affecting the TMJ, received strong consideration. Nonetheless, careful assessment of the clinical, radiographic, MRI, and surgical findings strongly suggested the synchronous occurrence of 2 separate pathologic processes, despite their close proximity. Further, histopathologic examination confirmed the presence of both SC of the TMJ and pleomorphic adenoma of the superficial lobe of the ipsilateral parotid gland. Previous reports have pointed out the possibility of misdiagnosing extracapsular spread of SC as a salivary gland tumor. Vice versa, it has been noted that parotid gland tumors, especially malignant, may cause TMJ symptoms similar to those of SC. However, to the best of our knowledge, this is the first time that true synchronous occurrence of ipsilateral SC and pleomorphic adenoma, or parotid tumor of any kind, is reported.

CT features of synovial chondromatosis in the temporomandibular joint

OBJECTIVE

The purpose of this study was to determine the characteristic computed tomography (CT) findings of synovial chondromatosis of the temporomandibular joint (TMJ).

STUDY DESIGN

Eight subjects with synovial chondromatosis were examined with axial and coronal CT scans. All lesions were histopathologically confirmed either through an arthroscopic punch biopsy or surgery. CT appearances of the lesions were reviewed and classified.

RESULTS

Among the 8 subjects, 7 (87.5%) demonstrated soft tissue swelling, 7 (87.5%) showed loose calcified bodies, and 6 (75%) had bony changes of the articular surfaces. Patterns of the skull base changes as well as intracranial extension of the disease were identified.

CONCLUSIONS

Based on the CT findings, synovial chondromatosis of the TMJ is characterized by soft tissue swelling, loose calcified bodies, and bony changes of the skull base. The latter may lead to destruction of the central skull base and intracranial extension.

[Joint loose bodies in the mandible. Diagnostic criteria and pathways for therapy planning]

Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination.