Synovial chondromatosis of the temporomandibular joint extending to temporalis, masticator, and parotid spaces

Extraarticular Synovial Chondromatosis: Review of Epidemiology, Imaging Studies, Microscopy and Pathogenesis, with a Report of an Additional Case in a Child

A rare benign condition of uncertain etiology and pathogenesis, Synovial Chondromatosis (SC) is most often seen intraarticularly in adults but only a handful of cases have been reported extraarticularly in children. Symptoms and physical signs consist of pain, swelling, and osteoarthritic changes related to a mass effect. Here we discuss the case of a 9-year-old boy with documented SC of the knee and critically review the Epidemiology, Clinical Presentation, Gross Anatomy and Microscopic Histopathologic Features as well as the role of Imaging Studies in Diagnosis. In addition, this paper reviews Current Pathogenetic Concepts including the infrequent but distinct possibility of malignant transformation.

Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison

OBJECTIVES

The aim of this retrospective study was to characterize MRI findings of synovial chondromatosis in the temporomandibular joint (TMJ) by correlation with their pathological findings.

METHODS

22 patients with synovial chondromatosis in unilateral TMJ were referred for plain MRI prior to surgical management and pathological examinations. Parasagittal and coronal proton density-weighted imaging and T₂ weighted imaging were performed for each case.

RESULTS

MRI demonstrated multiple chondroid nodules and joint effusion in all patients (100%) and amorphous iso-intensity signal tissues within expanded joint space and capsule in 19 patients (86.4%). On T₂ weighted imaging, signs of low signal nodules within amorphous iso-intensity signal tissues were used to determine the presence of attached cartilaginous nodules in pathology, resulting in 100% sensitivity, 60% specificity and 90.9% accuracy. Signs of low and intermediate signal nodules within joint fluids were used to detect loose cartilaginous nodules and resulted in 80% sensitivity, 42.9% specificity and 68.2% accuracy.

CONCLUSIONS

MRI of synovial chondromatosis in TMJ was characterized by multiple chondroid nodules, joint effusion and amorphous iso-intensity signal tissues within the expanded space and capsule. The attached cartilaginous nodules in pathology were better recognized than the loose ones on MRI. Plain MRI was useful for clinical diagnosis of the disorder.

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.

An investigation of magnetic resonance imaging features in 14 patients with synovial chondromatosis of the temporomandibular joint

OBJECTIVES

To show the characteristic MRI features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ).

METHODS

All patients with histologically proven SC of the TMJ who underwent MRI at our clinic were examined. In 14 patients (male-to-female ratio, 2:12; average age 46+/-14 years), clinical and conventional radiographic findings were reviewed. In addition, the MRI findings of articular disc and condyle position, shape and signal intensity of the joint spaces, and bone changes of surrounding structures were analysed.

RESULTS

The main symptoms were pain (in 93% of the patients) and limitation of mouth opening (64%). Two cases showed typical multiple calcifications around the TMJ on conventional radiography. On MRI, the disc position was normal in 12 (86%) patients and the condyle was inferiorly displaced in 9 (64%) patients. 11 (79%) patients showed enlargement of the joint space, with either a "dumbbell" shape or bulging. SC in the upper compartment showed various degrees of bone changes of the articular eminence and fossa. SC in the lower compartment showed concavity or hypertrophy of the condyle. The severity of the bone changes progressed with duration of symptoms.

CONCLUSIONS

About 0.3% of the patients complaining of TMJ pain and dysfunction were found to have SC. There was great variation in the MRI features of the TMJs with SC. More severe destruction of surrounding bone structures with features resembling a tumour were found in patients with a longer duration of symptoms.

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.

Synovial chondromatosis of the temporomandibular joint: CT and MRI findings

We report a rare case of synovial chondromatosis of the temporomandibular joint (TMJ) in a 31-year-old man. CT examination showed a mixed soft tissue mass with small calcifications near the right TMJ joint space. MR images revealed a heterogeneous mass on the different sequences and, after contrast administration, originating in the right TMJ. Cytology showed chondroid cellularity. The lesion was surgically removed and final histological study demonstrated the diagnosis of a synovial chondromatosis. We highlight the importance of the complementary findings from CT and MR, especially the important specific feature described for TMJ synovial chondromatosis related to the mixed density within the mass, in order to perform an accurate preoperative diagnosis whenever there is an absence of ossified loose bodies.

MR imaging of the temporomandibular joint

Temporomandibular joint (TMJ) internal derangement is fairly prevalent in patients presenting with facial pain. MR imaging has become the primary modality for the assessment of the temporomandibular joint. A review of the normal anatomy and the key imaging findings of the different pathologic entities affecting this joint are presented. A reading algorithm to facilitate a systematic interpretation of the TMJ imaging study also is provided.

[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.

MR imaging of the temporomandibular joint

Technologic advances in MR imaging have had a decisive effect on the capacity of investigators to image the TMJ. This article provides a description of the normal anatomy and function of this joint. emphasizing the key imaging findings of internal derangement. A reading algorithm is given to achieve a systematic approach to the interpretation of a temporomandibular MR imaging study. Finally, a summary of key imaging findings of other miscellaneous pathologic processes involving this joint is provided.

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.