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Nodular Pseudogout of the Skull Base Arising From the Temporomandibular Joint. J Craniofac Surg 2021; 32:e475-e477. [PMID: 33741871 DOI: 10.1097/scs.0000000000007437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The authors report a case of a rare, large, nodular pseudogout which developed from the temporomandibular joint (TMJ).An 83-year-old female was referred to the hospital with swelling on her left cheek. Imaging studies revealed a large calcified mass surrounding the left mandibular condyle, partially destroying the adjoining bone and extending to the skull base. Magnetic resonance imaging (MRI) revealed soft tissue masses with low signal intensity on T1- and T2-weighted images and were enhanced after intravenous gadolinium injection.The mass was clinically and radiologically suspected to be a neoplastic lesion, such as chondrosarcoma or fibrous dysplasia. However, histological analysis showed that the mass contained granulomatous lesions with numerous multiple nodular rod-shaped and diamond-shaped crystal deposits, which validated the diagnosis of pseudogout. X-ray diffraction (XRD) was performed to identify the tumor's deposited materials and revealed that these were calcium pyrophosphate dihydrate (CPPD) crystals. This result confirmed the histopathological diagnosis of "tophaceous pseudogout."
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Periarticular chondrocalcinosis of the left temporomandibular joint: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fan J, Heimann A, Wu M. Temporal mandibular joint chondrocalcinosis (tophaceous pseudogout) diagnosed by ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2019; 47:803-807. [PMID: 30908901 DOI: 10.1002/dc.24181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
Tophaceous pseudogout is a calcium pyrophosphate dihydrate crystal (CPPD) deposition disease that frequently affects elderly patient in the temporomandibular joint (TMJ). A diagnosis of CPPD deposition disease in the TMJ is challenging due to its mimicking of other benign and malignant entities. Surgical exploration followed by histologic examination is by far the most frequently used diagnostic modality. We present a case of an 87-year-old female who presented with a right TMJ mass. A final diagnosis of tophaceous pseudogout was made on cellular material obtained by ultrasound-guided fine-needle aspiration (US-guided FNA). Based on our case and current available literature, ultrasound-guided FNA is a reliable tool for diagnosing tophaceous pseudogout of the TMJ.
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Affiliation(s)
- Jun Fan
- Department of Pathology, Stony Brook University Hospital, Stony Brook, New York
| | - Alan Heimann
- Department of Pathology, Stony Brook University Hospital, Stony Brook, New York
| | - Maoxin Wu
- Department of Pathology, Stony Brook University Hospital, Stony Brook, New York
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Kudoh K, Kudoh T, Tsuru K, Miyamoto Y. A case of tophaceous pseudogout of the temporomandibular joint extending to the base of the skull. Int J Oral Maxillofac Surg 2016; 46:355-359. [PMID: 27641810 DOI: 10.1016/j.ijom.2016.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/06/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
A case of tophaceous pseudogout (i.e., calcium pyrophosphate dihydrate (CPPD) crystal deposition disease) in the temporomandibular joint (TMJ), extending to the base of the skull, is reported. A 38-year-old man was referred to the hospital with mild pain in the right chin and tip of the tongue. Panoramic radiography showed a large calcified mass around the right TMJ. Computed tomography imaging revealed a large, granular, calcified mass surrounding the right condylar head and extending to the base of the skull. The mass was clinically and radiographically suspected to be a pseudogout lesion. A biopsy specimen was collected under general anaesthesia to confirm the diagnosis. On histology, the mass was found to contain deposits of numerous rod-shaped and rhomboid crystals, which suggested tophaceous pseudogout. The deposits were identified as CPPD crystal deposition, based on analysis by X-ray diffraction and Fourier transform infrared spectroscopy. These two crystallography methods were useful in confirming the diagnosis of CPPD crystal deposition disease in the TMJ.
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Affiliation(s)
- K Kudoh
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
| | - T Kudoh
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - K Tsuru
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Y Miyamoto
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Covani U, Orlando B, Galletti C, Nuterini C, Barone A. Chondrocalcinosis of the Temporomandibular Joint: Clinical Considerations and Case Report. Cranio 2014; 27:134-9. [DOI: 10.1179/crn.2009.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Meng J, Guo C, Luo H, Chen S, Ma X. A case of destructive calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: a diagnostic challenge. Int J Oral Maxillofac Surg 2011; 40:1431-7. [DOI: 10.1016/j.ijom.2011.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 04/25/2011] [Accepted: 05/10/2011] [Indexed: 01/16/2023]
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Zweifel D, Ettlin D, Schuknecht B, Obwegeser J. Tophaceuos calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint: the preferential site? J Oral Maxillofac Surg 2011; 70:60-7. [PMID: 21855194 DOI: 10.1016/j.joms.2011.06.207] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel Zweifel
- Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Zurich, Switzerland.
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Kathju S, Cohen R, Lasko LA, Aynechi M, Dattilo DJ. Pseudogout of the temporomandibular joint: immediate reconstruction with total joint arthroplasty. Head Neck 2010; 32:406-10. [PMID: 19340868 DOI: 10.1002/hed.21074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pseudogout of the temporomandibular joint (TMJ) is a rare disorder with <40 reported cases in the English-language literature. It is usually treated with surgical resection and condylectomy alone. METHODS We report the case of a 68-year-old woman presenting with a preauricular mass resulting from calcium pyrophosphate deposition (pseudogout) in the TMJ, who underwent surgical resection with immediate reconstruction. RESULTS Open surgical resection to completely remove the mass confirmed substantial erosion of the condyle and disc, necessitating condylectomy and discectomy. The joint was thereafter immediately reconstructed by total joint arthroplasty using a Christensen TMJ implant sized to the patient's anatomy. The patient was able to resume a regular diet and demonstrated marked improvement in her interincisal opening. CONCLUSION Immediate reconstruction of the TMJ with total joint arthroplasty is a safe and effective measure following removal of this (and potentially other) TMJ lesions.
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Affiliation(s)
- Sandeep Kathju
- Division of Oral/Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
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Kalish LH, Ng T, Kalnins I, Da Cruz MJ. Pseudogout mimicking an infratemporal fossa tumor. Head Neck 2009; 32:127-32. [PMID: 19283846 DOI: 10.1002/hed.21059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The infratemporal fossa is a well-concealed, complex anatomical space. Neoplasms arising in this area are heterogenous in nature and have an insidious onset and usually present late. METHODS AND RESULTS We present a case of a 71-year-old woman who presented with worsening facial pain, trismus, and a large mass in her infratemporal fossa with minimal associated temporomandibular joint destruction. She underwent a surgical excision of the mass, which revealed a pseudogout deposit. CONCLUSION The clinical and radiological features of patients with tophaceous pseudogout frequently mimic those of a benign or malignant neoplasm of the infratemporal fossa, often resulting in more radical surgery.
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Affiliation(s)
- Larry H Kalish
- Department of Otorhinolaryngology, Westmead Hospital, Sydney, Australia.
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Mikami T, Takeda Y, Ohira A, Hoshi H, Sugiyama Y, Yoshida Y, Ambo J. Tumoral calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: Identification on crystallography. Pathol Int 2008; 58:723-9. [DOI: 10.1111/j.1440-1827.2008.02300.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Smolka W, Eggensperger N, Stauffer-Brauch EJ, Brekenfeld C, Iizuka T. Calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint. Oral Dis 2005; 11:104-8. [PMID: 15752084 DOI: 10.1111/j.1601-0825.2004.01065.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A case of a 74-year-old woman with calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint (TMJ) is presented. This disease rarely involves the TMJ and is not usually considered in the differential diagnosis of TMJ disorders. To our knowledge, only 23 cases have been reported in the literature and only four without any destructive changes of the condyle as in the present case.
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Affiliation(s)
- W Smolka
- Department of Cranio-Maxillofacial Surgery, University of Berne, Inselspital CH-3010 Berne, Switzerland.
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Aouba A, Lidove O, Gepner P, Brousse C, Somogyi A, Piette AM, Scherrer A, Graveleau P, De Bandt M, Patri B, Blétry O. [Crowned dens syndrome: three new cases]. Rev Med Interne 2003; 24:49-54. [PMID: 12614858 DOI: 10.1016/s0248-8663(02)00005-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999. EXEGESIS The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms. CONCLUSION This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course.
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Affiliation(s)
- A Aouba
- Service de médecine interne, hôpital Foch, Suresnes, France.
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Aoyama S, Kino K, Amagasa T, Kayano T, Ichinose S, Kimijima Y. Differential diagnosis of calcium pyrophosphate dihydrate deposition of the temporomandibular joint. Br J Oral Maxillofac Surg 2000; 38:550-3. [PMID: 11010794 DOI: 10.1054/bjom.2000.0313] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Calcium pyrophosphate dihydrate (CPPD) deposition disease (pseudogout) of the temporomandibular joint (TMJ) is rare. It is characterized by the presence of crystal deposits that are birefringent under polarized light. Although these crystals are characteristically weakly birefringent, some other crystals such as those of calcium oxalate, synthetic steroids, and ethylenediaminetetraacetic acid are also birefringent. The differential diagnosis should therefore be based on a quantitative analysis of crystals or observation of the crystal structure in calcified sections. We present a case of CPPD deposition disease of the TMJ and report on the value of such an analysis to substantiate the diagnosis.
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Affiliation(s)
- S Aoyama
- Maxillofacial Surgery, Maxillofacial Reconstruction and Function, Division of Maxillofacial and Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Pynn BR, Weinberg S. Calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint update. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:133-4. [PMID: 10052364 DOI: 10.1016/s1079-2104(99)70283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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