Synovial chondromatosis of the temporomandibular joint

Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique

Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

Relapsing Polychondritis Concomitant With Synovial Chondromatosis of the Temporomandibular Joint

Relapsing polychondritis (RP) is a rare, multisystem autoimmune disease characterized by inflammation, structural damage, and impaired function of cartilaginous tissues throughout the body. In the craniofacial region, this rare disease has been reported to affect structures of the ear and nose; however, reports of temporomandibular joint (TMJ) involvement are scarce. A second uncommon disorder of cartilage is synovial chondromatosis (SC), a progressive and proliferative disorder of the synovial membrane associated with the formation of variably sized cartilaginous and calcified loose bodies, often causing dysfunction of the joints and enlargement of the joint capsule. It commonly affects the larger joints; TMJ involvement is uncommon. We present the case of a 45-year-old woman with previously diagnosed RP in whom right TMJ pathology subsequently developed, undergoing arthroscopy and biopsy followed by arthroplasty, which was proved to be SC, likely due to her autoimmune disease. To our knowledge, this is the first case describing concomitant SC of the TMJ presumably from pre-existing RP.

Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings

Synovial chondromatosis of the temporomandibular joint is a rare benign joint disorder that has been reported in only a few studies. However, we recently encountered a pathologically proven case of this disorder. This case also showed the typical imaging findings on panoramic radiographs and on CT and MR images. Therefore, we report this case and the imaging and pathological findings.

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.

Mandibular and temporomandibular joint arthropathy in the differential diagnosis of the parotid mass

OBJECTIVE

To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass.

STUDY DESIGN

We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland.

CONCLUSIONS

Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.

Tc-99m HMPAO brain perfusion SPECT in drug-free obsessive-compulsive patients without depression

The aim of this study was to confirm prior results of brain-imaging studies on obsessive-compulsive disorder (OCD) in a sample of Turkish patients, as a cross-cultural study. Tc-99m HMPAO brain perfusion SPECT imaging was performed in nine drug-free OCD patients without depression and six controls. The patients' Hamilton Depression Rating Scale scores were <16. The severity of obsessive-compulsive symptoms was rated with the Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS). Quantitative evaluation of regional cerebral blood flow revealed that right thalamus, left frontotemporal cortex and bilateral orbitofrontal cortex showed significant hyperperfusion in patients with OCD compared with controls. YBOCS scores did not show any correlation with hyperperfusion in regional cerebral blood flow in these areas. Results of this cross-cultural study may support orbitofrontal and thalamic dysfunction in OCD in a sample of Turkish patients.

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.

Synovial chondromatosis of the temporomandibular joint

We report two cases of temporomandibular joint (TMJ) synovial chondromatosis, one of which was in the early stage and treated arthroscopically. The second was more advanced and recurred after removal of the free bodies, and so required condylectomy and synovectomy.

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.

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.

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.

Synovial chondromatosis with intracranial extension. A case report

A case of unilateral synovial chondromatosis of the temporomandibular joint with intracranial extension is presented. Extracapsular extension of these lesions is rare, and few cases have previously been reported. The case presentation will also reflect the inadequacy of routine preoperative temporomandibular joint x-ray films to reflect the extent of the lesion. Despite the benign nature of the lesion, excision was done because of the clinical aggressive behavior.

Synovial chondromatosis associated with experimental osteoarthritis in adult monkeys

This report describes the synovial response to temporomandibular joint disc perforation in an experimental animal model. Histologic examination revealed the presence of marked synovial membrane hypertrophy in all experimental joint recesses. Gradual transformation of synovial islands from a cellular to a metaplastic stage, with chondroid or even osteochondroid-containing tissue also was seen. The cartilage was arranged in a lobular pattern with intervening fibrous septae within the synovial islands. These synovial islands were observed in the anterior recess of three joints and in the posterior recess of another joint. The experimental findings suggest a relation between synovial chondromatosis and osteoarthritis.

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.

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

Synovial chondromatosis is an uncommon, benign condition of unknown etiology which affects articular joints. Foci of cartilage develop through metaplasia in the underlying connective tissue of the synovial membrane. These foci of cartilage enlarge with time into cartilage fragments, and may be detached from the affected synovium and released into the joint cavity. These cartilaginous foci and fragments may undergo calcification and ossification. The literature is reviewed and an additional case reported.

Synovial chondromatosis of the temporomandibular joint

Synovial chondromatosis is a benign, chronic, progressive synovial metaplasia that will not resolve spontaneously. Although it is non-neoplastic, the condition can easily be mistaken histologically as malignant. One Chinese male patient with synovial chondromatosis of the temporomandibular joint is described. Awareness of this rare lesion is important to prevent overdiagnosis and radical treatment. Treatment consists of synovectomy and removal of loose bodies within the joint space.

Synovial chondromatosis of the temporomandibular joint

Synovial chondromatosis of the temporomandibular joint is a rare, benign condition of metaplastic change of the synovium. A case is reported and the world literature is reviewed.

Synovial chondromatosis of the temporomandibular joint

An illustrative case of synovial chondromatosis in the temporomandibular joint (TMJ) region is presented, and 36 cases reported earlier are reviewed. The present patient, a 35-year-old woman, had been suffering from swelling and pain in the TMJ area as well as limited mandibular movements for 7 years. The condition had been treated with various conservative methods without any relief of the symptoms. Finally, radiological examination revealed calcified nodules within the joint space and a surgical exploration was performed. In all, 27 loose particles were removed from the joint in connection with the extirpation of the perforated and deformed disk. The result of surgical therapy has been favourable during the follow-up period of 18 months. Although synovial chondromatosis is rare in the TMJ, it should be kept in mind as one possible disease when treating patients suffering from symptoms similar to those of mandibular dysfunction syndrome.

Osteochondrosis of the temporomandibular joint presenting as an apparent parotid mass

A mass in the preauricular area usually indicates the presence of a neoplastic or inflammatory process within the parotid gland. Osteochondrosis is an unusual disease process affecting large joints, particularly the knee. Rarely, the temporomandibular joint (TMJ) may be affected. The disease process involves the synovial lining of the TMJ and is commonly ascribed to a benign neoplastic process or metaplasia, although trauma and inflammation have also been implicated. This process can result in single or multiple loose cartilage bodies (joint mice) within the joint cavity. Symptoms are usually those of a mass in the preauricular area, or those of TMJ dysfunction (pain, dislocation, click, decreased range of motion). Physical findings are limited to presence of a mass in the pre-auricular parotid area with a paucity of other parotid findings. Treatment involves removal of the loose cartilage bodies from the TMJ and possibly the synovial lining, if it appears to be severely damaged.

Chondromatosis of the temporomandibular joint arising in the meniscus

A rare case of chondromatosis of the temporomandibular joint is presented in which the chondral bodies appear to have developed by chondrometaplasia of the meniscus.

Synovial chondromatosis of the temporo-mandibular joint. Report of three cases and a review of the literature

Synovial chondromatosis of the temporo-mandibular joint is a rare affection, characterized by the formation of cartilage particles in the synovial membrane. These particles can break through and enter the joint compartments. The diagnosis must be considered for patients who complain of slowly progressive swelling, pain, and crepitus in the region of the temporo-mandibular joint. When the changes are not visible on plain X-rays due to absence of ossification, important diagnostic information can be obtained by a technetium 99m (99m Tc) bone scan and a computerized tomography (CT) sialogram. The diagnosis can be established only by histopathologic examination of surgically removed particles or resected synovial membrane. Discussed are 25 cases of histopathologically verified chondromatosis of the temporo-mandibular joint reported in the literature, as well as 3 new cases seen and treated at the University Hospital Groningen since 1970. A good clinical result can be obtained by removal of all particles and synovectomy. Condylectomy is seldom required.

Loose bodies of the temporomandibular joint: arthrographic diagnosis

We report a series of four patients presenting with symptoms of temporomandibular joint pain and dysfunction, and manifesting calcified loose bodies within the temporomandibular joint. Tomographic and arthrotomographic findings are described. Surgical confirmation was obtained in two patients and the histopathology in one demonstrated that the loose body was calcified cartilage surrounded by synovial tissue. The synovial tissue of the joint space was normal in all four cases by arthrotomography and at surgery in two patients. The findings suggest that these cases may be examples of osteochondrosis dissecans.