Synovial chondromatosis of the temporomandibular joint: a case report and literature review

Temporomandibular joint synovial chondromatosis: An analysis of 7 cases and literature review

OBJECTIVE

To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ).

METHODS

Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint", and found 181 cases.

RESULTS

There was no specific difference in the symptoms of SC in the TMJ in different Milgram's stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram's stage.

CONCLUSIONS

The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.

A Multidisciplinary Approach to Synovial Chondromatosis of the Temporomandibular Joint With Cranial Base Involvement: A Brief Review of the Literature and Case Report

Synovial chondromatosis (SC) is an infrequent, benign condition of unknown etiology affecting the synovium within articular joints. Often considered a metaplastic process, multiple cartilaginous nodules develop in the confines of the synovial membrane. In time, these cartilage nodules develop into fragments, sometimes detaching from the synovium and, thus, become loose in an adjacent synovial cavity. The temporomandibular joint (TMJ) is an unusual site of involvement, with the extracapsular compromise of the cranial base exceedingly rare. A 68-year-old woman presented with a tender mass to the left TMJ that later proved to be SC. Computed tomography illustrated a rare extension of the lesion into the middle cranial fossa. The multidisciplinary effort to remove the mass in its entirety included both oral and maxillofacial surgical and neurosurgical teams. We have reviewed the presentation, diagnosis, surgical treatment, and outcomes of the present case, with diagnostic images and photomicrographs of the lesion included. We also briefly reviewed the reported studies.

Synovial osteochondromatosis of the temporomandibular joint: A case report

BACKGROUND

Synovial osteochondromatosis is a rare but benign condition that can result in significant impairment of joint functionality. This case report documents an uncommon presentation of this disorder occurring within the temporomandibular joint, causing the patient significant pain, trismus, and difficulty with daily activities such as eating and speaking. A review of the literature including disease mechanisms and previously documented cases is included to provide comprehensive background for clinical decision-making.

CASE SUMMARY

A 48-year-old male patient presented with a 3-mo history of trismus, crepitus with jaw movement and significant pain while chewing. Physical examination revealed a firm mass and tenderness to palpation at the right temporomandibular joint. Further workup revealed a bilobed mass extending into the joint space as well as significant bony erosion of the glenoid fossa. The patient underwent mass excision with joint reconstruction and pathology revealed synovial osteochondromatosis. The patient reported significant improvement in his symptoms postoperatively.

CONCLUSION

This report outlines the investigative approach and treatment course of synovial osteochondromatosis. The positive outcome following surgical intervention in this case emphasizes the importance of interdisciplinary collaboration and the potential for improvement in quality of life of this patient population.

Synovial chondromatosis of the temporomandibular joint with extension into the middle cranial fossa and internal carotid canal

This report presents the case of an extensive synovial chondromatosis of the temporomandibular joint (TMJ), with extension into the middle cranial fossa, middle ear, and carotid canal. Synovial chondromatosis of the TMJ is rare, particularly when associated with intracranial involvement. This case is unique owing to its size and the involvement with the internal carotid artery. The importance of a multidisciplinary approach in the surgical management of such a rare and complex form of this condition is highlighted.

Open surgery assisted with arthroscopy to treat synovial chondromatosis of the temporomandibular joint

Open surgery and arthroscopy for the treatment of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) have their advantages and disadvantages. The aim of this study was to report the application and results of the combined use of these two methods in the treatment of SC and the indications for use. A total of 36 patients with magnetic resonance imaging (MRI) confirmation of SC, treated from 2010 to 2015, were included. Patients with tumours in the upper articular cavity and with the extended margin of the medial groove still in-between the medial crest of the condyle and infratemporal space on coronal MRI were selected to undergo open surgery with the assistance of arthroscopy to clear the loose bodies and affected synovium. All 36 patients first went through open surgery. Subsequent arthroscopy examinations indicated the presence of loose bodies in the medial groove in 14 patients (in the anterior or posterior recess), which were removed using a cup-shaped clamp. Thirty-three of the patients were followed up for an average of 33.3 months; there was no recurrence in these patients. This technique has the benefits of the complete elimination of diseased tissues with a minimal osteotomy and a short surgical duration.