1
|
Gonzalez LV, López JP, Orjuela MP, Mejía M, Gallo-Orjuela DM, Granizo López RM. Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review. J Craniomaxillofac Surg 2023; 51:551-559. [PMID: 37562984 DOI: 10.1016/j.jcms.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/26/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21-81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.
Collapse
Affiliation(s)
- Luis Vicente Gonzalez
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana. Bogotá, Colombia
| | - Juan Pablo López
- Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá Colombia; Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia.
| | - María Paula Orjuela
- Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia
| | - Manuel Mejía
- Biomedical Engineer, Escuela Colombiana de Carreras Industriales, Bogotá, Colombia
| | | | | |
Collapse
|
2
|
de Almeida D, de Souza PSAP, de Mendonça LP, Verner FS, Devito KL. Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations. Imaging Sci Dent 2020; 50:99-104. [PMID: 32601584 PMCID: PMC7314601 DOI: 10.5624/isd.2020.50.2.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to use cone-beam computed tomography (CBCT) images to determine the prevalence of calcifications in the temporomandibular joint (TMJ) and to evaluate any associations between the presence of such calcifications and degenerative bone alterations of the TMJ, sex, or age. Materials and Methods In this retrospective study, 1,058 CBCT exams were analyzed, and data regarding the presence and quantity of calcifications, the affected side, any degenerative alterations of the condyle, sex, and age were collected. To evaluate associations between the presence of calcifications and sex or age, the Fisher exact test or the Spearman correlation coefficient, respectively, was used. To assess the association between the presence of calcifications and joint bone alterations, the chi-square and Fisher exact tests were used. The significance level adopted was 5% (P<0.05). Results Twenty-eight patients (2.7%) presented with TMJ calcifications, including 23 women (82.1%) and 5 men (17.9%). Significant correlations were found between the presence of calcifications and age (P<0.05) and between the presence of calcifications and the presence of condylar alterations (P<0.05), with 73.2% of patients with bone alterations having TMJ calcifications. Conclusion It may be concluded that, although rare (with a prevalence of only 2.7%), intra-articular calcifications are associated with both degenerative bone alterations and age.
Collapse
Affiliation(s)
- Daniela de Almeida
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Luana Pereira de Mendonça
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Karina Lopes Devito
- Department of Dental Clinic, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| |
Collapse
|
3
|
Nishiyama M, Nozawa M, Ogi N, Ariji Y, Fukuda M, Kise Y, Naitoh M, Kuwada C, Kurita K, Ariji E. Computed tomographic features of synovial chondromatosis of the temporomandibular joint with a few small calcified loose bodies. Oral Radiol 2020; 37:236-244. [PMID: 32303973 DOI: 10.1007/s11282-020-00438-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The present study aimed to clarify the characteristic computed tomography (CT) features that indicate synovial chondromatosis (SC) with a few small calcified bodies or without calcification on panoramic images, and to discuss their differences from the features of temporomandibular disorder (TMD). METHODS Panoramic and CT images from 11 patients with histologically verified SC of the temporomandibular joint were investigated. Based on the panoramic images, the patients were classified into a distinct group (5 patients) with typical features of calcified loose bodies and an indistinct group (6 patients) without such bodies. On the CT images, findings for high-density structures suggesting calcified loose bodies, joint space widening, and bony changes in the articular eminence and glenoid fossa (eminence/fossa) and condyle were analyzed. RESULTS All 5 distinct group patients showed high-density structures on CT images, while 2 of 6 indistinct group patients showed no high-density structures even on soft-tissue window CT images. A significant difference was found for the joint space distance between the affected and unaffected sides. A low-density area relative to the surrounding muscles, suggesting joint space widening, was observed on the affected side in 2 indistinct group patients. All 11 patients regardless of distinct or indistinct classification showed bony changes in the eminence/fossa with predominant findings of extended sclerosis and erosion. CONCLUSION Eminence/fossa osseous changes including extended sclerosis and erosion may be effective CT features for differentiating SC from TMD even when calcified loose bodies cannot be identified.
Collapse
Affiliation(s)
- Masako Nishiyama
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Michihito Nozawa
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan.
| | - Nobumi Ogi
- Department of Oral and Maxillofacial Surgery, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Motoki Fukuda
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Yoshitaka Kise
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Chiaki Kuwada
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya, 464-8651, Japan
| |
Collapse
|
4
|
Lee LM, Zhu YM, Zhang DD, Deng YQ, Gu Y. Synovial Chondromatosis of the Temporomandibular Joint: A clinical and arthroscopic study of 16 cases. J Craniomaxillofac Surg 2019; 47:607-610. [PMID: 30799132 DOI: 10.1016/j.jcms.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/08/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Present and overview the clinical finding, management and arthroscopic study of Synovial Chondromatosis (SC) cases in Temporomandibular Joint (TMJ) treated by our team. STUDY DESIGN During year 2008-2018, 16 TMJ SC cases were treated and reviewed. The clinical manifestations, radiographic data, arthroscopic study and pathologic findings were recorded and analyzed. RESULTS Average age of first visit was 32.68. The ratio of male/female was 2/14, right/left was 7/9. The most common symptoms were pain, continuous crepitus and limited mouth opening (LMO). All cases were examined by computed tomography (CT) and magnetic resonance imaging (MRI) preoperative and proved by pathology postoperative. The diagnostic rates of CT and MRI were 12.5% and 93.75% respectively. 1 case could not be detected by both, but by arthroscopy. Particles in all cases occurred in the upper joint cavity and were all removed by arthroscopic technique. No recurrence was found after 3 years follow-up. CONCLUSIONS MRI and arthroscopic technique could be the first choice in the diagnosis and treatment of SC. Most cases were in stage 3 of the disease at the first visit. Low recurrence rate may be attributed to the improvement of intra-articular environment after surgery. Larger sample sizes are needed for further study.
Collapse
Affiliation(s)
- Lee Mui Lee
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Yao Min Zhu
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Dan Di Zhang
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Yong Qiang Deng
- Department of Oral and Maxillofacial Surgery, Shenzhen University General Hospital, Department of Medicine, Shenzhen University, 1098# Xue Yuan Road, Nan Shan District, Shenzhen City, Guang Dong Province, 518055, People's Republic of China.
| | - Ying Gu
- Graduate Institution, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou City, Guangdong Province, 511436, People's Republic of China.
| |
Collapse
|
5
|
Kim HS, Lee W, Choi JW, Han WJ, Kim EK. Temporomandibular joint synovial chondromatosis accompanying temporal bone proliferation: A case report. Imaging Sci Dent 2018; 48:147-152. [PMID: 29963487 PMCID: PMC6015928 DOI: 10.5624/isd.2018.48.2.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 01/15/2023] Open
Abstract
Synovial chondromatosis is a rare metaplastic disease affecting the joints, including the temporomandibular joint (TMJ). Since its symptoms are similar to those of temporomandibular disorders, a careful differential diagnosis is essential. A 50-year-old male patient was referred with the chief complaint of pain and radiopaque masses around the left TMJ on panoramic radiography. Clinically, pre-auricular swelling and resting pain was found, without limitation of mouth opening. On cone-beam computed tomographic images, multiple calcified nodules adjacent to the TMJ and bone proliferation with sclerosis at the articular fossa and eminence were found. T2-weighted magnetic resonance images showed multiple signal-void nodules with high signal effusion in the superior joint space and thickened cortical bone at the articular fossa and eminence. The calcified nodules were removed by surgical excision, but the hypertrophic articular fossa and eminence remained. A histopathological examination confirmed the diagnosis. The patient was followed up few months later without recurrence.
Collapse
Affiliation(s)
- Hak-Sun Kim
- Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan, Korea
| | - Wonae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Jin-Woo Choi
- Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan, Korea
| | - Won-Jeong Han
- Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan, Korea
| | - Eun-Kyung Kim
- Department of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan, Korea
| |
Collapse
|
6
|
Liu X, Huang Z, Zhu W, Liang P, Tao Q. Clinical and Imaging Findings of Temporomandibular Joint Synovial Chondromatosis: An Analysis of 10 Cases and Literature Review. J Oral Maxillofac Surg 2016; 74:2159-2168. [DOI: 10.1016/j.joms.2016.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 01/04/2023]
|
7
|
Yoshitake H, Kayamori K, Wake S, Sato F, Kino K, Harada K. Synovial chondromatosis of the right side temporomandibular joint extending to the middle cranial fossa: A case report with 7-year postoperative follow up and expression of a biomarker of cell proliferative activity. Int J Surg Case Rep 2016; 20:133-7. [PMID: 26855075 PMCID: PMC4818305 DOI: 10.1016/j.ijscr.2016.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Synovial chondromatosis of the temporomandibular joint (TMJ) with cranial extension is rare. Here, we report 7-year follow-up of a case with immunohistochemical examination of cell proliferative activity. PRESENTATION OF CASE The patient was a 72-year-old man. Severe bone resorption of the glenoid fossa was apparent on CT images. Pathological findings by biopsy led to diagnosis of synovial chondromatosis of the right side TMJ. Extirpation of the tumor was performed via temporopreauricular incision under general anesthesia. PCNA expression was examined by immunohistochemical analysis. The lesion had penetrated into the middle cranial fossa, but the cranial dura mater was intact. Expression of PCNA was confirmed. DISCUSSION The PCNA expression suggested that growth activity caused expansion of the lesion to the skull base. CONCLUSION We were able to follow up this case for a long period without recurrence postoperatively.
Collapse
Affiliation(s)
- Hiroyuki Yoshitake
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School, Tokyo Medical and Dental University, Japan
| | - So Wake
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumiaki Sato
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Kino
- Temporomandibular Joint and Oral Function (Temporomandibular Joint Clinic) Graduate School, Tokyo Medical and Dental University, Japan
| | - Kiyoshi Harada
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
8
|
Yoshitake H, Kayamori K, Nakamura R, Wake S, Harada K. Pseudotumor in the temporomandibular joint: A case report. Int J Surg Case Rep 2015; 15:5-9. [PMID: 26298241 PMCID: PMC4601956 DOI: 10.1016/j.ijscr.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/03/2022] Open
Abstract
Neoplastic disease of the TMJ is a rare condition. We report a case of pseudotumor of the TMJ. This case was difficult to differentiate from synovial chondromatosis.
Introduction Neoplastic disease in the temporomandibular joint (TMJ) is a rare condition and is difficult to differentiate from temporomandibular disorders (TMD) based on symptoms and simple X-ray examinations. Potential differential diagnoses include synovial chondromatosis and pseudotumor, both of which are also relatively rare in the TMJ. Presentation of case We report a case of pseudotumor of the TMJ that was difficult to differentiate from synovial chondromatosis in a 71-year-old woman with a chief complaint of pain in the left TMJ. MRI of the right TMJ initially led to diagnosis of synovial chondromatosis. Extirpation of the lesion was performed under general anesthesia. Histopathological findings of the resected specimen revealed inflammatory granulation tissue without cellular atypism. Discussion The pathological findings for the resected specimen were compatible with pseudotumor of the TMJ. These findings were not supportive of synovial chondromatosis or other tumor diseases. Conclusion This case illustrates the importance of careful examination of a mass lesion in the TMJ for differentiation from other TMJ-related diseases.
Collapse
Affiliation(s)
- Hiroyuki Yoshitake
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Japan.
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School, Tokyo Medical and Dental University, Japan
| | - Ryosuke Nakamura
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Japan
| | - Sou Wake
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Japan
| | - Kiyoshi Harada
- Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Japan
| |
Collapse
|
9
|
Synovial chondromatosis of the tempromandibular joint: Relationship between MRI information and potential aggressive behavior. J Craniomaxillofac Surg 2015; 43:349-54. [DOI: 10.1016/j.jcms.2015.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 12/20/2022] Open
|
10
|
Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am 2013; 57:405-418. [PMID: 23809300 DOI: 10.1016/j.cden.2013.04.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The focus of this article is diagnostic imaging used for the evaluation of temporomandibular disorders and orofacial pain patients. Imaging modalities discussed include conventional panoramic radiography, panoramic temporomandibular joint imaging mode, cone beam computed tomography, and magnetic resonance imaging. The imaging findings associated with common diseases of the temporomandibular joint are presented and indications for brain imaging are discussed. Advantages and disadvantages of each imaging modality are presented as well as illustrations of the various imaging techniques.
Collapse
Affiliation(s)
- Allison Hunter
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Georgia Regents University, GC 2248, 1120 15th Street, Augusta, GA 30912-1241, USA.
| | | |
Collapse
|
11
|
Matsumura Y, Nomura J, Nakanishi K, Yanase S, Kato H, Tagawa T. Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout). Dentomaxillofac Radiol 2013; 41:703-7. [PMID: 23166363 DOI: 10.1259/dmfr/24183821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report describes a very rare case of synovial chondromatosis with deposition of calcium pyrophosphate dihydrate (CPPD) crystals (pseudogout) in the temporomandibular joint (TMJ) of a 46-year-old male patient. Synovial chondromatosis is a non-neoplastic disease characterized by metaplasia of the connective tissue leading to chondrogenesis in the synovial membrane. Pseudogout is an inflammatory disease of the joints caused by the deposition of CPPD, producing similar symptoms to those observed in gout but not hyperuricaemia. Both diseases commonly affect the knee, hip and elbow joints, but rarely affect the TMJ.
Collapse
Affiliation(s)
- Y Matsumura
- Department of Oral and Maxillofacial Surgery, Division of Reparative and Regenerative Medicine, Institute of Medical Science, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu, Mie 514-8507, Japan.
| | | | | | | | | | | |
Collapse
|
12
|
Okochi K, Nakamura S, Tetsumura A, Honda E, Kurabayashi T. Magnetic resonance imaging of temporomandibular joint cyst. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:827-31. [DOI: 10.1016/j.oooo.2011.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 12/15/2022]
|
13
|
Matsumoto K, Sato T, Iwanari S, Kameoka S, Oki H, Komiyama K, Honda K. The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis. Dentomaxillofac Radiol 2012; 42:15388284. [PMID: 22282505 DOI: 10.1259/dmfr/15388284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ.
Collapse
Affiliation(s)
- K Matsumoto
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Nihon University, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
14
|
Cai XY, Yang C, Chen MJ, Jiang B, Zhou Q, Jin JM, Yun B, Chen ZZ. Arthroscopic management for synovial chondromatosis of the temporomandibular joint: a retrospective review of 33 cases. J Oral Maxillofac Surg 2011; 70:2106-13. [PMID: 22177814 DOI: 10.1016/j.joms.2011.09.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 09/24/2011] [Accepted: 09/27/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE To present clinical, radiologic, and arthroscopic results of patients with synovial chondromatosis of the temporomandibular joint; to introduce a technique for removal of loose bodies in different areas; and to summarize the indications of therapeutic arthroscopy according to the magnetic resonance imaging (MRI) features. PATIENTS AND METHODS From April 2001 to April 2010, 33 consecutive patients underwent arthroscopy. Their demographics, clinical manifestations, imaging studies, arthroscopic findings, treatments, and outcomes were reviewed. RESULTS The predominant symptoms were pain, limitation of mouth opening, and joint sounds. Obvious joint effusion was shown on MRI in 21 of 33 patients. Mass lesions were shown on MRI in 29 of 33 cases. The presence of loose bodies was shown in 31 cases under an arthroscope. Synovial hyperplasia was noted in 12 patients. Bony erosion of the articular surface was discovered in 11 patients. Thirty-two patients underwent therapeutic arthroscopy. Smaller loose bodies were commonly removed with joint lavage or biopsy forceps in 24 patients. Fragmentation with forceps or a wider additional incision was applied to remove larger loose bodies in 7 patients. Debridement was applied to remove intrasynovial lesions in 7 patients. Coblation was used to remove the hyperplastic synovium in 10 of 32 patients. Eight patients were lost to follow-up. The mean follow-up period was 38 months. No recurrence was suspected clinically and radiologically. CONCLUSIONS Therapeutic arthroscopy was appropriate for patients with separate mass lesions and no extra-articular extension. Surgical treatment comprised thorough removal of loose bodies and affected synovial tissues.
Collapse
Affiliation(s)
- Xie-Yi Cai
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Wang P, Tian Z, Yang J, Yu Q. Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison. Dentomaxillofac Radiol 2011; 41:110-6. [PMID: 22116129 DOI: 10.1259/dmfr/36144602] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- P Wang
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | | | | | | |
Collapse
|
16
|
Chen MJ, Yang C, Cai XY, Jiang B, Qiu YT, Zhang XH. Synovial chondromatosis in the inferior compartment of the temporomandibular joint: different stages with different treatments. J Oral Maxillofac Surg 2011; 70:e32-8. [PMID: 22033448 DOI: 10.1016/j.joms.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 10/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Min-jie Chen
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | | | | | | | | | | |
Collapse
|
17
|
Shah SB, Ramanojam S, Gadre PK, Gadre KS. Synovial chondromatosis of temporomandibular joint: journey through 25 decades and a case report. J Oral Maxillofac Surg 2011; 69:2795-814. [PMID: 21470750 DOI: 10.1016/j.joms.2010.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 12/28/2010] [Indexed: 02/03/2023]
Affiliation(s)
- Shishir B Shah
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India.
| | | | | | | |
Collapse
|
18
|
Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint. Int J Oral Maxillofac Surg 2011; 40:150-4. [DOI: 10.1016/j.ijom.2010.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/05/2010] [Accepted: 09/13/2010] [Indexed: 11/23/2022]
|
19
|
Cai XY, Yang C, Chen MJ, Jiang B, Wang BL. Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint. Int J Oral Maxillofac Surg 2010; 39:1236-9. [DOI: 10.1016/j.ijom.2010.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/10/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
|
20
|
Meng J, Guo C, Yi B, Zhao Y, Luo H, Ma X. Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. ACTA ACUST UNITED AC 2010; 109:441-8. [PMID: 20097104 DOI: 10.1016/j.tripleo.2009.09.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 08/28/2009] [Accepted: 09/27/2009] [Indexed: 10/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Juanhong Meng
- Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
| | | | | | | | | | | |
Collapse
|
21
|
A case of synovial chondromatosis of the temporomandibular joint secondary to preauricular trauma. Int J Oral Maxillofac Surg 2009; 38:1212-5. [DOI: 10.1016/j.ijom.2009.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/14/2009] [Accepted: 05/11/2009] [Indexed: 11/21/2022]
|