Synovial chondromatosis of the temporomandibular joint with intracranial extension. Case report

Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review

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.

Giant solitary synovial chondromatosis of the temporomandibular joint with intracranial extension

Synovial chondromatosis are rare entities but are well-described lesions in the literature that can affect many joint areas of the body. A case of tumoral synovial chondromatosis involving the temporomandibular joint with intracranial extension through mandibular fossa is reported. As long as there was significant infratemporal and extradural invasion of the middle and posterior fossa, a transtemporal and infratemporal approach was performed and total removal of the lesions was achieved. A brief review of skull base synovial chondromatosis is presented.

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 intracranial extension

A 52-year-old man presented with an extremely rare case of synovial chondromatosis in the temporomandibular joint (TMJ) with extension into the middle cranial fossa manifesting as swelling and exacerbation of pain. He had a long history of right TMJ disorders. Computed tomography and magnetic resonance imaging showed a mass in the right TMJ with extension into the intracranial part through the destroyed temporal skull base. The preoperative diagnosis was chondrosarcoma or osteosarcoma. The patient underwent surgery via combined trans-zygomatic temporal skull base and pre-auricular approaches and the mass was totally removed. Histological examination found an enormous number of closely packed loose bodies of various sizes, consisting of hyaline chondrocytes. The histological diagnosis was synovial chondromatosis. This rare lesion is difficult to discriminate from chondrosarcoma, so total removal is essential for correct diagnosis and cure.

Synovial chondromatosis of the temporomandibular joint with middle cranial fossa extension

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.

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.

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 with intracranial extension

An unusual case of synovial chondromatosis of the temporomandibular joint with intracranial extension, which resulted in complete dehiscence of the floor of the middle cranial fossa, is reported. An overview of the current literature and a discussion of the diagnosis and surgical management of synovial chondromatosis are presented.

Tumours and pseudotumorous lesions of the temporomandibular joint: a diagnostic challenge

Tumours and pseudotumorous lesions originating from the synovial membrane of the temporomandibular joint are rare. We report a series of six cases of such disorders. There were two cases of synovial chondromatosis, two of calcium pyrophosphate dihydrate crystal deposition disease, one nodular synovitis and one synovial sarcoma. Three patients were female and three were male. Their ages ranged from 36 to 70 years. All had atypical clinical and radiographical presentation. The prevalence, clinical and radiographical findings and pathological features of each disease entity are discussed and a review of the literature is made concerning all tumours and pseudotumours arising from the temporomandibular joint.

Synovial chondromatosis with cranial extension

Synovial chondromatosis is a benign arthropathy characterized by metaplasia in synovial membranes that can produce detached particles of cartilage. It occurs most often in the knee, hip, and elbow but has been reported in the temporomandibular joint. This is a rare presentation of synovial chondromatosis with glenoid fossa erosion and cranial extension.

Asymptomatic, radiologically detected chondrometaplasia in the temporomandibular joint

Asymptomatic loose bodies were detected in the temporomandibular joint of a 62-year-old woman during an examination before comprehensive dental care. The radiologic interpretation was synovial chondrometaplasia (synovial osteochondromatosis). A histologic diagnosis was not obtained, because surgery was unwarranted in view of the lack of symptoms and the benign differential diagnosis. Review of the literature revealed 62 reported cases of temporomandibular joint chondrometaplasia, all of which included one or more of the following: swelling, pain, joint noise, and limited mandibular movement. These reports have described this entity as a rare lesion, but the rate of reports has increased, perhaps because of greater practitioner awareness and increased sensitivity of diagnostic tests.

Synovial chondromatosis of the temporomandibular joint possibly secondary to trauma. A case report

A histologically confirmed case of synovial chondromatosis of the temporomandibular joint associated with a glenoid fossa callus is described. The lesion appeared 6 years after trauma to the chin. Conservative surgical treatment without excision of the synovial membrane or meniscus but including arthroplasty of both the eminence and the lateral side of the glenoid fossa was successful. The possible role of trauma in the etiology of synovial chondromatosis is discussed.