Chondromatose de l’articulation temporomandibulaire : étude multicentrique et mise au point à partir de 14 cas

Abstract

The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease. We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant. Fourteen patients could be included: 85.7% were women. Average age at diagnosis was 40.14 (σ=13.82; IC95: 32.90-47.38) (41for women [σ=14.74; IC95: 33.28-48.72] and 35years for men [σ=5.66, IC95: 27.16-42.84]). Average age at surgery was 40.86 (σ=14.18; IC95: 33.43-48.28). There was no predominance of side; 57.14% of the patients had a joint syndrome, 57.14% a tumor syndrome, 28.57% had pain and 14.29% had headaches. Panoramic X-ray was informative in 3cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10years later. Chondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.