Abstract
BackgroundTumoral calcinosis is an uncommon clinicopathological condition which is characterized by the formation of calcium salt deposition in intra-articular or peri-articular soft tissues. It usually presents as a focal growth of hard tissue, either solitary or multiple, beneath the skin and connective tissue. Diagnostic techniques mainly include clinical and radiographic evaluation. The most commonly involved locations include the hip, elbow, shoulder and knee. Involvement of the head and neck regions are far less common. There have been 5 case reports of temporomandibular joint involvement in the literature so far.Case presentationWe present a case report which describes the diagnosis and management of a 59 year old female patient with chronic right temporomandibular joint pain and localized bony hard swelling over the right pre-auricular region. Patient retained normal range of motion and mouth opening. Computed tomography taken showed a radio-opaque juxta-articular ovoid mass over the right pre-auricular region in close proximity but not fused to the mandibular condyle. Surgical excision was performed for this swelling via a pre-auricular approach under general anaesthesia. Histological examination performed confirmed the diagnosis of tumoral calcinosis. Pain at the right temporomandibular joint was resolved after the surgery. Serum calcium and phosphate levels were normal in this patient.ConclusionSurgical excision is the primary treatment modality for tumoral calcinosis. Tumoral calcinosis may be associated with elevated serum calcium and phosphate levels. In patients with elevated serum electrolytes, it is important to consider the overall systemic health in management of this condition. Management of serum electrolytes levels plays a role in reducing recurrence rates. This case report and review aims to discuss the diagnosis, treatment and overall systemic management of this rare condition.
Highlights
Tumoral calcinosis is an uncommon clinicopathological condition which is characterized by the formation of calcium salt deposition in intra-articular or peri-articular soft tissues
Tumoral calcinosis may be associated with elevated serum calcium and phosphate levels
Tumoral calcinosis associated with the temporomandibular joint is a rare condition
Summary
Tumoral calcinosis associated with the temporomandibular joint is a rare condition. Proper diagnosis requires detailed history taking, clinical examination, radiographic investigations and baseline serum electrolytes. Surgical excision is usually the treatment of choice for Primary Normophosphatemic TC and Primary Hyperphosphatemic TC sub-types. Medical therapy such as phosphate binders, calcitonin can play a role in management of Secondary TC sub-type. It is important to consider the overall systemic health in patients belonging to Primary Hyperphosphatemic TC and Secondary TC subtypes, due to raised serum electrolytes. It is advisable to refer patients belonging to the Primary Hyperphosphatemic TC or Secondary TC sub-types to the appropriate physician for evaluation of underlying causes in relation to raised serum electrolytes. Monitoring for recurrence of lesions is important for the Primary Hyperphosphatemic TC or Secondary TC sub-types, due to the higher recurrence rates.
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