Letter to the Editor in re: Chen M-J, Yang C, Zhang X-H, Qiu Y-T: Synovial chondromatosis originally arising in the lower compartment of the temporomandibular joint: a case report and literature review. J Craniomaxillofac Surg 39: 459–462, 2011

Abstract

In re: ChenM-J, Yang C, Zhang X-H, Qiu Y-T: Synovial chondromatosis originally arising in the lower compartmentof the temporomandibular joint: a case report and literature review. J Craniomaxillofac Surg 39: 459–462, 2011. The paper was read with interest and the authors are to be complimented on their report. With the imprimatur of the Editor the writer would advise that our earlier literature review (Norman et al., 1988) showed that the first report of temporomandibular osteochondromatosis was made by Baron Albrecht von Haller in his magnum opus Elementa physiologiae corporis humani (1764). The first account in the modern era was by the preeminent German surgeon Georg Axhausen (1933). In the writer’s personal experience the condition presents with temporomandibular pain and joint crepitus, and later with joint locking and unlocking indicative of an internal derangement. A pre-auricular swelling simulating a parotid tumour (originating in the glenoid lobe of the parotid) is a much later event and physical sign. In one of our patients the symptoms were present, with exacerbation and remission, over 3 years and she volunteered a sense of dysocclusion and there was a subtle but noticeable mandibular laterognathia to the contralateral side. Contrary to experience with large joints a large solitary loose body is not usually palpable and that was with one exception the writer’s experience with the jaw joint. Orthopaedic surgeons have reported that a patient may complain that the joint does not seem to “seat properly” and referring to failure of anatomical enlocation. If there is any calcification of the loose bodies plain radiographs are useful and it has been our practice not to proceed to CT or MRI until plain films were examined. This observation may be useful to our colleagues working in regions where CT and MRI scans are not available. Examination of the synovial fluid in each case showed it to be straw-coloured and of increased volume and viscosity, and not fibrin-flecked. The Rheumaton test of the fluid was negative. In one of our later cases there was a large conglomerate mass of loose cartilaginous bodies firmly fused together and tissue was sent for frozen section pathology (Dr Leo Feain). In essence plain film radiography may be of value but first and foremost a careful history and physical examination. Fine needle aspiration is required if there is a firm pre-auricular lump. In thewriter’s experience a nuclear isotope scanwith Tc99mHDP may be of particular value, and a pixel count in numeric and graphic