Synovial Chondromatosis Of Temporomandibular Joint Research Articles

Imaging features of temporomandibular joint synovial chondromatosis with associated osseous degenerative changes

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).

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.

Temporomandibular joint synovial chondromatosis: An analysis of 7 cases and literature review.

To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint", and found 181 cases. There was no specific difference in the symptoms of SC in the TMJ in different Milgram's stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram's stage. The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.

Acquired Atresia of External Auditory Canal Associated With Synovial Chondromatosis of the Temporomandibular Joint

Synovial chondromatosis (SC) is a rare disease involving long bones, rarely affecting the temporomandibular joint (TMJ). It can manifest as preauricular swelling, pain, and joint dysfunction. This report represents the case of acquired atresia of external auditory canal in association with SC of TMJ. Active evaluation and treatment of TMJ pathology seem essential when addressing the acquired atresia of external auditory canal.

A rare case of temporomandibular joint synovial chondromatosis with cranial base extension

Synovial chondromatosis is an uncommon benign lesion in which the synovial membrane within the joint forms cartilaginous nodules and loose bodies due to cartilaginous metaplasia. It is rare to develop in the temporomandibular joint, and may be accompanied by cranial base expansion or temporal bone morbidity. A 41-year-old male patient visited our hospital complaining of preauricular pain and crepitus. On CT and MRI, increased synovial fluid in the joint cavity, loose body, temporal bone erosion and cranial base expansion were observed. It was diagnosed as synovial chondromatosis through imaging and clinical symptoms. After arthrocentesis, the symptoms slightly decreased, and arthrotomy was performed for complete resolution of the pain. The patient's pain and crepitus were resolved, and no recurrence of the lesion was observed.

A rare case of temporomandibular joint synovial chondromatosis with cranial base extension

A rare case of temporomandibular joint synovial chondromatosis with cranial base extension

A Case of Synovial Chondromatosis of Temporomandibular Joint with Numerous Loose Bodies

Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.

Comparative Evaluation of Success in Cases of Synovial Chondromatosis of Temporomandibular Joint Treated with Temporomandibular Joint Arthroscopy: A Case Series.

Synovial chondromatosis of the temporomandibular joint (TMJ) is characterized by the formation of multiple nodules of cartilage with varying sizes due to metaplastic development of the synovial membrane. Aetiology revolves with primary lesion, and pathogenesis is still unknown with multiple factors, which includes low-grade trauma or internal derangement. This condition remains undiagnosed and leads to therapeutic challenges from clinical manifestations which are non-specific and needs various tools to diagnose with combination of radiologic and histopathological examination. We report a case series of five cases which were diagnosed as cases of TMD of the temporomandibular joint. Diagnostic arthroscopy including lysis and lavage with Ringers lactate, hyaluronic acid was carried out. Intra-operative findings were suggestive of synovial chondromatosis. Sample taken for histopathological examination confirmed the diagnosis of synovial chondromatosis of TMJ. Postoperative status of mouth opening and pain was assessed at 15days, one month, 3months, 6months and one year during the review to evaluate the success of arthroscopy of TMJ. All patients reported success with the modality of arthroscopy lysis and lavage at 12months of follow-up with improvement at every follow-up visit in terms of range of motion and reduction of pain score on VAS. Hence, arthroscopy with lysis and lavage came out to be a promising alternative for open joint surgery in cases of synovial chondromatosis of the TMJ with same outcomes in relieving patients who complain of reduced maximum inter-incisal opening and pain. Thus, arthroscopic procedures can be considered an alternative and effective modality for successful management of cases of synovial chondromatosis of temporomandibular joint.

Synovial chondromatosis of the temporomandibular joint and its management

Synovial chondromatosis is a condition in which loose fragments of cartilage develop in the synovial membrane of joints due to metaplasia of the subsynovial connective tissue. The resulting symptoms are similar to those of temporomandibular joint (TMJ) dysfunction. Clinical diagnosis can therefore be challenging. Synovial chondromatosis rarely occurs in the TMJ as its predilection is towards larger joints. A systematic review up until June 2010 reported a total 241 cases of TMJ synovial chondromatosis. We present two cases of TMJ synovial chondromatosis seen and treated in our department. CPD/Clinical Relevance: Awareness of TMJ synovial chondromatosis can enable patients to receive appropriate management before progression of the condition.

Three dimensional reconstruction imaging of temporomandibular joint synovial chondromatosis

AbstractAimWe have completed the first documented three dimensional (3D) reconstruction of temporomandibular joint synovial chondromatosis from computed tomography and discuss the application of this technique in diagnosis and treatment of this condition with particular relevance to its surgical management.We describe our case of a 52‐year‐old woman who was admitted to the medical assessment unit with an acute exacerbation of headaches; diagnostic head imaging revealed left TMJ calcification most suggestive of synovial osteochondromatosis.Methods and materialsMaterialise Mimics inPrint 3.0 is an advanced tool that allows for the import of medical image data from either CT or magnetic resonance imaging (MRI) as DICOM files. The data is analysed by the user and then an image is segmented in an accessible environment resulting in an accurate 3D anatomical model that can be 3D printed or visualised in either augmented reality or virtual reality (AR/VR).ResultsWe demonstrate our novel 3D reconstruction of this florid appearance of TMJ SC from an incidental finding on CT.ConclusionThis is an unusual presentation of a rare condition; despite the florid appearance on imaging, the patient’s function was entirely normal. TMJ SC is a benign condition but can require surgical management. We present our novel 3D imaging technique for diagnosis and to aid surgical management.

Surgical Treatment of Massive Temporomandibular Joint Synovial Chondromatosis with Intracranial Extension

Synovial chondromatosis (SC) is a rare benign condition characterized by osteocartilaginous loose bodies within the synovium and joint space. Only 155 total cases of SC affecting the temporomandibular joint (TMJ) have been reported in English literature1, of which only 9 cases have been reported with erosion into the skull base2, and only 2 cases with calcium pyrophosphate deposition.3 In an effort to establish an appropriate treatment for TMJ-SC with intracranial extension, we present a case of TMJ-SC and discuss the surgical approach and postoperative outcomes.

Synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion: disk preservation for early anatomical recovery

Background: Synovial chondromatosis (SC) of temporomandibular joint is a pseudoneoplastic condition characterized by benign cartilaginous metaplasia of mesenchymal residues of synovial tissue with intra articular nodules formation. TMJ involvement is rare. Interposition of loose bodies in the intra-articular space generates a pressure that could lead to glenoid fossa erosion with intracranial extension.

Role of synovium-derived fibrous cartilage in temporomandibular joint synovial chondromatosis.

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) occupies 3% SC cases. In other joints like hip and knee which were composed hyaline cartilage (HC), loose bodies (LBs) were reported to be a HC feature. However, condyle surface and disc in TMJ are fibrous cartilage (FC). Therefore, we proposed a different pathogenesis of TMJSC. LBs and synovium were collected from seven TMJSC patients, and histological and immunohistological examinations were performed. Three ways of HC formation were discovered: regular-shaped cartilaginous nodules (CNs) in sublining layer (SL) of vascularized synovium, regional chondrification of SL, and finger-like tissue with a tail attaching to synovium. Detached LBs could fuse and were only positively stained by aggrecan. Without synovium attachment to LBs, fused LBs remained a hyaline extracellular matrix (ECM). However, after synovium attachment, transformation from HC to FC occurred. Two types of FC were observed. First type FC was featured by vertical-distributed type I collagen fibers imbedding few chondrocytes, suggesting mature phase with superior mechanical features. Second type FC was featured by medium-density chondrocytes with type I collagen and aggrecan-positive ECM, suggesting primary phase. The transformation process started in appearance of 2nd type FC deriving from synovium covering LB, and gradually replaced HC from periphery to center. Three ways of HC formation were closely related. Different with SC in other joints, hyaline ECM in LBs of TMJSC could be replaced by FC deriving from synovium, during which 2nd type FC first replaced HC and then transformed to 1st type FC.

Clinical and radiological findings of temporomandibular joint synovial chondromatosis perforating the glenoid fossa: A rare case report

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) is a rare benign disorder in which mesenchymal remnants of synovial tissue undergo cartilaginous metaplasia. It is usually confined to the superior joint space; however, it can occasionally extend beyond the joint capsule into the cranium, parotid gland, infratemporal fossa, or external auditory meatus. SC of TMJ with intracranial invasion is very rare. Few cases with such large extent of the disease have been reported in the literature. In this report, we present the clinical features and imaging findings of a rare case of TMJ SC perforating the glenoid fossa leading to communication with the base of the skull. This case report attempts to identify clinical characteristics of intracranial extension and highlighting the various imaging modalities which aid in the diagnosis of SC.

Imaging findings in a case of synovial chondromatosis of temporomandibular joint

Synovial chondromatosis (SC) is a benign pathology that usually affects the joints of axial skeleton and being rare in temporomandibular joint region. Clinically, the presentation can be in the form of swelling, pain, clicking sounds, and mouth opening limitation. Imaging is a vital component to distinguish the conditions similar to SC. A case of SC diagnosed with the help of imaging has been discussed in the present paper along with a brief review of differential diagnosis.

Open surgery assisted with arthroscopy to treat synovial chondromatosis of temporomandibular joint

Open surgery assisted with arthroscopy to treat synovial chondromatosis of temporomandibular joint

側頭骨吸収を伴い頭蓋内進展を呈した顎関節滑膜性軟骨腫症の1例

側頭骨吸収を伴い頭蓋内進展を呈した顎関節滑膜性軟骨腫症の1例

Clinical and Imaging Findings of Temporomandibular Joint Synovial Chondromatosis: An Analysis of 10 Cases and Literature Review

This study investigated clinical and imaging features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) for use in clinical applications. We analyzed clinical data from 10 patients with SC of the TMJ in our hospital from 2011 to 2015. We also reviewed and analyzed relevant literature included in the National Center for Biotechnology Information database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint." The incidence of SC of the TMJ was higher in female patients than in male patients (male-to-female ratio, 1:2.22). It occurred most often in middle age (mean, 47.2years). The characteristic symptoms of SC in the TMJ were pain (90.8%), swelling (67.1%), limited ability to open the mouth (68.4%), deviant jaw opening (34.2%), and crepitation (31.6%). Computed tomography (CT) (42.9%) and magnetic resonance imaging (45.4%) were the most common techniques used to assess SC in the TMJ, and cone-beam CT (10.9%) also was used to make preliminary diagnoses based on its imaging findings. Open surgery was the preferred treatment of SC of the TMJ, and the recurrence rate was low. The main clinical characteristics of SC of the TMJ are pain, swelling, limited mouth opening, joint sounds, and deviant jaw opening. Imaging features include abnormal high-density shadows, condyle hyperostosis or destruction, changes in the temporal bone, and widening of the joint space. Cone-beam CT is useful for diagnosis of SC of the TMJ.

Transforming growth factor beta 3 involved in the pathogenesis of synovial chondromatosis of temporomandibular joint.

Synovial chondromatosis (SC) of temporomandibular joint is rare proliferative disorder featured by the formation of cartilaginous nodules in synovium and joint space. Transforming growth factor beta 3 (TGF-β3) is closely related to chondrogenic differentiation, and might participate in pathogenesis of SC. We discovered that increased quantity of synoviocytes and blood vessels were observed in SC synovium. The vessel wall and sublining fibroblasts were stained positively by the antibodies against TGF-β3, fibroblast growth factor 2 (FGF-2), and CD34. In loose bodies (LBs), TGF-β3 was mainly expressed in chondrocytes and FGF-2 was expressed in chondrocytes, fibroblasts, and vessel walls. Expressions of TGF-β1, TGF-β3, FGF-2, Sox9, Wnt-4, Foxc2, and VEGF-A mRNA were significantly higher in SC synovium. Stimulation of TGF-β3 on synoviocytes increased alkaline phosphatase (ALP) activity and expressions of chondrogenic genes (Sox9, Col2α1, Aggrecan, Wnt-4, and Wnt-11), osteogenic genes (Runx2, Foxc2, osteocalcin, and Col1α1), and VEGF-A, but failed to influence FGF-2 expression. However, the addition of FGF-2 increased TGF-β3 expression. In conclusion, TGF-β3 existed in synovium and LBs of SC, and was responsible for the pathogenesis of SC.

A case report of a primary synovial chondromatosis of temporomandibular joint, producing medial displacement of the articular disc

AbstractSynovial chondromatosis in the temporomandibular joint (TMJ) is a rare benign cartilaginous metaplasia characterized by the formation of loose bodies within the synovial joint space. This condition presents a specific triad of semiological characteristics featuring pain, swelling, and limitation of function. We will present a clinical case of a 49 years‐old female patient who presented to the clinica Davila's maxillofacial service with severe functional alterations in her right TMJ. Clinically, the patient had a maximum aperture of 15 mm wide, alteration of mandibular dynamics and preauricular pain. Posterior conducting a complete clinical examination and conclusive magnetic resonance imaging (MRI) findings it was decided to perform surgery on the joint. Articular cavity was exposed through a preauriclar approach, where the joint capsule presented no evident alteration. After opening the capsule, we were able to identify and extract multiple cartilaginous bodies both above and below the disc space. The articular surfaces were in good condition, while the articular disc was shifted to the medial portion of the cavity. The removal of the loose bodies was held the meniscopexy of the articular disc with a small joint anchor. The immediate post‐operative period was uneventful, and the patient did not present any alteration with respect to motor function of facial expression. At the 6‐week control, we recorded an increase in maximum mouth opening of 30 mm and a reduction of the pain. Six months later, we recorded an even wider mouth opening with no signs or evidence of recurrence.