Short communication
Bilateral synovial chondromatosis of the temporomandibular joint

https://doi.org/10.1016/j.jcms.2010.04.016Get rights and content

Abstract

Purpose

To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data.

Patients and methods

A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ.

Results

SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians’ lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy.

Conclusion

SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

Introduction

Synovial chondromatosis (SC) is a rare monoarticular arthropathy of unknown aetiology characterized by the development of cartilaginous bodies in the synovial membrane and joint space. Pathologically, this condition is considered to be a metaplastic disease of the synovial connective tissue (Lieger et al., 2007). It is more common in larger joints such as the knee, elbow, wrist, shoulder and hip, whereas involvement of the temporomandibular joint (TMJ) is unusual (Von Lindern et al., 2002, Ardekian et al., 2005, Lieger et al., 2007). The first description of SC of the TMJ was made by Georg Axhausen in 1933. Subsequently about 80 cases have been added to the scientific literature. In the Journal of Cranio-Maxillofacial Surgery, two series (Norman et al., 1988, Carls et al., 1995a) and several isolated cases (Cho-Lee et al., 2008, Guijarro-Martínez et al., 2008) have been reported during the last two decades. The advantages of arthroscopy for diagnosis and a reduction of operative trauma have been documented (Carls et al., 1995a, Carls et al., 1995b, Fernández et al., 2006). Involvement of both TMJs with SC is extremely rare in the scientific literature, only two cases have been reported prior to this one.

The purpose of this article is to present a case of bilateral SC of the TMJ and to discuss current diagnostic approaches, treatment options and relevant follow-up data.

Section snippets

Case report

A 38-year-old woman was referred to our Department of Oral and Maxillofacial Surgery with a 12-month history of unilateral preauricular swelling, progressive local pain and intermittent headaches. Her medical history was non-significant.

Clinical examination revealed a tender elastic mass in the left preauricular region. Clicking of the left TMJ and slight deviation of the mandible to the right were evident with mouth opening, which was painful but unrestricted (40 mm).

Initial imaging studies

Discussion

SC is rare in the TMJ. “Synovial chondrometaplasia”, “osteochondromatosis” or “synovial chondrosis” are often used synonymously. Bilateral involvement is exceptional to our knowledge, only two cases besides this one have been reported (Keogh et al., 2002, Peng et al., 2009).

Although some authors identify cytogenetic features suggesting clonal proliferation (Szendrói and Deodhar, 2000) and others even regard SC as a chondrogenic neoplasm (Von Lindern et al., 2002, Adachi et al., 2008), the

Conclusion

SC is an uncommon condition in the TMJ. It should be included in the differential diagnosis of preauricular pain, swelling and crepitus. Bilateral involvement is extremely rare. MRI is a valuable tool for both diagnosis and postoperative follow-up, which must be long-term. Complete removal of the involved tissue usually gives an excellent prognosis. As awareness of this uncommon clinical condition continues to increase and new imaging tools become available, early diagnosis and proper surgical

References (23)

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