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Gonzalez LV, López JP, Orjuela MP, Mejía M, Gallo-Orjuela DM, Granizo López RM. Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review. J Craniomaxillofac Surg 2023; 51:551-559. [PMID: 37562984 DOI: 10.1016/j.jcms.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/26/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
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.
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Affiliation(s)
- Luis Vicente Gonzalez
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana. Bogotá, Colombia
| | - Juan Pablo López
- Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá Colombia; Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia.
| | - María Paula Orjuela
- Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia
| | - Manuel Mejía
- Biomedical Engineer, Escuela Colombiana de Carreras Industriales, Bogotá, Colombia
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Jenzer AC, Trotta R, Hechler BL, Powers DB. Synovial chondromatosis: a case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:276-283. [PMID: 37321929 DOI: 10.1016/j.oooo.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy of the joint to remove the cartilaginous and osteocartilaginous nodules. The second is a 63-year-old male who was evaluated and treated for synovial chondromatosis of the right TMJ with the removal of extracapsular masses and an arthrotomy with intra-joint removal of nodules. Six-year radiographic follow-up demonstrated no recurrence of the pathology in his case. The cases are reviewed in this article, along with a current review of the literature.
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Affiliation(s)
- Andrew C Jenzer
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
| | - Benjamin L Hechler
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
| | - David B Powers
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
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Han ZX, Chen MJ, Yang C, Dong MJ. Recurrent synovial chondromatosis of the temporomandibular joint: report of two cases. Br J Oral Maxillofac Surg 2017; 55:965-7. [PMID: 28964665 DOI: 10.1016/j.bjoms.2017.08.367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
Abstract
Synovial chondromatosis is the most common tumour-like lesion that is found in the temporomandibular joint (TMJ). Although it is benign and self-limiting, it can recur. We retrospectively reviewed 274 cases that were treated in our department from 2001-16 and found two recurrences, the radiological, surgical, histopathological, and follow-up results of which we report here. The reasons for their recurrence were analysed and elucidated.
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Massereau E, Cheynet F, Bénateau H, Veyssière A, Bencheman Y, Gallucci A, Hammoutène S, Chossegros C. [Chondromatose of the temporomandibular joint: Multicentric study and clarification from 14 cases]. ACTA ACUST UNITED AC 2016; 117:234-9. [PMID: 27531415 DOI: 10.1016/j.revsto.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease. MATERIAL AND METHODS We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant. RESULTS Fourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90-47.38) (41 for women [σ = 14.74; IC95: 33.28-48.72] and 35 years 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 3 cases 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 10 years later. DISCUSSION 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.
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Pinto AA Jr, Ferreira e Costa R, de Sousa SF, Chagas MR, do Carmo MA, de Lacerda JC. Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery. Head Neck Pathol 2015; 9:525-9. [PMID: 25912648 DOI: 10.1007/s12105-015-0626-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 04/01/2015] [Indexed: 01/17/2023]
Abstract
Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up features of this lesion are also discussed. To our knowledge, this is the second report of SC of the TMJ in Brazil.
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de Sa D, Horner NS, MacDonald A, Simunovic N, Ghert MA, Philippon MJ, Ayeni OR. Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence. Arthroscopy 2014; 30:1499-1504.e2. [PMID: 25064754 DOI: 10.1016/j.arthro.2014.05.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Synovial chondromatosis of the hip is a benign condition whereby pain and functional limitations occur due to numerous intra-articular osteochondral fragments produced by a metaplastic synovium. Recurrence not only worsens morbidity but may lead to malignant transformation. With reported recurrence rates as high as 22% by open surgical approaches and given the increasing use of hip arthroscopy for the treatment of synovial chondromatosis, we sought to quantify the recurrence rate after arthroscopy, as well as identify predisposing factors for recurrence. METHODS Using predetermined inclusion criteria, 3 electronic databases--Embase, Medline, and PubMed-were searched for relevant articles addressing arthroscopic surgery for synovial chondromatosis of the hip across all available dates up to and including February 16, 2014. A hand search of the reference sections of the included studies was also completed. Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented. RESULTS From an initial retrieval of 2,542 studies, 14 studies satisfied the criteria for inclusion. A total of 197 patients (age range, 13 to 81 years) underwent hip arthroscopy for removal of intra-articular osteochondral fragments and synovectomy to alleviate both mechanical symptoms and pain. Follow-up periods ranged from 1 to 184 months, with approximately 7.6% of patients (15 of 197) lost to follow-up. The recurrence rate after hip arthroscopy was 7.1% (14 of 197), and the rate of minor complications, such as perineal and pedal neurapraxia, was 1%. CONCLUSIONS For synovial chondromatosis of the hip, arthroscopic removal of osteochondral fragments with synovectomy is both safe and effective, with a mean recurrence rate of 7.1%. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Souza DPE, Loureiro CCDS, Falchet PF, Leandro LFL, Raitz R. Synovial Chondromatosis of the Temporomandibular Joint: An Asymptomatic Case Report and Literature Review. Cranio 2014; 28:67-71. [DOI: 10.1179/crn.2010.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shah SB, Ramanojam S, Gadre PK, Gadre KS. Synovial chondromatosis of temporomandibular joint: journey through 25 decades and a case report. J Oral Maxillofac Surg 2011; 69:2795-814. [PMID: 21470750 DOI: 10.1016/j.joms.2010.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 12/28/2010] [Indexed: 02/03/2023]
Affiliation(s)
- Shishir B Shah
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India.
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Meng J, Guo C, Yi B, Zhao Y, Luo H, Ma X. Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. ACTA ACUST UNITED AC 2010; 109:441-8. [PMID: 20097104 DOI: 10.1016/j.tripleo.2009.09.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 08/28/2009] [Accepted: 09/27/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our aim was to study the clinical and radiologic findings of synovial chondromatosis (SC) affecting the temporomandibular joint (TMJ) and provide references for diagnosis and treatment. STUDY DESIGN Twenty patients confirmed as SC histopathologically were included in the investigation. Nineteen cases were treated with arthrotomy and 1 case with arthroscopy. The clinical manifestations, radiographic findings, histopathologic features, surgical treatment, and differential diagnosis were combined to study this disease. The SC features of TMJ on magnetic resonance (MR) images were summarized on proton density-weighted (PD) and T2-weighted images. RESULTS Synovial chondromatosis of TMJ occurred more often in women and on the right. Symptoms included preauricular pain, swelling, limitation of mouth opening, crepitations, and deviation on opening. The detection rate of calcified loose bodies was 30% on conventional radiographs and 53.3% on computerized tomography. Multiple small ring-like or tubular signals could be seen on PD and T2-weighted MR images. SC mainly affected the superior joint space; it could involve the inferior space when a perforated or deformed disc was present. SC could extend into intracranial fossa, infratemporal fossa, and lateral pytergoid muscle. CONCLUSIONS The characteristic ring-like signals could be found on MR images of the patients with SC of TMJ. This lesion should be differentially diagnosed with TMJ disorders and preauricular masses. Considering its recurrence and the different behavior of SC in different patients, various treatment strategies should be considered.
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Affiliation(s)
- Juanhong Meng
- Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
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Tiedjen K, Senge A, Schleberger R, Wiese M. Synovial osteochondromatosis in a 9-year-old girl: clinical and histopathological appearance. Knee Surg Sports Traumatol Arthrosc 2006; 14:460-4. [PMID: 16328462 DOI: 10.1007/s00167-005-0702-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Accepted: 05/03/2005] [Indexed: 02/06/2023]
Abstract
This article reports the clinical and histopathological appearance of synovial osteochondromatosis in the right knee joint of a 9-year-old girl. Initial symptoms such as monoarticular joint swelling led to further diagnostic procedures with the aid of different imaging techniques including X-ray examination and MRI. The definitive diagnosis was based on histopathological findings after performing arthroscopy of the affected joint and the intraoperative appearance of the synovial lesions. Besides antiphlogistical drug-therapy, the treatment of choice is synovectomy.
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Affiliation(s)
- K Tiedjen
- Department of Orthopedic Surgery, St. Josef-Hospital Bochum, University Hospital, Gudrunstrasse 56, 44791, Bochum, Germany.
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Ardekian L, Faquin W, Troulis MJ, Kaban LB, August M. Synovial Chondromatosis of the Temporomandibular Joint: Report and Analysis of Eleven Cases. J Oral Maxillofac Surg 2005; 63:941-7. [PMID: 16003619 DOI: 10.1016/j.joms.2005.03.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Synovial chondromatosis (SC) is a benign monoarticular condition that is uncommon in the temporomandibular joint (TMJ). The purpose of this article is to present 11 additional cases of SC of the TMJ and discuss newer modes of imaging, diagnostic approaches, treatment options, and follow-up data. METHODS Medical records of 11 patients with SC treated within our department from 1991 to the present were reviewed. Demographic data, etiology, clinical presentation, diagnostic evaluation, treatment, and follow-up information were collected. Previously reported cases (both TMJ and others) from 1988 to present were identified for comparison and the literature reviewed. RESULTS There were 8 females and 3 males with an average age of 54 years. Pain and preauricular swelling were the most common presenting clinical complaints. Etiologic factors (parafunction, inflammatory joint disease) were found in 7 of 11 cases. Plain radiographs showed joint calcifications in only 2 of 11 cases. Computed tomography identified calcifications in 3 of 6. Magnetic resonance imaging clearly demonstrated the mass and its extension in 10 of 10 cases. Fine needle aspiration was diagnostic in 4 of 9. All patients were treated with an open arthrotomy. Meniscectomy was required in 7 of 11. Average follow-up was 5.2 years with no recurrences reported. CONCLUSION The current case series of SC shows a female predilection with age and presenting complaints similar to those previously reported. A traumatic etiology was not identified, although a weak association is reported in the literature. The superiority of magnetic resonance imaging for both diagnosis and evaluation of extension of disease is shown. In a subset of cases, fine needle aspiration is useful for confirming the clinicoradiographic impression. Complete removal of involved tissue is associated with an excellent prognosis.
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Abstract
Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination.
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Affiliation(s)
- H E Umstadt
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Philipps-Universität Marburg.
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Abstract
Synovial chondromatosis of the temporomandibular joint (TMJ) is very rare. We report a case of synovial chondromatosis of the TMJ with extraarticular extension that was diagnosed with MRI and CT. Histopathologic evaluation indicated that this case was synovial chondromatosis in intermediate phase.
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Affiliation(s)
- S T Yildiz
- Guney Medical Imaging Center, Antalya, Turkey
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