Pigmented villonodular synovitis of the temperomandibular joint

Transglenoidal Approach in Pigmented Villonodular Synovitis of the Temporomandibular Joint

Pigmented villonodular synovitis is a benign pathology with locally aggressive behavior caused by an uncontrolled proliferation of the articular synovial membranes. Here the authors present a case of pigmented villonodular synovitis of the temporomandibular joint with middle cranial fossa extension and review the different management options including surgery, which have been proposed to target this condition in the recent literature.

Management of tenosynovial giant cell tumour of the temporomandibular joint: a systematic review

Diffuse type tenosynovial giant cell tumour of the temporomandibular joint (D-TGCT-TMJ) is a rare proliferative disorder. The aim of this study was to perform a systematic review of the literature to summarize D-TGCT-TMJ management regimes and recurrence rates with at least 12 months of follow-up. Our secondary aim was to propose a minimum period of post-operative follow-up. A medline search for any D-TGCT-TMJ case detailing treatment, follow-up of at least 12 months, and presence of recurrence was undertaken. The following variables were extracted from the studies: patient's age and sex, presence of middle cranial fossa invasion, treatment undertaken, total length of follow-up, and presence of recurrence. All studies were assessed for bias as per the Joanna Briggs Institute systematic reviews appraisal tool. There were 63 cases reviewed and were predominantly managed with total resection (60.3%). Other modalities included: arthroplasty, subtotal resection with or without postoperative radiotherapy, medical therapy and surveillance. The recurrence rate was 9.52% and the longest follow-up period where recurrence was observed was at 60 months. Total resection and arthroplasty are common D-TGCT-TMJ management regimes. Patients with D-TGCT-TMJ should be followed up annually for at least 5 years postoperatively to assess for recurrence.

Computed tomography and magnetic resonance imaging characteristics of giant cell tumors in the temporomandibular joint complex

Purpose

This study aimed to investigate the computed tomography and magnetic resonance imaging features of giant cell tumors in the temporomandibular joint region to facilitate accurate diagnoses.

Materials and Methods

From October 2007 to June 2020, 6 patients (2 men and 4 women) at Yonsei University Dental Hospital had histopathologically proven giant cell tumors in the temporomandibular joint. Their computed tomography and magnetic resonance imaging findings were reviewed retrospectively, and the cases were classified into 3 types based on the tumor center and growth pattern observed on the radiologic findings.

Results

The age of the 6 patients ranged from 25 to 53 years. Trismus was found in 5 of the 6 cases. One case recurred. The mean size of the tumors, defined based on their greatest diameter, was 32 mm (range, 15–41 mm). The characteristic features of all cases were a heterogeneously-enhancing tumorous mass with a lobulated margin on computed tomographic images and internal multiplicity of signal intensity on T2-weighted magnetic resonance images. According to the site of origin, 3 tumors were bone-centered, 2 were soft tissue-centered, and 1 was peri-articular.

Conclusion

Computed tomography and magnetic resonance imaging yielded a tripartite classification of giant cell tumors of the temporomandibular joint according to their location on imaging. This study could help clinicians in the differential diagnosis of giant cell tumors and assist in proper treatment planning for tumorous diseases of the temporomandibular joint.

Uncommon tumors of temporomandibular joint: An institutional experience and review

BACKGROUND

The temporomandibular joint (TMJ) harbors a myriad of pathologic alterations including arthritides and benign and malignant neoplasms.

METHODS

Herein, we describe our institutional experience of some uncommon and unusual synovial pathologies of the TMJ along with a review of literature. We searched through the archives of department of pathology and institutional electronic medical record for specimens of TMJ between 1999 and 2019. Hematoxylin and eosin slides were reviewed and data (final diagnosis, age, gender, clinical presentation, tumor size, treatment modality, recurrence, and vital status) were collected.

RESULTS

A total of seven cases were identified including four cases of synovial chrondromatosis; and one case each of tenosynovial giant cell tumor, localized type, tenosynovial giant cell tumor, diffuse type, and synovial sarcoma.

CONCLUSIONS

The article emphasizes on the clinical, radiologic, pathologic, and molecular features of these uncommon entities. The differential diagnosis of each entity is also discussed. Current updates in the management are also reviewed.

Pigmented Villonodular Synovitis Presenting as Unilateral Hearing Loss: Review of the Literature and Case Report

BACKGROUND/AIMS

To review the existing literature on pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) and report a rare case of PVNS of the TMJ presenting with unilateral hearing loss.

METHODS

Review of the existing literature and a description of personal experience with PVNS of the TMJ presenting with unilateral hearing loss.

RESULTS

Review of the existing literature revealed 76 reported cases of PVNS of the TMJ. The most common presenting symptom was of a slowly enlarging mass or swelling of the preauricular area, with dysfunctional TMJ also frequently reported. All patients underwent surgical excision with some pursuing radiation as adjuvant therapy. Presented Patient: A 46-year-old man presented with several months of unilateral subjective hearing loss and aural fullness. Imaging revealed a mass centered along the superior TMJ with expansion through the squamous temporal bone and extra-axial intracranial extension into the middle cranial fossa. Imaging characteristics and fine-needle aspiration biopsy were consistent with PVNS.

INTERVENTION

The patient underwent near-total excision of the mass via frontotemporal craniectomy and lateral temporal bone resection.

FOLLOW-UP

At the 16-month follow-up there was no evidence of disease recurrence.

CONCLUSION

PVNS of the TMJ represents a rare entity that can present with a variety of symptoms including unilateral hearing loss.

Chondroid tenosynovial giant cell tumour: a rarity in the temporomandibular joint

Tenosynovial giant cell tumours of the temporomandibular joint (TMJ) are extremely rare, particularly the subset of chondroid tumours. They can be broadly divided into localised and diffuse types, of which we know of only 116 reported cases in the TMJ. Rarer still are the subset of chondroid tenosynovial giant cell tumours, of which we know of only 30 cases that have affected the TMJ. We present a case that involved the TMJ, and include a discussion of its management.

[CT imaging features of diffuse tenosynovial giant cell tumor of temporomandibular joint]

OBJECTIVE

This study aimed to investigate the characteristic features of CT images of diffuse tenosynovial giant cell tumor (D-TSGCT) from the temporomandibular joint (TMJ) to understand CT imaging diagnosis of the disease.

METHODS

CT images and clinical information from 10 patients with D-TSGCT of TMJ were recruited for retrospective analysis from March 2013 to March 2017 in Peking University Hospital of Stomatology. All cases were treated by surgery and confirmed by pathology.

RESULTS

CT scan demonstrated hyperdense soft-tissue masses and various kinds of calcification in all of the 10 subjects. Contrast-enhanced scan exhibited obvious enhancement in six patients. Bone destruction of the mandibular condyles and skull base was found in seven and six subjects, respectively.

CONCLUSIONS

CT appearance of D-TSGCT of the TMJ is characterized by hyperdense soft tissue with calcification, further enhancement in contrast-enhanced scan, and bone destruction in the mandibular condyles and skull base in some cases.

Tenosynovial, diffuse type giant cell tumor of the temporomandibular joint, diagnosis and management of a rare tumor

The purpose of this paper was to describe a rare unusual case of primary mandibular condylar tenosynovial giant cell tumor of diffuse type with predominantly intraosseous growth and its management by resection and functional reconstruction with a vascularized costochondral graft. Clinical presentation was swelling in the right condylar area and limited mouth opening with radiological evidence of central bone destruction and magnetic resonance imaging showed central hemosiderin deposition. Fine needle aspiration did not lead to a diagnosis and an open biopsy had to be performed. Management consisted of tumor resection and reconstruction with a free vascularized costochondral graft. Tenosynovial diffuse type giant cell tumor of the temporomandibular joint is very rare. Complete resection leads to a low recurrence rate and reconstruction with a costochondral free vascularized flap leads to an excellent functional outcome.

Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint

BACKGROUND

Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ.

METHODS

We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT.

RESULTS

71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled.

CONCLUSIONS

PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review

BACKGROUND

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review.

METHODS

Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases.

RESULTS

Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence.

CONCLUSION

PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions.

Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report

Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.

Pigmented villonodular synovitis of the temporomandibular joint

Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovium-lined joints, bursae, and tendon sheaths. It appears in both diffuse and localized forms, depending on the extent of synovial involvement. PVNS rarely involves the temporomandibular joint (TMJ); when it does, it manifests clinically as a slowly growing and painless preauricular mass that resembles a parotid tumor. TMJ dysfunction, paresthesia, and/or hearing loss can result. We present a case of a large extra-articular PVNS of the TMJ, and we review the literature.

Pigmented villonodular synovitis of the temporomandibular joint: CT imaging findings

OBJECTIVE

The purpose of this study was to determine the characteristic computed tomography (CT) findings of pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ).

STUDY DESIGN

Eight subjects with PVNS were examined with both pre and post contrast CT scans. All lesions were histopathologically confirmed through surgery. CT appearances of the lesions were reviewed.

RESULTS

Among the eight subjects, 8 (100%) demonstrated soft tissue mass and enhancement after contrast administration, 6 (75%) appeared as all or focal areas of noncontrast hyperdensity, 6 (75%) had widening of the joint spaces. Bony erosion of the mandibular condyles and articular surfaces were found in 7 (87.5%) and 6 (75%) subjects, respectively.

CONCLUSIONS

Based on the CT findings, PVNS of the TMJ is characterized by hyperdensity soft tissue mass and further increase in density after contrast administration, bony destruction of the mandibular condyles and skull base, and intracranial extension.

Giant cell tumor of the masticator space: case report and literature review

Giant cell tumors of the head and neck are rare. We describe the case of a 50-year-old man who presented with otalgia and eustachian tube dysfunction. After his symptoms persisted despite aggressive medical management, further investigation revealed the presence of a firmness in his left parotid tail. Computed tomography identified a heterogeneously enhancing mass in the left masticator space. The tumor was removed surgically, and it was diagnosed on histopathology as a giant cell tumor. The patient recovered uneventfully and was closely followed for signs of recurrence. To the best of our knowledge, ours is the first reported case of a giant cell tumor in the masticator space. We review the literature on giant cell tumors of the head and neck, with particular attention given to cases involving the temporomandibular joint.

Pigmented villonodular synovitis of the temporomandibular joint: case report and review of the literature

Pigmented villonodular synovitis (PVNS) is an aggressive proliferative lesion that usually involves the synovial tissues of big joints. To date, there are ∼52 cases of PVNS affecting the temporomandibular joint reported in the English-language literature, about one-third of them exhibiting intracranial involvement. We herein describe an additional case of PVNS of the temporomandibular joint with skull base invasion affecting a 26-year-old male patient and discuss its clinicopathologic features considering previously published cases. Histopathology and imaging evaluation are important for the diagnosis of PVNS, which should be included in the differential diagnosis of preauricular aggressive swellings.

Malignant pigmented villonodular synovitis of the temporomandibular joint with lung metastasis: a case report and review of the literature

Malignant pigmented villonodular synovitis (PVNS) is an extremely rare lesion. Approximately 30 cases of malignant PVNS have been reported to date and of these, only 1 case involved the temporomandibular joint. Owing to the rarity of well-documented cases and the heterogeneous histologic features of this group of tumors, there has been some confusion regarding its diagnosis. The heterogeneous features of the sarcomatous areas contain fibrosarcomatous, myxosarcomatous, malignant fibrous histiocytomalike or giant cell tumorlike patterns. However, despite the absence of frank sarcomatous change in the histopathogy of PVNS, there have been 3 reported cases of metastatic lesions in the lung or lymph nodes. Here we present an additional case of clinically malignant PVNS with pulmonary metastasis after recurrence. A 29-year-old man presented in our hospital with a recurrent swelling and pain in the right preauricular area, where benign tumor had been previously resected. MRI demonstrated a large mass with a low signal intensity that seemed to demonstrate a ferromagnetic effect. Surgical resection of the lesion was performed and the diagnosis of PVNS with focal atypical cells was made. Unfortunately, at 30 months post surgery, a thoracic CT found a metastatic nodule in the left lower lobe of the lung.

Benign fibrous histiocytoma of the buccal mucosa: case report and literature review

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.

Extra-articular diffuse tenosynovial giant cell tumour of the infratemporal fossa: report of a case and literature review

The authors describe a 34-year-old man who presented with an unapparent swelling on the right preauricular zygomatic region, with progressive limitation of mouth opening and slight temporomandibular joint pain. Based on fine-needle aspiration cytology and radiological investigations, the patient was diagnosed preoperatively as having a possible tenosynovial giant cell tumour (TGCT). Surgical treatment was effective and no local recurrence was observed. Histological and immunohistochemical examination diagnosed an extra-articular diffuse TGCT. The clinical features, histopathological characteristics, imaging modalities, diagnostic methods and treatment of TGCT are discussed and a review of the relevant literature is presented.

Pigmented villonodular synovitis of the temporomandibular joint: a rare tumor of the temporal skull base

Musculoskeletal tumors are not usually encountered at the skull base. Benign lesions such as cholesterol granuloma, cholesteatoma, fibrous dysplasia, and Paget disease are common examples of such tumors arising from the bone of the cranial base. The authors report a case involving an adult male patient with the rare finding of pigmented villonodular synovitis of the temporomandibular joint. This case is reported as an example of another lesion to consider in the differential diagnosis. Due to the complexity of the anatomy at the cranial base, radical resection as recommended for the usual sites of occurrence in major joints is problematic. Because of the reported high recurrence rates at other sites, as radical excision as possible with vigilance for recurrence is recommended.

Osseous abnormalities related to the temporomandibular joint

With the arrival of arthrography, computed tomography, and magnetic resonance imaging, diagnostic imaging of the temporomandibular joint has improved tremendously over the last 20 years. In patients with temporomandibular joint pain and dysfunction, the main focus was on meniscal pathology. The purpose of this article is to discuss several osseous abnormalities and demonstrate their association with temporomandibular joint pain and dysfunction.

Pigmented villonodular synovitis of the temporomandibular joint: Differential diagnosis of the parotid mass

Pigmented villonodular synovitis (PVNS) is a benign, locally invasive lesion of the synovium of joints, bursae, and tendon sheaths. Its occurrence in the temporomandibular joint is very rare. We report two cases of PVNS involving temporomandibular joint (TMJ), not only for its unusual location but also to underscore how its clinical presentation can mimic a parotid mass. Treatment requires total TMJ synovectomy whereas multiple recurrences or aggressive clinical behavior may require postoperative radiation therapy following complete surgical extirpation.

Pigmented Villonodular Synovitis of the Temporomandibular Joint

Pigmented villonodular synovitis (PVNS) is a relatively rare disease, affecting the synovial-lined joints. PVNS was first fully described by Jaffè in 1941, who considered it to be a benign inflammatory state of the synovium of an uncertain etiology. Reports of this disease in the temporomandibular joint (TMJ) are extremely rare. The authors report a case of a 38-year-old woman affected by pigmented villonodular synovitis of the TMJ. Clinical examination revealed the presence of a preauricular mass in the left side; a computed tomography scan showed a 3.0 x 2.0 cm preauricular mass in close continuity to the TMJ capsule. The purpose of this report is to describe the clinicopathological features of a case involving the TMJ. The previously reported cases in the literature are also reviewed.

Pigmented villonodular synovitis of the temporomandibular joint: an extensive case with skull-base involvement

Pigmented villonodular synovitis (PVNS) is a benign lesion of unclear etiology involving the synovial membranes of joints, bursae, and tendon sheaths. Its occurrence in temporomandibular joint (TMJ) is distinctly rare. Despite its benign nature, PVNS is locally destructive to the surrounding structures. Misdiagnosis and delay in diagnosis contribute to the frequency of tumors presenting at an advanced stage at the time of treatment. Thus, PVNS often requires extensive surgery. A case of PVNS of the left TMJ, involving the left infratemporal fossa and subtemporal cranial base, is presented herein. Preoperative computerized tomography, magnetic resonance imaging, and fine-needle aspiration biopsy were used to establish a presumptive diagnosis and to determine the extent of the lesion. Complete excision of the lesion through an infratemporal fossa approach has provided 7 years of a disease-free period with adequate preservation of function.

Pigmented villonodular synovitis of the temporomandibular joint: differential diagnosis and case report

Pigmented villonodular synovitis of the temporomandibular joint (TMJ) is rare. We present a patient in whom the lesion had invaded the infratemporal fossa and destroyed the mandibular condyle.

Common abnormalities in temporomandibular joint imaging

Magnetic resonance imaging has evolved as a prime diagnostic method for soft-tissue abnormalities of the temporomandibular joint. The most common temporomandibular joint abnormalities are internal derangement and osteoarthritis, but there are many other reasons for pain and dysfunction that are often overlooked. The purpose of this paper is to illustrate several of these more unusual and less well-recognized causes for temporomandibular joint pain and dysfunction. For example, internal derangement is often seen in asymptomatic individuals. Another purpose is to illustrate the difference in magnetic resonance imaging of asymptomatic and symptomatic internal derangement.

Pigmented Villonodular Synovitis of the Temporomandibular Joint: A Report of Two Cases

Pigmented villonodular synovitis is a benign but locally destructive disease that originates in the synovial membranes of the joints. It is a proliferative disorder of unknown etiology, and it is usually monarthric. Approximately 80% of cases involve the knee; the hip, ankle, foot, hand, elbow, and shoulder account for most other cases. Pigmented villonodular synovitis in the temporomandibular joint is rare. When it does occur, its features include preauricular swelling, trismus, and symptoms of temporomandibular joint dysfunction. It can be diagnosed by a combination of the history, clinical examination, characteristic radiologic findings, and fine-needle aspiration or biopsy results. Wide local excision, including the involved bone, and a total synovectomy are advocated because the lesion can recur if it is not adequately excised. We report two new cases of pigmented villonodular synovitis of the temporomandibular joint, and we review the literature on this subject.

Temporomandibular joint: MR imaging

Diagnostic imaging of TMJ has improved remarkably in the last 20 years. Various abnormalities related patient symptoms. Further studies using the latest imaging techniques will allow a better understanding of the sources of joint pain and the discrepancy between imaging findings and patient symptoms. For clinical practice, appropriate clinical examinations are needed to determine exactly which imaging findings are significant.

[Pigmented villonodular synovitis of the temporo mandibular joint. Differential diagnosis and therapy]

For the temporomandibular joint (TMJ), functional disorders are common but tumors and tumor like lesions are rare, although these are often mistaken for functional ailments. Early examination by computed tomography or, as a method of choice, magnetic resonance imaging is recommended in case of persisting TMJ problems. Pigmented villonodular synovitis (PVNS) is a rare benign but locally destructive fibrohistiocytic lesion originating in synovial tissue. Involvement of the temporomandibular joint is extremely rare, with the average age of patients being 44.6 years. This paper reports on a 13-year-old patient with diffuse PVNS involving the middle ear and middle cranial fossa. The treatment of choice involves wide local excision and reconstruction of the temporomandibular joint with long-term follow-up. Pathogenesis and differential diagnosis are discussed.

[Transvestibular closure with an autologous bone graft as surgical repair of a nasoseptal defect due to Le Fort-I osteotomy]

Defects of the nasal septum are a common complication after nasal surgery. Affected patients frequently suffer from bleeding, crusting and impaired nasal air flow. The surgical closure of septal defects remains a distinctive challenge. Though many different techniques have been described, the failure rate of this procedure remains high. In the case presented here, a large basal septum defect occurred after a prosthetic Le Fort-I osteotomy. The attempt to cover the distance between the bony nasal floor and the nasal septum with pedicled mucosal flaps failed due to extensive scar formation of the nasal mucosa. Therefore a nasal floor elevation by insertion of an autologous bone graft from the iliac crest was conducted. The bone graft was connected with the hard palate via two titanium screws. Other than with an autologous cartilage graft, no major resorption of the bone graft is to be expected. This indirect method for the closure of a basal nasal septum defect is new.

Fine-needle aspiration biopsy diagnosis of "invasive" temporomandibular joint pigmented villonodular synovitis

The clinical and aspiration cytologic details of a case of temporomandibular joint pigmented villonodular synovitis are presented and correlated with imaging, surgical, histopathologic, and clinical follow-up findings; the origin of such lesions is discussed. The lesion originally presented in a 36-year-old, otherwise healthy, white man as a unilateral mass involving the temporal fossa and temporomandibular joint region. The tumor's extent was defined by magnetic resonance imaging and computed tomographic scan; there was destruction of the temporomandibular joint and erosion of the temporal cranial bones by a lesion whose maximum dimensions were estimated by imaging to be 2.75 x 3.25 cm. The lesion was initially sampled and classified by computed tomography-guided fine-needle aspiration biopsy. Following complete resection, the original diagnosis was confirmed with both hematoxylin-eosin-stained paraffin sections and immunohistochemical staining. The patient remains free of disease 7 years postoperatively.

Mandibular and temporomandibular joint arthropathy in the differential diagnosis of the parotid mass

OBJECTIVE

To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass.

STUDY DESIGN

We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland.

CONCLUSIONS

Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.

Magnetic resonance imaging of the temporomandibular joint

The spectrum of disease that affects the temporomandibular joint (TMJ) can be varied. To differentiate among the diseases that cause pain and dysfunction, an intimate knowledge of the anatomy, physiology, and pathology of this region is necessary. Due to the joint's complex anatomy and relationship to the skin, it has been difficult to image in the past. Magnetic resonance imaging is ideally suited for visualizing TMJ because of its superb contrast resolution when imaging soft tissues. Magnetic resonance imaging allows simultaneous bilateral visualization of both joints. The ability to noninvasively resolve anatomic detail can be performed easily and quickly using magnetic resonance imaging. The development of magnetic resonance imaging has greatly aided the diagnosis of TMJ disorders. An understanding of TMJ anatomy and pathogenesis of TMJ pain is crucial for interpretation of magnetic resonance imaging and subsequent treatment.

Extra-articular pigmented villonodular synovitis of the temporomandibular joint

Pigmented villonodular synovitis, a benign but locally destructive fibrohistiocytic proliferative lesion involving tendon sheaths, bursae and diarthrodial joints, is distinctly rare in the temporomandibular joint. We report one such case occurring in a 42-year-old housewife who presented with a progressively enlarging right zygomatic mass for six months. On exploration, an orange-brown firm mass, 5 x 3 x 2 cm, was seen adherent to the lateral aspect of the capsule of the right temporomandibular joint, and eroding into the inferior aspect of the right temporal bone and part of the mandibular condyle. The mass was completely excised. Pathological examination showed features typical of those of pigmented villonodular synovitis and the lesion was entirely extra-articular in location. The patient remained well with no evidence of local recurrence two years after operation. Review of the literature and careful analysis of the clinicopathological features showed that the vast majority of the reported cases of pigmented villonodular synovitis of the temporomandibular joint belonged to the extra-articular variant, which is associated with a more aggressive local infiltrative behaviour and higher rate of local recurrence than the localized type. The recommended treatment for this condition is therefore wide local excision, aiming to remove the lesion as completely as possible without producing severe disability for the patient.

Tumours and pseudotumorous lesions of the temporomandibular joint: a diagnostic challenge

Tumours and pseudotumorous lesions originating from the synovial membrane of the temporomandibular joint are rare. We report a series of six cases of such disorders. There were two cases of synovial chondromatosis, two of calcium pyrophosphate dihydrate crystal deposition disease, one nodular synovitis and one synovial sarcoma. Three patients were female and three were male. Their ages ranged from 36 to 70 years. All had atypical clinical and radiographical presentation. The prevalence, clinical and radiographical findings and pathological features of each disease entity are discussed and a review of the literature is made concerning all tumours and pseudotumours arising from the temporomandibular joint.

Fine-needle aspiration of pigmented villonodular synovitis of the temporomandibular joint masquerading as a primary parotid gland lesion

The fine-needle aspiration findings in a case of pigmented villonodular synovitis of the temporomandibular joint are presented. The characteristic cytomorphologic and clinical features of this uncommon, benign fibrohistiocytic lesion are discussed. In addition, due to the initial clinical impression of a primary parotid gland lesion, the differential diagnosis for the cytomorphologic features observed (histiocytoid cells admixed with osteoclast-like giant cells) are discussed within the context of a primary salivary gland mass.

Pigmented villonodular synovitis of the temporomandibular joint: report of a case

Pigmented villonodular synovitis is a benign reactive process of the synovial tissue, that usually involves the knee or other major joints. Reports of this entity in the temporomandibular joint are rare. The authors describe a case involving this joint, initially clinically diagnosed as a parotid tumour.