Calcium pyrophosphate dihydrate arthropathy with condylar destruction of the temporomandibular joint

Abstract

Abstract:We report a case of calcium pyrophosphate dihydrate (CPPD) arthropathy with condylar destruction of the temporomandibular joint. Diagnosis was made on the basis of clinical findings and x-ray evidence of severe destruction of the condyle. The most likely diagnosis was considered to be neoplasm and a secondary infection of the left TMJ. Review of sections of the condyle taken at operation confirmed the diagnosis of left TMJ pseudogout. The postoperative course was uneventful with improvement in the clinical symptoms. (J. Oral Sci. 45, 223-226, 2003)

Cytopathologic diagnosis on joint lavage fluid for patients with temporomandibular joint disorders

“…For crystalline arthritis, presence of macrophages or foreign body‐type giant cells in the fluid can be seen under a microscope; however, detecting the actual crystalline components on the specimens is essential for a definitive diagnosis. These cells usually cannot be detected alone in the tissue or in the aspirated samples from patients with crystalline arthritis.…”

“…Temporomandibular joint (TMJ) disorders (TMD) are diagnosed based on the patient's clinical findings and the results of image investigations; however, understanding of the inflammatory processes in TMJ is difficult. In addition, many TMJ disease types (such as crystalline arthritis, synovial chondromatosis, and TMD) share some principal symptoms, such as TMJ sounds and pain, lateral deviation, and difficulty in mouth opening. Therefore, TMJ diseases in the early stage can be misdiagnosed with TMD …”

“…Neutrophils and lymphocytes are both predominant in tissues in the transitional phase between acute and chronic inflammation. Presence of monocyte lineage cells or multinucleated giant cells in inflamed tissue suggest the presence of calcium phosphate crystals, which cause crystalline arthritis . Furthermore, presence of osteoclasts suggests modeling or remodeling of the TMJ, and the presence of cartilaginous components suggests synovial chondromatosis …”

Calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint

“…Radiologically, calcification of the TMJ disc and joint space as well as destructive processes with erosive changes of the mandible condyle and mass formation in the joint space have been reported in most of the previous cases (Pritzker et al, 1976;de Vos et al, 1981;Good and Upton, 1982;Gross et al, 1987;Hutton et al, 1987;Kamatani et al, 1987;Mogi et al, 1987;Lambert et al, 1990;Magno et al, 1992;Chuong and Piper, 1995;Dijkgraaf et al, 1995;Ishida et al, 1995;Pynn et al, 1995;Kurihara et al, 1997;Osano et al, 2003). Only four publications did not report bony destruction of the condyle (Zemplenyi and Calcaterra, 1985;Onodera et al, 1997;Vargas et al, 1997;Aoyama et al, 2000).…”

“…Therefore it is surprising that the temporomandibular joint (TMJ), a joint in which fibrocartilage predominates, is rarely affected by CPPD crystal deposition disease. CPPD arthropathy of the TMJ has only been described in 23 cases in the literature (Pritzker et al , 1976; de Vos et al , 1981; Good and Upton, 1982; Zemplenyi and Calcaterra, 1985; Gross et al , 1987; Hutton et al , 1987; Kamatani et al , 1987; Mogi et al , 1987; Lambert et al , 1990; Magno et al , 1992; Chuong and Piper, 1995; Dijkgraaf et al , 1995; Ishida et al , 1995; Pynn et al , 1995; Kurihara et al , 1997; Onodera et al , 1997; Vargas et al , 1997; Aoyama et al , 2000; Osano et al , 2003).…”