Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout)

Matsumura, Yoshihiko; Nomura, Junichi; Nakanishi, Koki; Yanase, Setsuko; Kato, Hiroyuki; Tagawa, Toshirou

doi:10.1259/dmfr/24183821

Cited by 20 publications

(5 citation statements)

References 15 publications

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“…Deposition of calcium pyrophosphate dihydrate crystals occurs within and around TMJ, especially involving the articular cartilage and fibrocartilage, appearing as spotted hyperechoic signals on US images. Sometimes a marked destruction of the condyle with erosive changes may be observed in association ( 60 ).…”

Section: Methodsmentioning

confidence: 99%

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

et al. 2022

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Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.

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Section: Methodsmentioning

confidence: 99%

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

et al. 2022

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“…Therefore, taken together, the aforementioned findings suggested a coexistence of CPPD and SC in the right TMJ in the present case, the rare pathology. The mechanism by which SC and CPPD coexist is not well understood [ 3 , 41 , 42 ]. CPPD, a noninfectious inflammatory arthropathy could result from joint overloading, trauma, comorbidities such as metabolic disorders, osteoarthritis, and other TMJ disorders and later mediates SC [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Simultaneous occurrence of CPPD and SC is rarely reported in the TMJ [ 3 , 41 , 42 ]. Herein, we present this unusual TMJ comorbidity in a 61-year-old Japanese man, delineate the molecular etiopathology of these diseases, reiterate the importance of confirmatory testing in minimizing diagnostic limitations and discuss surgery with the removal of lesions and synovectomy as the preferred choice of treatment.…”

Section: Introductionmentioning

confidence: 99%

Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis

Murahashi

Ntege

Higa³

et al. 2022

BMC Oral Health

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Background The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. Case presentation We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. Conclusions Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.

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“…MRI can better identify the extent of lesion involvement and the relationships between the lesion and articular disc, parotid gland, facial nerve and inferior temporal fossa. Articular cartilage calcification in CPPD often develops later than arthropathy on imaging, and MRI can detect lesions earlier than X-ray or CT[ 4 , 14 ]. MRI showed a mass with abnormal signals in the articular cavity, which was mostly T1WI hypointense and T2WI hypointense with significant inhomogeneous enhancement.…”

Section: Discussionmentioning

confidence: 99%

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports

Tang

Han

2021

WJCC

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BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyro-phosphate dihydrate crystals, but it is invasive. Pseudogout of the temporo-mandibular joint (TMJ) is uncommon, and it rarely invades the skull base or penetrates into the middle cranial fossa. The disease has no characteristic clinical manifestations and is easily misdiagnosed. CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa. A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region. Another patient, a 52-year-old man with a mass in the left TMJ for 6 years, was admitted to the hospital. Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area. Both patients underwent excision of the lesion. The lesion was pathologically diagnosed as tophaceous pseudogout. The symptoms in these patients were relieved after surgery. CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction. A pathological examination is the gold standard for diagnosing this disease. Surgical treatment is currently the recommended treatment, and the prognosis is good after surgery.

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Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout)

Cited by 20 publications

References 15 publications

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports

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