Temporomandibular joint synovial chondromatosis: An analysis of 7 cases and literature review

Abstract

Objective: To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Methods: Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms “synovial chondromatosis” and “temporomandibular joint”, and found 181 cases. Results: There was no specific difference in the symptoms of SC in the TMJ in different Milgram’s stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram’s stage. Conclusions: The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.

Chondroma Arising from the Temporomandibular Joint: A Case Report

“…The most common age and sex of this disease are thought to be patients in their 40s and female, respectively. Song et al recently performed a systematic review of chondroma of the TMJ [ 10 ]. Among 188 cases, 70.7% were female, and 34% showed bony changes including calcification.…”

“…Calcification and ossification may be present” [ 18 ]. Milgram proposed classification into three stages based on histological findings, as follows; Stage I: chondrogenesis occurs in synovial mesenchymal stem cells, with no formation of loose bodies; Stage II: a transitional lesion with active chondrogenesis in the synovium and cartilaginous nodules enlarge or are released into the articular cavity as loose bodies; Stage III: chondrogenesis in the synovial membrane disappears and loose bodies can be observed [ 10 , 19 ].…”

Synovial chondromatosis of the temporomandibular joint

“…14 The majority of publications state that SC is typically only present in the upper compartment. 2 Seven examples of SC in the lower compartment of TMJ were documented in three articles. 15,16 The narrower joint compartment and smaller synovial membrane area in the lower compartment of TMJ may be to blame for the low prevalence rate of SC there.…”

“…X-rays, CT scans, and MRIs are crucial diagnostic methods for identifying SC in TMJX-rays and CT scans can reveal multiple granular calcification shadows, sclerosis of the condyle and glenoid fossa, and changes to the joint spaces. 2 The loose body is the most valuable diagnostic sign. However, SC in Milgram's stage 1 or 2 lacks calcified loose bodies, which provides difficulty in CT or X-ray-based diagnosis, wrong treatment, expansion of lesion, and delay of surgery.…”

“…1 Pain, restricted mouth opening, preauricular edema, malocclusion, crepitus, and a clicking sound when opening the mouth are the most typical clinical indications and symptoms of SC in the TMJ. 2 Georg Axhausen 1 provided the first precise, scientific description of SC of the temporomandibular…”