Clinicostatistical Evaluation of Synovial Chondromatosis Affecting the Temporomandibular Joint
Clinicostatistical Evaluation of Synovial Chondromatosis Affecting the Temporomandibular Joint
《Statements of the problem》
Although synovial chondromatosis (SC) usually affects larger joints, it rarely occurs in the temporomandibular joint (TMJ). However with progress in imaging technology in the past few decades, a considerable number of studies have been conducted on how SC affects the TMJ. This study summarizes our cases involving diagnosis and treatment of SC affecting the TMJ.
《Materials and methods》
The clinical cases of SC affecting the TMJ in our hospital were reviewed retrospectively from 1999 to 2013. Twelve cases were treated surgically and 3 were followed without surgical intervention. Diagnostic imaging was carried out by conventional radiography (CR), MRI and/or CT. The imaging findings were evaluated by a TMJ specialist and an oral radiologist. We examined details of the demographic data, imaging findings and surgery.
《Results》
Five males and 10 females were included in this group with an average age of 53 years. The duration of symptoms was from 2 weeks to 84 months. The right side was affected in 9 cases and the left in 5, and only one case was bilateral. All of the patients noted TMJ pain and 13 noted joint noise on the affected side. The range of maximum mouth opening was from 28 to 45 mm. Previous treatments included drug therapy (5 cases) and occlusal splint treatment for TMJ disorder (5 cases). Bone changes were noted on the articular surface in 8 cases by CR and in 10 cases by CT. Loose bodies were observed in 7 cases by CR and in 10 by CT. Loose bodies were observed with MRI in all cases, and characteristic dumbbell-shaped or small ring-like signals were seen in T2-weighted images. Among the 12 surgically treated subjects, open surgery through a pre-auricular approach was performed in 11 cases, 8 of which were done with arthroscopic assistance. The open surgery consisted of removal of loose bodies and partial synovectomy of the affected areas, both were done in 5 cases, while only the former was done in 7 cases. The final histopathological diagnoses were 9 cases of SC and 2 of synovial osteochondromatosis. The postoperative follow-up varied from 5 to 164 months. Although residual loose bodies in the joint space were found in 3 cases, there was no dysfunction of the TMJ and there were no signs of growth of the loose bodies.
《Conclusions》
We make it a rule to take CT and/or MRI whenever SC is suspected. This is because CT and MRI have the advantage over CR in that it shows some loose bodies that could not otherwise be detected. MRI has further advantages in the diagnosis of SC, in that it shows changes in the TMJ structure without radiation exposure. Various treatments have been reported. Surgery, which includes open surgery, synovectomy, removal of the loose bodies and arthroscopy, is the therapeutic choice. Arthroscopy is less invasive, but it is limited by its inability to remove large loose bodies. Thus we use arthroscopy exclusively as an aid to open surgery to improve the visualization in areas difficult to access. Arthroscopy has allowed us to completely remove all of the small loose bodies.
《References》
Guarda-Nardini L, et al. Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review. Int J Oral Maxillofac Surg 2010; 39: 745–755.
Juanhong M, et al. Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 441-448.
Although synovial chondromatosis (SC) usually affects larger joints, it rarely occurs in the temporomandibular joint (TMJ). However with progress in imaging technology in the past few decades, a considerable number of studies have been conducted on how SC affects the TMJ. This study summarizes our cases involving diagnosis and treatment of SC affecting the TMJ.
《Materials and methods》
The clinical cases of SC affecting the TMJ in our hospital were reviewed retrospectively from 1999 to 2013. Twelve cases were treated surgically and 3 were followed without surgical intervention. Diagnostic imaging was carried out by conventional radiography (CR), MRI and/or CT. The imaging findings were evaluated by a TMJ specialist and an oral radiologist. We examined details of the demographic data, imaging findings and surgery.
《Results》
Five males and 10 females were included in this group with an average age of 53 years. The duration of symptoms was from 2 weeks to 84 months. The right side was affected in 9 cases and the left in 5, and only one case was bilateral. All of the patients noted TMJ pain and 13 noted joint noise on the affected side. The range of maximum mouth opening was from 28 to 45 mm. Previous treatments included drug therapy (5 cases) and occlusal splint treatment for TMJ disorder (5 cases). Bone changes were noted on the articular surface in 8 cases by CR and in 10 cases by CT. Loose bodies were observed in 7 cases by CR and in 10 by CT. Loose bodies were observed with MRI in all cases, and characteristic dumbbell-shaped or small ring-like signals were seen in T2-weighted images. Among the 12 surgically treated subjects, open surgery through a pre-auricular approach was performed in 11 cases, 8 of which were done with arthroscopic assistance. The open surgery consisted of removal of loose bodies and partial synovectomy of the affected areas, both were done in 5 cases, while only the former was done in 7 cases. The final histopathological diagnoses were 9 cases of SC and 2 of synovial osteochondromatosis. The postoperative follow-up varied from 5 to 164 months. Although residual loose bodies in the joint space were found in 3 cases, there was no dysfunction of the TMJ and there were no signs of growth of the loose bodies.
《Conclusions》
We make it a rule to take CT and/or MRI whenever SC is suspected. This is because CT and MRI have the advantage over CR in that it shows some loose bodies that could not otherwise be detected. MRI has further advantages in the diagnosis of SC, in that it shows changes in the TMJ structure without radiation exposure. Various treatments have been reported. Surgery, which includes open surgery, synovectomy, removal of the loose bodies and arthroscopy, is the therapeutic choice. Arthroscopy is less invasive, but it is limited by its inability to remove large loose bodies. Thus we use arthroscopy exclusively as an aid to open surgery to improve the visualization in areas difficult to access. Arthroscopy has allowed us to completely remove all of the small loose bodies.
《References》
Guarda-Nardini L, et al. Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review. Int J Oral Maxillofac Surg 2010; 39: 745–755.
Juanhong M, et al. Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 441-448.