Surgical Treatment of Synovial Chondromatosis in the Inferior Compartment of the Temporomandibular Joint With Articular Disc Involvement

Abstract

The authors report an unusual case of painful synovial chondromatosis originated in the inferior compartment of the temporomandibular joint (TMJ) with articular disc involvement in a 56-year-old woman with complaint of severe pain in the right preauricular region. Magnetic resonance images showed advanced destruction of the right articular disc anteriorly displaced, condylar erosion, and distinct nodules within an extremely expanded inferior joint compartment with large amount of fluid, as well as a large TMJ effusion. A scintigraphy showed elevated bone uptake in the right TMJ, demonstrating intense bone remodeling activity in the region. After a right internal maxillary artery embolization, the patient underwent open surgery. The intraoperative procedures, including articular disc removal, condylar remodeling, and replacement of the articular disc, are described in detail. Synovial chondromatosis of the TMJ is a rare disease, especially when it affects the inferior compartment and the articular disc. Initial diagnosis is challenging and imaging techniques (magnetic resonance imaging and scintigraphy) play an important role in identifying signs, making accurate diagnosis, and offering additional information not available with conventional imaging, such as TMJ inflammation or remodeling. In these patients, open surgery may be considered a definitive treatment, since the postoperative recurrence rate is very low.

Intra- and extracapsular synovial chondromatosis of the temporomandibular joint: Rare case and review of the literature

“…With only 3% of all reported cases, SC is uncommon in the TMJ. 3,5 This first discovery of the SC in the TMJ was made by Axhausen 6 in 1933. Since then, only around 200 cases of SC affecting the TMJ were reported in the literature.…”

“…13,14 Therefore, and to rule out malignant lesions sometimes, positron emission tomography (PET)-CT, gadolinium- or technetium-scintigraphy is recommended in the actual literature. 3…”

“…Recurrence is likely if cartilaginous foci or hyperplastic synovium are incompletely removed but unlikely even after sparing extracapsular particles, provided total synectomy and disectomy are performed. 3,18 So once diagnosed, removal of loose bodies and the synovium with or without condylectomy is the recommended and accepted treatment to prevent recurrence because the condition does not undergo spontaneous resolution. Malignant transformation of SC to chondrosarcoma has very rarely been reported in the knee joint 19 but may also be possible in the TMJ.…”

“…1 The current literature review reveals only around 200 previous cases of SC affecting the TMJ. 2,3 We report an unusual case of intra- and extracapsular chondromatosis of 25 osteochondral loose bodies in the right TMJ.…”

Synovial chondromatosis of the temporomandibular joint with 400 loose bodies: a case report and literature review

“…SC is an uncommon benign lesion of the synovial joint that is especially rare in the TMJ, where it is seen in only 3% of reported cases. 3 There is a clear female predominance for the condition. 4 Its etiology remains elusive, but inflammation, trauma, and joint overuse have been cited as potential causative factors.…”