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Synovial
chondromatosis of the temporomandibular joint.
Med Oral Patol Oral Cir Bucal. 2007 Jan 1;12(1):E26-9.
Synovial
Chondromatosis (SC) is a disease whose etiology is unknown, can be
defined as a benign synovial process characterized by the formation of
metaplastic cartilaginous nodes inside connective tissue of articular
surfaces, is considered an active metaplastic phenomenon better than a
neoplastic process; it presents a greater preference to affect women
who constitute almost 70% of reported cases, the age range is wide and
oscillates between 18-75 years (average 44.6 years). Between the main
clinical findings are: pain, crackle, volume augmentation and a
limited buccal opening. SC is an unusual state and the reports in the
English literature are no more than 75 cases, only 66 of those where
histologically verified, most of those were affecting great joints
like hip, knee and shoulder, but if SC is not frequent in this sites,
is even more infrequent on temporomandibular joint. The aim of this
paper is to report a clinical case and at the same time to realize a
brief review of the literature.
Synovial
chondromatosis of the temporomandibular joint.J
Craniofac Surg. 2007 Nov;18(6):1486-8.
Synovial
chondromatosis is a cartilaginous metaplasia of the mesenchymal
remnants of the synovial tissue of the joints. Its main
characteristic is the formation of cartilaginous nodules in the
synovium and inside the articular space (loose bodies). Synovial
chondromatosis mainly affects big synovial joints such as the elbow
and knee and is uncommon in the temporomandibular joint. The main
symptoms are pain, limitation of jaw movement, crepitation, and
inflammation. Diagnosis is made by panoramic radiograph, computed
tomography scan, and mainly magnetic resonance imaging. Surgery is
the therapeutic choice. The authors describe their experience in the
treatment and in the follow up of a patient with unilateral synovial
chondromatosis.
Arthrocentesis in the treatment of loose bodies of the
temporomandibular joint associated with synovial chondromatosis.Br
J Oral Maxillofac Surg. 2007 Oct 6.
Synovial
chondromatosis is a benign disorder of joints of unknown aetiology,
characterised by the presence of loose bodies in the articular space.
We present a case that affected the temporomandibular joint (TMJ) and
was treated with arthrocentesis, which is an efficient, conservative,
and inexpensive treatment.
Synovial chondromatosis of the temporomandibular joint with middle
cranial fossa extension.
Int J Oral Maxillofac Surg. 2007 Jul;36(7):652-5. Epub 2007 Mar
26.
Synovial
chondromatosis of the temporomandibular joint (TMJ) is relatively
rare. An unusual case with extension through the glenoid fossa and
into the middle cranial fossa is reported. Invasion of the
infratemporal fossa and the middle cranial fossa was seen on both
computed tomography and magnetic resonance imaging. Complete removal
of the loose bodies with excision of the affected synovium is the
accepted treatment of synovial chondromatosis. A conservative approach
should be followed while trying to eliminate any remaining lesion in
the infratemporal fossa and the middle cranial fossa. An overview of
previously reported cases of synovial chondromatosis with cranial
extensions is also presented.
Synovial chondromatosis of the temporomandibular joint with condylar
extension.Oral
Surg Oral Med Oral Pathol Oral Radiol Endod. 2006
Jun;101(6):e83-8. Epub 2006 Apr 24.
Synovial
chondromatosis is a benign disease that rarely affects the
temporomandibular joint (TMJ). It can be seen commonly in the superior
joint space and presents with various signs and symptoms according to
the stage of progression. Sometimes it presents as a large swelling in
the preauricular area with or without cranial extension, and the
clinical and radiographic findings may be misdiagnosed as other benign
or malignant diseases of TMJ. Therefore, we report an uncommon case of
synovial chondromatosis presenting as a large preauricular mass
arising from the inferior joint space of the TMJ with bony resorption
of the mandibular condyle, which mimicked osteochondroma.
Synovial chondromatosis of the temporomandibular joint with extension
to the middle cranial fossa.
J Postgrad Med.
2005 Apr-Jun;51(2):122-4.
A rare case of
synovial chondromatosis with extension to the middle cranial fossa is
reported. Synovial chondromatosis, a benign disorder characterized by
multiple cartilaginous, free-floating nodules that originate from the
synovial membrane is not exclusive to the temporomandibular joint (TMJ).
This condition is commonly seen in the axial skeleton and can involve
multiple joints. In this case, synovial chondromatosis of the TMJ led
to complete bony erosion of the glenoid fossa extending into the
middle cranial fossa. Although plain radiographs showed the
involvement of the joint, Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI) provided more detailed information about the
lesion in all three dimensions. This case demonstrates the value of CT
and MRI in both the diagnosis and treatment planning. A review of
previously reported cases of synovial chondromatosis with cranial
extensions is included.
Synovial chondromatosis of the temporomandibular joint: report and
analysis of eleven cases.J
Oral Maxillofac Surg. 2005 Jul;63(7):941-7.
PURPOSE: Synovial
chondromatosis (SC) is a benign monoarticular condition that is
uncommon in the temporomandibular joint (TMJ). The purpose of this
article is to present 11 additional cases of SC of the TMJ and discuss
newer modes of imaging, diagnostic approaches, treatment options, and
follow-up data. METHODS: Medical records of 11 patients with SC
treated within our department from 1991 to the present were reviewed.
Demographic data, etiology, clinical presentation, diagnostic
evaluation, treatment, and follow-up information were collected.
Previously reported cases (both TMJ and others) from 1988 to present
were identified for comparison and the literature reviewed. RESULTS:
There were 8 females and 3 males with an average age of 54 years. Pain
and preauricular swelling were the most common presenting clinical
complaints. Etiologic factors (parafunction, inflammatory joint
disease) were found in 7 of 11 cases. Plain radiographs showed joint
calcifications in only 2 of 11 cases. Computed tomography identified
calcifications in 3 of 6. Magnetic resonance imaging clearly
demonstrated the mass and its extension in 10 of 10 cases. Fine needle
aspiration was diagnostic in 4 of 9. All patients were treated with an
open arthrotomy. Meniscectomy was required in 7 of 11. Average
follow-up was 5.2 years with no recurrences reported. CONCLUSION: The
current case series of SC shows a female predilection with age and
presenting complaints similar to those previously reported. A
traumatic etiology was not identified, although a weak association is
reported in the literature. The superiority of magnetic resonance
imaging for both diagnosis and evaluation of extension of disease is
shown. In a subset of cases, fine needle aspiration is useful for
confirming the clinicoradiographic impression. Complete removal of
involved tissue is associated with an excellent prognosis.
Synovial chondromatosis of the temporomandibular joint: a clinical,
radiological and histological study.Med
Oral Patol Oral Cir Bucal. 2005 May-Jul;10(3):272-6.
Synovial
chondromatosis (SC) is a cartilaginous metaplasy of the mesenchymal
remnants of the synovial tissue of the joints. It is characterized by
the formation of cartilaginous nodules in the synovium and inside the
articular space (loose bodies). SC mainly affects to big synovial
joints such as the knee and the elbow, being uncommon the onset within
the TMJ, where 75 cases have been published. The main symptoms are
pain, inflammation, limitation of the movements of the jaw and
crepitation. Different methods of diagnosis include panoramic
radiograph, CT, MR and arthroscopy of the TMJ. We report a new case of
unilateral SC of the TMJ, including diagnostic images, treatment
performed and histological analysis.
The
expression of fibroblast growth factor receptor-3 in synovial
osteochondromatosis of the temporomandibular joint.Arch
Oral Biol. 2004 Jul;49(7):591-4.
Primary synovial
osteochondromatosis (PSC) is a disease of unknown aetiology. It was
reported recently that expression of fibroblast growth factor
receptor-3 (FGFR-3) was observed specifically in PSC. We classified
six cases of synovial osteochondromatosis (SC) of the
temporomandibular joint (TMJ) into two types of SC, PSC (five cases)
and secondary synovial osteochondromatosis (SSC) (one case), by means
of clinical findings and haematoxylin and eosin stain. The five PSC
cases were classified into three different phases according to
Milgram's classification. Immunohistochemical staining of FGFR-3 was
carried out for each SC case, along with specimens of internal
derangement (ID) of the TMJ, and normal articular disc and synovial
membrane. FGFR-3 was found in all three phases of PSC, but not in SSC,
ID or normal TMJ. Moreover, in a comparison between cultured synovial
cells of PSC (Phase III) and ID, reverse transcription-polymerase
chain reaction revealed a stronger positive reaction in PSC. These
results indicate that the synovial membrane in Phase III PSC can
produce cartilage nodules, as in Phases I and II.
Synovial chondromatosis of the temporomandibular joint: clinical and
immunohistopathological considerations.Br
J Oral Maxillofac Surg. 2004 Jun;42(3):259-60.
A
histopathological study of 30 cases of synovial osteochondromatosis
found that the process followed a temporal sequence characterised by
three phases: (I) active intrasynovial disease only; (II) transitional
lesions with both active intrasynovial proliferation and free loose
bodies; and (III) many free osteochondral bodies with no demonstrable
intrasynovial disease [J. Bone Joint Surg. 59 (1977) 792]. We present
five cases of synovial chondromatosis of the temporpmandibular joint (TMJ)
which we studied by immunohistochemical methods of for transforming
growth factor beta (TGFbeta) and tenascin.
Synovial chondromatosis of the temporomandibular joint: clinical,
surgical and histological aspects.Int
J Oral Maxillofac Surg. 2003 Apr;32(2):143-7.
Nine patients
with histologically confirmed unilateral synovial chondromatosis of
the temporomandibular joint were treated surgically with extirpation
of loose bodies and partial synovectomy. In six of them the
histological material was available for a systematic examination. The
results of treatment were evaluated clinically and with MRI after a
follow-up ranging between 1 and 17 years. Our findings suggest that
synovial chondromatosis of the temporomandibular affects only the
synovial lining of the upper compartment. The histological appearance
is that of a benign chronic inflammation varying in severity and with
metaplastic activity. The most specific clinical sign of synovial
chondromatosis is swelling over the joint. Distension of the lateral
capsule and fluid in the joint on the MRI are very suggestive of this
diagnosis. Loose bodies also indicate synovial chondromatosis, but
they are not always detected on the preoperative MRI. The surgical
treatment should be conservative and include thorough removal of the
loose bodies and partial synovectomy in areas with marked
inflammation.
Extra-articular synovial chondromatosis of the temporomandibular
joint: pitfalls in diagnosis.
Arch Otolaryngol Head Neck Surg. 1999 Dec;125(12):1394-7.
Synovial
chondromatosis is a benign disease that only rarely affects the
temporomandibular joint. When it does, disease is usually confined to
the joint space itself but can occasionally extend beyond the joint
capsule into the parotid gland, temporal bone, or cranium. The local
clinical behavior, radiographic appearance, and histopathologic
features can combine to create the appearance of a malignant lesion.
We report a case of synovial chondromatosis that affected the
temporomandibular joint and presented as an external auditory canal
mass. The lesion was thought to be a chondrosarcoma prior to the
definitive resection. Pitfalls in the diagnosis and management of
synovial chondromatosis are discussed.
Synovial chondromatosis of the temporomandibular joint: the effect of
interleukin-1 on loose-body-derived cells.Oral
Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(5):526-31.
OBJECTIVE: The
purpose of this study was to investigate the effect of interleukin-1
on cells from loose bodies of synovial chondromatosis of the
temporomandibular joint. STUDY DESIGN: The cells were isolated from
uncalcified loose bodies in a case of synovial chondromatosis of the
temporomandibular joint and cultured in alpha-MEM medium containing
10% fetal bovine serum. The cells were treated with or without
interleukin-1alpha and then stained with toluidine blue. Their
conditioned media were analyzed with gelatin zymography to detect
matrix-degrading proteinase(s). RESULTS: The cells from loose bodies
produced toluidine-blue-stained matrix. When the cells were treated
with 100 ng/ml of interleukin-1alpha for 3 days, toluidine-blue-stained
matrix was strikingly reduced. Gelatin zymography revealed that
interleukin-1alpha-treated cells released 62-kDa gelatinase.
CONCLUSIONS: Interleukin-1alpha may lead loose-body-derived cells to
degrade the cartilaginous matrix of loose bodies in synovial
chondromatosis of the temporomandibular joint.
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