Poster 258: The Diagnostic Dilemma of Tumor-Like Conditions of the Temporomandibular Joint: A Case Series

Scientific Poster Session Method of Data Analysis: Radiographic examinations, computed-tomography (CT) scanning examination and magnetic resonance imaging (MRI) examination were carried out before the surgical removal of the mass. During operation aspiration fluid inside the mass was subjected to biochemical analysis. Subsequently definitive histopathological analysis of the mass was performed. Results: CT scanning examination revealed no bone erosion or absorption in the fossa and condyle head of the temporomandibular joint. MRI examination depicted a T2 enhanced mass located in the soft tissue beneath the right temporal skin. However, no clear communication between the mass and temporomandibular joint capsule was observed in those images. Clinically, diagnosis of a benign tumor in the right temporal region was made. Under the general anesthesia, transtemporal approach was performed and total enucleation of the mass was achieved. The intraoperative findings revealed the mass was a cystic lesion because it had fluid inside, which contained 68 mmol/ml of chondroitin 4-sulfate and 101 mmol of chondroitin 6-sulfate. The lesion was easily detached from the capsule of the right temporomandibular joint. Histopathologically, cartilage-like tissue was observed in the parenchyma of the enucleated lesion, and the lesion was diagnosed as synovial chondromatosis. Conclusion: The correlation between the T2 enhanced mass in MRI and the capsule of the right temporomandibular joint was unclear. The intraoperative findings, in which the mass was to be easily detached from the temporomandibular capsule, confirmed the independence of the joint, which was consistent with data from the CT and MRI images before the operation. However, inside fluid contained the similar components to the joint. These data strongly suggested that the mass originated from the temporomandibular joint might grow and expand independently of the joint.

imageological information may contribute to misdiagnosis and eventually lead to either overtreatment or insufficient, ineffective therapeutics. Materials and Methods: The clinical archives of our department have been revisited on a search for cases diagnosed as unusual, tumor-like pathologies of the TMJ. Six complete clinical records were retrieved, with data analysis and summarizing conducted thereafter. Method of Data Analysis: Clinical records were reviewed for 1) demographic data, 2) general medical and dental history, 3) chief complaint, 4) presence/absence of pain, edema, mandibular deviation/deflection, malocclusion, and facial asymmetry, 5) history of trauma to the TMJ, previous treatments for temporomandibular disorders (TMD), and 6) history of the complaint. Available imaging records were reexamined, as well as histopathological data. Any other relevant data concerning the chief complaint were taken into account, if ever present. Surgical records were summarized, and data relative to follow-up were identified. Results: Three cases of synovial osteochondromatosis, one of temporomandibular ganglion, one of osteochondroma and one of condylar osteomyelitis were retrieved from our archives. Pain in the affected TMJ was present in 4 of the 6 cases. Two patients had experienced previous treatment for TMD. All patients were surgically treated, and no recidivation occurred. In all cases, only after histopathological analyses could diagnosis be precisely made. Conclusion: While being a nonspecific symptom, pain did appear as the chief complaint on 4 of the 6 presented cases. Two of the patients had received conservative treatment for TMD, indicative of how misleading can be the traits of these tumor-like conditions. Progress in the imaging field would be of invaluable help on determining the nature of such lesions and thereby guiding treatment decisions, but definitive diagnosis still seems to depend on histopathological analyses. References

References Med Oral Pathol Oral Cir Bucal. 2007 Jan 1; 12(1): E26-9 Skull Base Surg. 1998; 8(2):99-104

POSTER 258 The Diagnostic Dilemma of Tumor-Like Conditions of the Temporomandibular Joint: A Case Series Paulo Henrique Luiz de Freitas, DDS, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Chuo ku, Gakkocho dori 2-5274, Niigata, 951 8514, Japan (Ajima H; Ikeda N; Arashiyama T; Takagi R) Statement of the Problem: Tumor-like conditions of the temporomandibular joint (TMJ) are rare pathological findings whose signs and symptoms are often nonspecific. Uncommon incidence and confusing clinical and 43.e144

Takaku S, Sano T, Komine Y, Fukazawa N. Ganglion of the temporomandibular joint: case report. J Oral Maxillofac Surg 59:224-228,2001 Huh JK, Park JY, Lee S, Lee SH, Choi SW. Synovial chondromatosis of the temporomandibular joint with condylar extension. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e83-e88,2006

POSTER 259 Binocular Single Vision in Orbital Blow Out Fractures–The First 50 Cases Robert J. Banks, BDS, FDS RCS, MBBS, MRCS (Ed), MRCPS (Glas), Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, England (Stocker J) Statement of the Problem: In the treatment of orbital blow out fractures we do not regularly use a quantitative tool to objectively assess our results, be they pre and post operatively with a given technique, or as a tool to AAOMS • 2007