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A case of reankylosis of the temporomandiblar joint (TMJ) which indicated artificial condylar head replacement
P21-3 Temporomandibularjoint 7. Pseudogout in the Temporomandibular Joint - A case study, evaluation of the scanning electron microscopic and Xray diffraction findings
Igarashi, F.1, Matsuo, ,4.1, Fujimura, M. 1, Uchida, M. 1, Nonaka, H. 1, Hirota, E 2 1Second Department of Oral and Maxillofacial Surgery, Clinical Laboratory, 2Dental Research Institute, Nippon Dental University, School of Dentistry, Tokyo, Japan Pseudogout demonstrates gout-like symptoms and is caused by the deposition of pilophosphate crystals. It occurs most often in the knee joint, while occurring only rarely in the temporomandibular joint. We herein report a case of pseudgout in the temporomandibular joint on the right side. Case: The patient was a 55-year-old man who presented with the chief complaint of swelling in the preauricular area on the right side. At the first visit, preauricular diffuse swelling with redness and tenderness were observed, while the maximum mouth opening range was 18 mm. In addition, bean-sized irregular radiopaque masses were also found lying anterior to the condylar head on the panorama X-ray. The double-contrast arthrotomographic findings and arthroscopic findings revealed many stony-hard masses wrapped in the synovial membrane in the inferior joint compartment and sever adhesion in the superior joint compartment. Diagnosing it as synovial chondromatosis, we curetted both the masses and the synovial membrane, and resected the disks. A proliferation of chondolocytes with calcification and other crystal structures surrounded by giant cells around that were pathologically observed. The crystal structure was found to be pilophosphate based on the polarized microscopic findings. In addition, many rod-shaped crystal structures were seen using scanning electron microscopy. Although the pathological diagnosis was pseudgout the proliferation of the chondolocytes with calcification are findings usually attributed to synovial chondromatosis. No significant complications were observed six months after the operation, and the maximal mouth opening range was 40 ram.
8. Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A case report
Omura, S., Mizuki, N., Kawabe, R., Fujita, K. Department of Oral and Maxillofacial Surgery, School of Medicine, Yokohama City University, Yokohama, Japan Tenosynovial giant cell tumor (TSGCT) arises from the synovial lining of tendon sheaths and joints and has both localized and diffuse forms. The localized form (TSGCT-L) is one of the most common tumors of the hands and feet. The diffuse type (TSGCT-D), which is less common, shares several histopathologic features with TSGCT-L. However, the clinical presentation differs from that of TSGCT-L. Unlike
161
TSGCT-L, TSGCT-D forms a less well defined soft tissue mass, shows locally aggressive growth, and has a high recurrence rate. TSGCT-D affects relatively large joints, typically the knee and ankle. The present case study is the first report of TSGCT-D in the temporomandibular joint. An 18-year-old Japanese man presented with left TMJ pain and a decreased ability to open his mouth. Upon examination, a tender diffuse swelling was noted in the left preauricular region. Magnetic resonance images and computed tomography scans showed a soft tissue mass around :the TMJ, several calcified tissue segments within the mass, widening of the joint space, and cortical bone erosion of the condyle and the glenoid fossa. A 99mTc bone scan showed abnormal intense uptake involving the TMJ. After an incisional biopsy with frozen sections, the patient underwent resection. Histopathologically, the lesion consisted largely of rounded and spindled mononucleated cells admixed with inflammatory cells and multinucleated giant cells beneath the synovium. The background stroma was variably collagenous. Based on both the pathological findings and the locally aggressive clinical features, a postoperative diagnosis of TSGCT-D of the TMJ was made. The TMJ pain and the limited mouth opening ability was completely resolved and no sign of recurrence was observed during the 12-month follow up period.
9. A Case of Reankylosis of the Temporomandiblar Joint (TMJ) which Indicated Artificial Condylar Head Replacement
Uchida, If., Koie, M., Jinno, Y., Murata, H. Department of OMS, Ogaki Municipal Hosp., Ogaki, Japan Artificial condylar heads were replaced bilaterally in a 37year-old male patient of psoriasis. There are very few reports of psoriatic TMJ reankylosis which have indicated artificial titanium condylar heads. This patient had received bilateral TMJs arthroplasties fn July, 1993, and he was able to open his mouth 20 mm. Although he consistently performed exercises with his jaw, reankylosis of TMJs was gradually progressing and the patient was only able to open his mouth 2 mm again. In October, 1996, bilateral artificial condylar head replacement was performed. In the operative findings, complete bony reankylosis was seen. Postoperatively he was able to open his mouth 22 mm, and he continued doing mouth-opening exercises.
Igarashi, F.1, Matsuo, ,4.1, Fujimura, M. 1, Uchida, M. 1, Nonaka, H. 1, Hirota, E 2 1Second Department of Oral and Maxillofacial Surgery, Clinical Laboratory, 2Dental Research Institute, Nippon Dental University, School of Dentistry, Tokyo, Japan Pseudogout demonstrates gout-like symptoms and is caused by the deposition of pilophosphate crystals. It occurs most often in the knee joint, while occurring only rarely in the temporomandibular joint. We herein report a case of pseudgout in the temporomandibular joint on the right side. Case: The patient was a 55-year-old man who presented with the chief complaint of swelling in the preauricular area on the right side. At the first visit, preauricular diffuse swelling with redness and tenderness were observed, while the maximum mouth opening range was 18 mm. In addition, bean-sized irregular radiopaque masses were also found lying anterior to the condylar head on the panorama X-ray. The double-contrast arthrotomographic findings and arthroscopic findings revealed many stony-hard masses wrapped in the synovial membrane in the inferior joint compartment and sever adhesion in the superior joint compartment. Diagnosing it as synovial chondromatosis, we curetted both the masses and the synovial membrane, and resected the disks. A proliferation of chondolocytes with calcification and other crystal structures surrounded by giant cells around that were pathologically observed. The crystal structure was found to be pilophosphate based on the polarized microscopic findings. In addition, many rod-shaped crystal structures were seen using scanning electron microscopy. Although the pathological diagnosis was pseudgout the proliferation of the chondolocytes with calcification are findings usually attributed to synovial chondromatosis. No significant complications were observed six months after the operation, and the maximal mouth opening range was 40 ram.
8. Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A case report
Omura, S., Mizuki, N., Kawabe, R., Fujita, K. Department of Oral and Maxillofacial Surgery, School of Medicine, Yokohama City University, Yokohama, Japan Tenosynovial giant cell tumor (TSGCT) arises from the synovial lining of tendon sheaths and joints and has both localized and diffuse forms. The localized form (TSGCT-L) is one of the most common tumors of the hands and feet. The diffuse type (TSGCT-D), which is less common, shares several histopathologic features with TSGCT-L. However, the clinical presentation differs from that of TSGCT-L. Unlike
161
TSGCT-L, TSGCT-D forms a less well defined soft tissue mass, shows locally aggressive growth, and has a high recurrence rate. TSGCT-D affects relatively large joints, typically the knee and ankle. The present case study is the first report of TSGCT-D in the temporomandibular joint. An 18-year-old Japanese man presented with left TMJ pain and a decreased ability to open his mouth. Upon examination, a tender diffuse swelling was noted in the left preauricular region. Magnetic resonance images and computed tomography scans showed a soft tissue mass around :the TMJ, several calcified tissue segments within the mass, widening of the joint space, and cortical bone erosion of the condyle and the glenoid fossa. A 99mTc bone scan showed abnormal intense uptake involving the TMJ. After an incisional biopsy with frozen sections, the patient underwent resection. Histopathologically, the lesion consisted largely of rounded and spindled mononucleated cells admixed with inflammatory cells and multinucleated giant cells beneath the synovium. The background stroma was variably collagenous. Based on both the pathological findings and the locally aggressive clinical features, a postoperative diagnosis of TSGCT-D of the TMJ was made. The TMJ pain and the limited mouth opening ability was completely resolved and no sign of recurrence was observed during the 12-month follow up period.
9. A Case of Reankylosis of the Temporomandiblar Joint (TMJ) which Indicated Artificial Condylar Head Replacement
Uchida, If., Koie, M., Jinno, Y., Murata, H. Department of OMS, Ogaki Municipal Hosp., Ogaki, Japan Artificial condylar heads were replaced bilaterally in a 37year-old male patient of psoriasis. There are very few reports of psoriatic TMJ reankylosis which have indicated artificial titanium condylar heads. This patient had received bilateral TMJs arthroplasties fn July, 1993, and he was able to open his mouth 20 mm. Although he consistently performed exercises with his jaw, reankylosis of TMJs was gradually progressing and the patient was only able to open his mouth 2 mm again. In October, 1996, bilateral artificial condylar head replacement was performed. In the operative findings, complete bony reankylosis was seen. Postoperatively he was able to open his mouth 22 mm, and he continued doing mouth-opening exercises.