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Pigmented villonodular synovitis of the temporomandibular joint: a case report
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
We report a case of a patient who underwent a right partial parotidectomy, excision of retro-auricular node, resection of lesion right posterior auricular area and a selective neck dissection. Traditional teaching dictates the SAN almost always passes antero-laterally to the internal jugular vein however during the procedure, the unusual passing of the spinal accessory nerve directly through the internal jugular vein was identified. We that such anatomical variations need to be widely reported with the purpose to prevent iatrogenic damage to the spinal accessory nerve. http://dx.doi.org/10.1016/j.bjoms.2015.08.117 P 110 Pigmented villonodular synovitis of the temporomandibular joint: a case report J. Flexen ∗ , K. Andi St. George’s Hospital, Tooting, London, United Kingdom Introduction: Pigmented villonodular synovitis (PVNS) is a benign, proliferative condition of the synovial membranes of joints, tendon sheaths and bursae. It is characterised by pain and swelling of the affected joint with destruction of local structures. It mainly occurs in the hip and knee, however more rarely can present in the temporomandibular joint (TMJ). Case report: A 53 year old female presented to the ENT department with a six week history of trismus, pain and swelling associated with the right side of face, particularly around the TMJ. There was no history of any trauma. She was admitted for intravenous antibiotics with limited success and referred to the Maxillofacial team. Further radiological investigations revealed a pathological fracture of the right condyle. Occlusion was unaffected. Subsequent examination under anaesthesia and biopsies demonstrated PVNS of the right TMJ. The patient has since reported an improvement in symptoms and is being monitored clinically and radiographically. Discussion: PVNS in the TMJ is very rare with only around 50 cases reported in the literature however the aetiology remains unclear. Misdiagnosis is common due to the initial symptoms resembling those of other temporomandibular disorders and the lack of awareness surrounding PVNS. Treatment is symptomatic and often entails surgical resection due to the locally destructive nature and potential for recurrence of the disease process. Conclusion: Problems with the TMJ are relatively common however thorough history-taking, clinical examination and appropriate investigations are essential in order to correctly identify rarer disease processes like PVNS and treat them accordingly. http://dx.doi.org/10.1016/j.bjoms.2015.08.118
e77
P 111 Chondroid syringoma of the upper lip: a case report S. Girgis ∗ , G. Gillan, K. Piper Homerton University Hospital NHS Foundation Trust, United Kingdom Introduction: Chondroid syringomas (CS) are rare benign mixed tumours, with reported occurrence rates between 0.01% and 0.098% of all primary skin tumours. Clinical differentiation can be misleading due to the silent presentation, with only histopathological findings confirming the diagnosis. Case report: We present a twenty-three-year-old gentleman with an eighteen month history of increasing upper lip swelling. He presented with an oval, well circumscribed 15 mm diameter spheroidal swelling of his right upper lip. The initial clinical impression was thought to be related to the skin, although at that stage, the nature of the lesion was uncertain. Following a punch biopsy, histopathology confirmed appearance in keeping with part of a chondroid syringoma. Discussion: Chondroid syringomas present as a slowgrowing, asymptomatic, non-tender, non-ulcerated, smooth, firm subcutaneous, or intradermal nodule and can range from 0.5 to 3.0 cm, predominantly occurring in the head and neck region in older patients (>35yrs), with a male predication. The most effective diagnosis is confirmed by microscopic examination, and the gold standard treatment modality is by complete excision, with a margin of normal tissue in order to examine the histopathologic features, and prevent recurrence. Conclusion: Although rare benign lesions, chondroid syringomas should be included as a differential diagnosis of facial subcutaneous skin lesions in middle aged male patients. Careful evaluation, with a view of total excision and adequate surgical margin will enable diagnostic confirmation, whilst maintaining the aesthetic and functional unit to achieve satisfactory patient outcome. http://dx.doi.org/10.1016/j.bjoms.2015.08.119 P 112 Micromorts in maxillofacial surgery A. Harrison ∗ , A. Fry Sheffield University – School of Clinical Dentistry, United Kingdom Introduction: Effective communication of risk is central to the consent process as defined within GMC good medical practice. How we as clinicians present this information to patients has been shown to have a profound effect on the decision making process. It has also been demonstrated to be useful for patients to have comparators to equate these risks.
We report a case of a patient who underwent a right partial parotidectomy, excision of retro-auricular node, resection of lesion right posterior auricular area and a selective neck dissection. Traditional teaching dictates the SAN almost always passes antero-laterally to the internal jugular vein however during the procedure, the unusual passing of the spinal accessory nerve directly through the internal jugular vein was identified. We that such anatomical variations need to be widely reported with the purpose to prevent iatrogenic damage to the spinal accessory nerve. http://dx.doi.org/10.1016/j.bjoms.2015.08.117 P 110 Pigmented villonodular synovitis of the temporomandibular joint: a case report J. Flexen ∗ , K. Andi St. George’s Hospital, Tooting, London, United Kingdom Introduction: Pigmented villonodular synovitis (PVNS) is a benign, proliferative condition of the synovial membranes of joints, tendon sheaths and bursae. It is characterised by pain and swelling of the affected joint with destruction of local structures. It mainly occurs in the hip and knee, however more rarely can present in the temporomandibular joint (TMJ). Case report: A 53 year old female presented to the ENT department with a six week history of trismus, pain and swelling associated with the right side of face, particularly around the TMJ. There was no history of any trauma. She was admitted for intravenous antibiotics with limited success and referred to the Maxillofacial team. Further radiological investigations revealed a pathological fracture of the right condyle. Occlusion was unaffected. Subsequent examination under anaesthesia and biopsies demonstrated PVNS of the right TMJ. The patient has since reported an improvement in symptoms and is being monitored clinically and radiographically. Discussion: PVNS in the TMJ is very rare with only around 50 cases reported in the literature however the aetiology remains unclear. Misdiagnosis is common due to the initial symptoms resembling those of other temporomandibular disorders and the lack of awareness surrounding PVNS. Treatment is symptomatic and often entails surgical resection due to the locally destructive nature and potential for recurrence of the disease process. Conclusion: Problems with the TMJ are relatively common however thorough history-taking, clinical examination and appropriate investigations are essential in order to correctly identify rarer disease processes like PVNS and treat them accordingly. http://dx.doi.org/10.1016/j.bjoms.2015.08.118
e77
P 111 Chondroid syringoma of the upper lip: a case report S. Girgis ∗ , G. Gillan, K. Piper Homerton University Hospital NHS Foundation Trust, United Kingdom Introduction: Chondroid syringomas (CS) are rare benign mixed tumours, with reported occurrence rates between 0.01% and 0.098% of all primary skin tumours. Clinical differentiation can be misleading due to the silent presentation, with only histopathological findings confirming the diagnosis. Case report: We present a twenty-three-year-old gentleman with an eighteen month history of increasing upper lip swelling. He presented with an oval, well circumscribed 15 mm diameter spheroidal swelling of his right upper lip. The initial clinical impression was thought to be related to the skin, although at that stage, the nature of the lesion was uncertain. Following a punch biopsy, histopathology confirmed appearance in keeping with part of a chondroid syringoma. Discussion: Chondroid syringomas present as a slowgrowing, asymptomatic, non-tender, non-ulcerated, smooth, firm subcutaneous, or intradermal nodule and can range from 0.5 to 3.0 cm, predominantly occurring in the head and neck region in older patients (>35yrs), with a male predication. The most effective diagnosis is confirmed by microscopic examination, and the gold standard treatment modality is by complete excision, with a margin of normal tissue in order to examine the histopathologic features, and prevent recurrence. Conclusion: Although rare benign lesions, chondroid syringomas should be included as a differential diagnosis of facial subcutaneous skin lesions in middle aged male patients. Careful evaluation, with a view of total excision and adequate surgical margin will enable diagnostic confirmation, whilst maintaining the aesthetic and functional unit to achieve satisfactory patient outcome. http://dx.doi.org/10.1016/j.bjoms.2015.08.119 P 112 Micromorts in maxillofacial surgery A. Harrison ∗ , A. Fry Sheffield University – School of Clinical Dentistry, United Kingdom Introduction: Effective communication of risk is central to the consent process as defined within GMC good medical practice. How we as clinicians present this information to patients has been shown to have a profound effect on the decision making process. It has also been demonstrated to be useful for patients to have comparators to equate these risks.