Synovial chondromatosis of the temporomandibular joint: report and analysis of 12 cases.

OBJECTIVE - We had for aim to study the clinical manifestations, diagnostic imaging techniques, histopathological and therapeutic findings of patients presenting with synovial chondromatosis (CS) of the temporomandibular joint (TMJ). MATERIAL AND METHODS - We reviewed the clinical history of all our patients who were diagnosed with CS between 2009 and 2013. RESULTS - We identified 12 cases of TMJ-CS, in 4 male and 8 female patients, with a mean aged of 50.5 years at diagnosis (range: 43-86 years). The average symptom duration prior to diagnosis was 11 months (range: 1-24 months). The most frequent clinical manifestations were joint pain (10 cases), restricted movement (6 cases), and swelling (4 cases). Panoramic radiographs were not contributive. CT scan and MRI findings led to a diagnosis in every case. 2 to 30 foreign bodies with various degrees of aggregation were removed by arthrotomy in our series and synovectomy was performed in all patients. These foreign bodies were in the upper compartment and the articular disk was not affected in 10 cases. A histopathological examination confirmed the diagnosis. The mean postoperative follow-up was 78 months. No case of chondrosarcoma was identified and the recurrence rate was low (1 case). DISCUSSION - The clinical manifestations of TMJ-CS are common and conventional imaging is poorly contributive so that the diagnosis is often late. The delay before diagnosis was an average11 months for our patients given our experience; it was almost twice longer in other series. Arthrotomy and excision of the loose bodies led to confirmation by histopathological analysis. Most of the time, this treatment is sufficient but long term clinical and radiological monitoring is required.