CT diagnosis of synovial chondromatosis of the temporomandibular joint

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Abstract

Synovial chondromatosis of the temporomandibular joint (TMJ) is a very rare condition. It is characterised by the presence of loose bodies in the joint space. Clinical signs, histopathological findings and radiography play an important role in the diagnostic process. Conventional X-rays have shown to be of limited value, for they fail to depict the intra-articular loose bodies in a significant amount of cases. Axial as well as coronal computer tomography (CT) is extremely useful in detecting loose bodies in the temporomandibular joint (TMJ).

In this report we present and discuss a further case, and the use of CT in the diagnosis of TMJ-synovial chondromatosis is illustrated.

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    Most authors report CT and MRI as the most useful imaging techniques for diagnosis and surgical planning. CT scan allows a wider visualization of the joint space clearly showing erosions of the glenoid fossa, bony alterations of the skull base and condyle head and intracranial spreading mass [23,24]. CT scan also shows multiple calcified loose bodies in the joint space which form the basis of Milgram’s classification [23–25].

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    Plain radiographs are of limited value because these fail to show the cartilaginous nodules in almost 40% of cases. For detecting loose bodies, computed tomography is extremely useful; moreover, high-resolution computed tomography detects bodies even smaller than 1 mm.23 MRI may show fluid collection, increased vascularity, partial disc displacement, and changes in disc morphology.24

  • Synovial chondromatosis of the temporomandibular joint with condylar extension

    2006, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
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    The diagnosis of synovial chondromatosis is frequently problematic and is made based on clinical symptoms as well as radiographic and histological findings. CT findings of synovial chondromatosis include the presence of multiple, calcified, loose bodies in the joint space, widening of the joint space, irregular or sclerotic glenoid fossa, and bony changes of the skull base.12 The presence of loose bodies in the joint space is neither a universal finding nor diagnostic.13

  • Malocclusion associated with osteocartilaginous loose bodies of the temporomandibular joint

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    In many cases, no radiographic changes are evident on plain images such as panoramic radiographs. Because the process is insidious and may go unnoticed for years, when such pathology is suspected, clinicians should use CT12–16 or magnetic resonance imaging16 as diagnostic tools. When loose bodies are smaller than 1 mm, they often are overlooked; therefore, a high-resolution CT scan will be more diagnostic than a regular CT scan.9

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