Ultrasonography of the temporomandibular joint: a literature review

This review summarizes knowledge on the accuracy and clinical usefulness of ultrasonography (US) for the diagnosis of temporomandibular joint (TMJ) disorders. A systematic search in the National Library of Medicine's Database was performed to identify all peer-reviewed papers in the English literature that assessed the accuracy of US with respect to magnetic resonance (MR), computerized tomography (CT), clinical assessment or autopsy specimens for the diagnosis of TMJ disk displacement, effusion and osteoarthrosis. The combined search words “ultrasonography” and “temporomandibular joint”, “temporomandibular disorders”, “effusion”, “disk displacement”, “condyle”, yielded 20 papers. Most studies (N = 17) focused on detecting disk displacement, with less emphasis on assessing joint effusion (N = 6) and osteoarthrosis (N = 7). US accuracy was 54–100% for diagnosing disk displacement, 72–95% for joint effusion and 56–93% for osteoarthrosis. US is operator-dependent. Better standardization of the technique is required and normal parameters must be set. Standardization is also required for the taxonomic aspects of pathologies. Despite these limitations, US remains potentially useful as an alternative imaging technique for monitoring TMJ disorders, particularly the presence of intrarticular effusion.     

Craniocervical dysfunction levels in a patient sample from a temporomandibular joint clinic

Results gathered by examining 40 patients with temporomandibular disorders and 40 matched controls for craniocervical dysfunction showed that high scores were more frequent for patients with temporomandibular disorders. Results indicated that these patients should be screened routinely for craniocervical problems.     

Treatment of temporomandibular joint luxation: a systematic literature review

Clinical Oral Investigations - To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation. This systematic literature review searched PubMed, the...     

Synovial cyst of the temporomandibular joint: a case report and literature review

Synovial cysts are lesions that usually occur on the wrist, foot and knee. They are rarely involved in the region of the temporomandibular joint (TMJ), with only 10 cases reported from 1978 to 2007. The authors report a case of a synovial cyst of the TMJ in a 45-year-old woman. The patient presented with a right preauricular swelling, 1 cm anterior to the tragus. A computed tomography (CT) scan showed a small oval hypodense mass of soft tissue in the right temporomandibular region with no relation to the condyle. Fine needle aspiration reported a synovial cyst of the TMJ. The patient was taken to the operating room and a preauricular approach extending to the temporal region was carried out resulting in surgical excision of the mass. The histological findings were consistent with the diagnosis of a synovial cyst. The long term clinical and radiological follow-up (after 18 months) showed no sign of recurrence. The authors suggest, in accordance with the literature, that a surgical approach should be the treatment of choice in the case of a synovial cyst of the TMJ.     

Chondrosarcoma of the temporomandibular joint: a case report and review of the literature

Chondrosarcoma is the second most common sarcoma arising in the bone, but it rarely involves the temporomandibular joint (TMJ). To date, 30 cases of TMJ chondrosarcoma have been reported in the English literature, and the authors report an additional case arising from a cystic lesion in a 60-year-old female patient.

Clinical presentation:The clinical and radiological diagnosis of the lesion was initially synovial cyst, and periodic check-ups were done after aspiration of the lesion. After three years, the patient perceived swelling of the lesion, and surgical excision was performed. The final diagnosis was grade I chondrosarcoma.

Conclusion:When clinicians detect a cystic lesion in the radiographic imaging of the TMJ, chondrosarcoma should be included in the differential diagnosis. In addition, computed tomography (CT) as well as magnetic resonance imaging (MRI) is recommended for the accurate diagnosis and proper preoperative planning in TMJ chondrosarcoma.     

Osteochondrosis dissecans of the temporomandibular joint: a case report and a review of literature

A case of a 71-year-old female patient with osteochondrosis dissecans of the right temporomandibular joint is presented. Osteochondrosis dissecans usually occurs at the weight-bearing convex cartilage in all larger joints. It is rarely found in the temporomandibular joint and usually shows one or two loose bodies dislodged from defects which are present on the condylar head. Because of multiple loose bodies and a defect on the temporomandibular fossa, the case presented here is very uncommon.     

Ganglion of the temporomandibular joint. Case report and literature survey

A case report of a female patient presenting with a painless lump related to the right temporomandibular joint is described. The swelling was surgically excised and the histopathological examination of the specimen showed a very clear resemblance to a ganglion of the synovial membrane. The literature of this rare entity is reviewed.     

Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease characterized by the presence of calcified loose bodies within the joint, and few systematically gathered data are available about its epidemiology. The aim of this paper was to describe a case of SC of the TMJ, and to carry out a systematic review of the literature on epidemiology over the past decade. A case of a 53-year-old female with the classical triad of signs and symptoms of SC (pain, swelling, restricted mouth opening) is described. A systematic search in the National Library of Medicine's PubMed Database was performed. 155 cases were described in 103 publications. Most dealt with single case reports. Females are affected more than males with a 2.5:1 ratio and the mean age of patients was about 46 years. Late diagnosis is common and in most cases more than 2 years elapsed between symptom onset and surgical intervention. Open TMJ surgery is the treatment of choice, since less invasive techniques, such as arthroscopy, allowed complete removal of the loose bodies only in about half of cases. A single recurrence was described, confirming the benign nature of the disease.     

Pigmented villonodular synovitis of the temporomandibular joint: a case report and the literature review

Pigmented villonodular synovitis (PVNS) is an uncommon benign proliferative disorder of synovium that may involve joints, tendon sheaths, and bursae. It most often affects the knees, and less frequently involves other joints. It presents in the temporomandibular joints (TMJs) extremely rarely. The authors report an elderly female patient with PVNS of the TMJ with skull base extension, who had traumatic history in the same site. It was diagnosed through core-needle biopsy, which was not documented in the literature. Radical excision and follow-up for 7-8 years was recommended because of the reported malignant transformation and high recurrence rate. This case and previously reported cases in the literature are reviewed and discussed.     

Synovial chondromatosis of the temporomandibular joint. Report of a case and review of the literature

An illustrative case of synovial chondromatosis in the temporomandibular joint (TMJ) region is presented, and 36 cases reported earlier are reviewed. The present patient, a 35-year-old woman, had been suffering from swelling and pain in the TMJ area as well as limited mandibular movements for 7 years. The condition had been treated with various conservative methods without any relief of the symptoms. Finally, radiological examination revealed calcified nodules within the joint space and a surgical exploration was performed. In all, 27 loose particles were removed from the joint in connection with the extirpation of the perforated and deformed disk. The result of surgical therapy has been favourable during the follow-up period of 18 months. Although synovial chondromatosis is rare in the TMJ, it should be kept in mind as one possible disease when treating patients suffering from symptoms similar to those of mandibular dysfunction syndrome.     

Vascular malformation of the temporomandibular joint: report of a case and review of the literature

The diagnosis and treatment of vascular anomalies is extremely challenging because of inconsistent terminology and classification systems, as well as nonspecific clinical and radiological findings. We report a vascular malformation that was treated successfully via resection, and reconstructed using a custom-made temporomandibular joint fossa and condylar prosthesis by TMJ Concepts. The available pertinent literature is also reviewed.     

Radiology of the temporomandibular joint. Diagnostic imaging of the temporomandibular joint

Diagnostic imaging plays an important role in the diagnosis of disorders of the masticatory system. The most frequent disorders are osteoarthrosis and internal derangements. The clinical diagnosis of these disorders may be confirmed by diagnostic imaging. In addition, diagnostic imaging contributes to the staging of the degenerative changes. Techniques for examination of the temporomandibular joint, including conventional (panoramic, transpharyngeal, transcranial) as well as more sophisticated techniques (tomography, fluoroscopy, arthrography, computed tomography, scintigraphy and magnetic resonance imaging) are briefly described. The interpretation of the radiological image of the joint in health and when affected by osteoarthrosis and internal derangement is presented.     

Synovial hemangioma of the temporomandibular joint: report of a case and review of the literature

This is the first report of a localized intra-articular synovial hemangioma of the temporomandibular joint. Although, a rare finding, synovial hemangioma should be included in the differential diagnosis of soft tissue lesions in this region.     

Effect of Herbst treatment on temporomandibular joint morphology: a systematic literature review.

The purpose of this systematic review was to evaluate the effect of Herbst appliance therapy on temporomandibular joint (TMJ) morphology, with special reference to glenoid fossa remodeling, condylar remodeling, condylar position, and articular disc position. Publications of controlled trials of Herbst treatment of Class II patients using magnetic resonance imaging (MRI), computerized tomography scans, or tomography to assess TMJ morphology were identified with Medline (1966-2001), Best Evidence (1991-2001), Cochrane Database of Systematic Reviews (second quarter, 2001), and Embase (1998-2001). Case reports were excluded. Based on our search, only 5 studies met the selection criteria. All studies used internal controls with pretreatment and posttreatment imaging. Four studies used MRI, and 1 used tomograms. The 4 MRI studies used overlapping patient samples and were not considered as independent evidence. The MRI studies did not provide conclusive evidence of osseous remodeling or condyle position change. The tomography study demonstrated minor condyle position change. Methodological deficiencies prevented major conclusions regarding disc position. The reviewed studies highlight the importance of further research. Prospective controlled studies using serial MRI and tomography are required to establish the effect of Herbst treatment on TMJ morphology.     

MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder

Oral Radiology - To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. MRI...     

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case and literature review

Pigmented villonodular synovitis (PVNS) is a benign, yet locally aggressive proliferative lesion most commonly found in joints of the long bones; it rarely presents in the temporomandibular joint (TMJ). The authors report a case of PVNS involving the TMJ and review similar cases reported in the English literature. This is the first case of PVNS with long-term follow-up of 11 years to include imaging studies. A 36-year-old male with symptoms suggestive of a temporomandibular disorder (TMD) presented with a progressive preauricular/parotid swelling and restricted mandibular range of motion. Imaging suggested a lesion with an aggressive course due to tissue displacement and destruction proximal to the lesion. A multidisciplinary team performed complete excision of the lesion with immediate reconstruction. PVNS often presents with similar symptoms to a TMD, but must be distinguished from symptomatic TMD as it can be highly destructive. Owing to its aggressive nature and potential for recurrence, complete and early extirpation and long-term follow-up with advanced imaging is indicated.     

Loose joint bodies of the temporomandibular joint: a case report

Osteochondral loose bodies are an uncommon finding in the temporomandibular joint (TMJ), but occur relatively frequently in large joints such as the knee, elbow, hip, wrist, and ankle. Loose joint bodies can be divided in three groups: 1) synovial chondromatosis; 2) osteochondral fracture fragments and; 3) cases of degenerative arthritis or avascular necrosis. The most common clinical features of loose joint bodies are pain, swelling, joint noise and impaired joint movements. A case of loose joint bodies of the temporomandibular joint is presented. The pantomograph and lateral cephalograph revealed several irregularly shaped, variably sized radiopaque structures in the region of the right temporomandibular joint. CT and MR scans confirmed the initial diagnosis. The dimensions of the loose joint bodies varied from 1–2 to 5–6 mm. In this patient, the loose joint bodies may have been secondary to osteoarthritis, may have preceded and caused the degenerative changes, or may be only a coincidental finding.     

Synovial chondromatosis of the temporomandibular joint. Review of the literature and case report

Synovial chondromatosis is an uncommon, benign condition of unknown etiology which affects articular joints. Foci of cartilage develop through metaplasia in the underlying connective tissue of the synovial membrane. These foci of cartilage enlarge with time into cartilage fragments, and may be detached from the affected synovium and released into the joint cavity. These cartilaginous foci and fragments may undergo calcification and ossification. The literature is reviewed and an additional case reported.