颞下颌关节滑膜软骨瘤病2例报告

结合2例颞下颌关节滑膜软骨瘤病的临床表现,X线、CT和MRI特征,以及术中所见,分析发生于颞下颌关节的滑膜软骨瘤病的临床特点、诊断及治疗方法.2例患者术前均有关节区疼痛、肿胀,无开口受限.X线片见颞下颌关节间隙增宽,其中1例CT显示颞下窝关节面骨质破坏并硬化,MRI可见关节腔内多发小结节状影.术后未出现咬合紊乱及开口受限.颞下颌关节滑膜软骨瘤病少见,临床表现无特异性,好发于关节上腔,钙化性游离体是其影像学特征,组织病理学常见软骨结构样小体,伴周围组织慢性炎症及纤维增生,一般需手术治疗.     

髁突骨软骨瘤并发滑膜软骨瘤病的临床治疗:附3例报道

目的 :探讨颞下颌关节骨软骨瘤并发滑膜软骨瘤病的诊断与治疗。方法 :回顾2001—2013年颞下颌关节骨软骨瘤和滑膜软骨瘤病患者的临床资料,最终确诊为原发性骨软骨瘤并发滑膜软骨瘤病患者共3例。对病史、临床表现、影像学检查和病理特征,以及之后3个月~5年的随访结果进行总结。结果:CT和MRI可提供精确的术前诊断,骨软骨瘤中发现游离软骨化或钙化小体,提示骨软骨瘤并发滑膜软骨瘤病可能。结论:治疗过程中需注意游离小体的存在,常提示骨软骨瘤并发滑膜软骨瘤病的可能,以免漏诊或误诊。     

颞下颌关节滑膜软骨瘤病3例临床分析

目的:探讨颞下颌关节滑膜软骨瘤病的临床特点。方法:报告3例(3侧)颞下颌关节滑膜软骨瘤病,对其临床表现、影像、诊断及治疗进行分析。结果:3例患者均有关节区疼痛(3/3),2例开口受限(2/3),1例关节区肿胀(1/3)。3例X线平片均见关节间隙增宽(3/3),2例关节造影发现关节内占位性改变(2/3),1例CT显示颅底骨质破坏(1/2),1例MRI发现关节腔积液和游离体(1/1),关节镜检查可早期诊断本病(3/3)。3例患者均行开放性关节手术。结论:颞下颌关节滑膜软骨瘤病临床上罕见,无特征性临床表现,好发于关节上腔。需结合影像学、关节镜和病理学进行诊断,游离体是最重要的特征。本病需手术治疗,常用手术方法为关节切开后行游离体和受累滑膜切除。     

颞下颌关节滑膜软骨瘤病的临床及影像学特征分析

目的研究人颞下颌关节滑膜软骨瘤病的临床及影像特征,为通过锥形束CT（CBCT）造影检查提供诊断依据。 方法采用回顾性研究1998年6月至2015年7月在中山大学附属口腔医院收治的21例组织病理学上诊断为滑膜软骨瘤病的患者,对其临床表现、影像检查、手术治疗、组织病理学特征等进行研究,对其CBCT造影检查的特征进行概括总结。 结果颞下颌关节滑膜软骨瘤病多发生在女性,主要症状包括关节区肿胀、关节杂音、关节周围疼痛、张口受限等。CBCT造影检查可检测出关节腔内的软骨小体。滑膜软骨瘤病主要发生于关节上腔,同时也可发生于关节下腔,而CBCT造影检查可轻易检测出病变有无合并关节盘的穿孔。 结论CBCT造影检查在滑膜软骨瘤病关节腔中可见特征性的类圆形缺损,其对关节滑膜软骨瘤病的诊断有重要帮助。     

颞下颌关节滑膜软骨瘤病三例

颞下颌关节滑膜软骨瘤病三例刘昕燕高岩吴奇光滑膜软骨瘤病是一种罕见的良性渐进性关节滑膜化生性病变，极少发生于颞下颌关节（ｔｅｍｐｒｏ－ｍａｎｄｉｂｕｌａｒｊｏｉｎｔ，ＴＭＪ）。现将我院的３例颞下颌关节滑膜软骨瘤病报告如下。病例１：男，４１岁。３年前曾行...     

内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病36例临床分析

目的:利用内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病,探讨其适应证及应用效果。方法 :选择2010年9月—2015年2月间收治的36例滑膜软骨瘤病患者,术前进行临床资料采集及影像学检查,明确诊断并确定病灶范围。对其中病变位于关节上腔,且MRI冠状位重建上显示关节囊内侧沟扩张低于髁突内侧嵴而未达颞下间隙的患者,选择开放性手术配合内镜行游离体摘除,并彻底进行关节囊及滑膜清扫。术后临床检查关节-颌骨-咬合情况并进行远期影像学随访,以评价应用效果。结果:36例患者先行开放性手术摘除关节腔内可见游离体,再利用内镜行关节上腔探查,发现14例患者在内侧沟、前后隐窝等区域存在游离体残余,配合杯状钳取出,最后行关节囊清扫和病变滑膜切除,术后病理提示滑膜软骨瘤病。术后33例患者完成随访,其颞下颌关节功能恢复良好,咬合及面型稳定,平均33.3个月的磁共振随访显示无肿瘤复发。结论:颞下颌关节镜辅助开放性手术可观察关节腔各个位置,以彻底清除病灶,避免术中截骨和病灶残留,减小手术创伤并缩短手术时长,是传统手术方案的有力补充。     

颞下颌关节滑膜软骨瘤病2例

颞下颌关节滑膜软骨瘤病极为罕见,1980-2000年英文文献仅有51例报道。本文报道2例颞下颌关节滑膜软骨瘤病,2例患者均为女性,年龄分别为45岁和70岁,病程分别为10年和30年,病变均累及左侧颞下颌关节。病理学检查支持滑膜软骨瘤病诊断。患者经手术治疗,主观症状消失,治愈出院。     

右侧颞下颌关节滑膜软骨瘤病1例报告

发生于颞下颌关节的滑膜软骨瘤病非常少见,本文报出1例首次术后复发且累及颅底的颞下颌关节滑膜软骨瘤病,并结合文献对该肿瘤的临床及影像学特征、诊断和治疗等进行讨论.     

颞下颌关节肿瘤及瘤样病变致颜面部畸形的手术治疗

目的：探讨颞下颌关节肿瘤及瘤样病变致颜面部畸形有效的手术治疗方案,以及术后美容及对术后咬合功能的影响。方法总结82例颞下颌关节肿瘤及瘤样病变,其中良性肿瘤54例（骨瘤17例,骨软骨瘤8例,关节滑膜软骨瘤病21例,成釉细胞瘤3例,软骨瘤和骨巨细胞瘤各2例,软骨母细胞瘤1例）;瘤样病变25例（髁状突增生或肥大23例,髁状突囊性变2例）;恶性肿瘤3例。61例以面部畸形而就诊。所有患者均采用手术方法治疗,21例关节滑膜软骨瘤病行滑膜软骨瘤病变摘除术;以面部畸形而就诊的61例病例手术方式包括：①单纯施行肿瘤或瘤样病变切除34例;②肿瘤切除加即刻肋骨肋软骨移植9例;③患侧下颌升支垂直截骨、体外切除髁状突肿瘤后升支再植入3例;④髁状突下升支后缘“L”形截骨术3例;⑤双侧下颌升支垂直截骨术4例;⑥双侧下颌升支矢状劈开术3例;⑦双侧下颌升支矢状劈开加上颌骨Le FortⅠ型截骨术摆正平面术3例;⑧部分或半侧下颌骨切除2例。术后随访6个月～10年。结果以面部畸形而就诊的61例病例,58例良性肿瘤和瘤样病变病例均无复发;53例患者术后面容恢复基本对称,咬合关系正常,开口度正常,咬合功能得到恢复。但是,单纯行髁状突切除患者中,2例手术后咬合不稳定而出现一系列症状,3例面容改善不理想。3例恶性肿瘤,2例情况稳定,1例死亡。结论单纯切除颞下颌关节肿瘤与瘤样病变是主要的手术方式,但少量病例手术治疗效果不理想,应根据具体情况采用多手段相结合的治疗方法,以恢复正常的面形、咬合关系和颞下颌关节功能。     

影像学对滑膜软骨瘤病的诊断价值

目的 探讨影像学对颞下颌关节滑膜软骨瘤病的诊断价值。方法 对北京大学口腔医学院1989～2003年6例(7侧)手术患者临床、病理及影像学进行综合对照分析。结果 滑膜软骨瘤病在临床上无特征性改变，术前诊断主要依靠影像学检查，而多个游离体的存在为最重要的诊断依据。本组病例普通X线检查发现2侧(2／7)，CT检查发现3侧(3／5)，MRI检查发现3侧(3／4)存在多个游离体，均为Milgram病理分期Ⅱ、Ⅲ期病例：而在2侧CT(2／5)、1侧MRI(1／4)上未发现游离体者均为Ⅰ期病例。结论影像学检查对于滑膜软骨瘤病MilgramⅡ、Ⅲ期有重要诊断价值，而对于其Ⅰ期病例往往术前无法做出诊断。     

Diagnostic magnetic resonance imaging in synovial chondromatosis of the temporomandibular joint

The aim of this paper was to investigate the clinical and magnetic resonance imaging (MRI) features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Fourteen patients with SC of the TMJ were included in the study. Clinical and MRI features were analysed and divided into three types based on MRI classification: type I with loose bodies, type II with homogeneous masses, and type III with a mixture of loose bodies and homogeneous masses. All SCs occurred in the superior compartment of the TMJ. There were two patients (14%) categorised as type I, five (36%) as type II and seven (50%) as type III. Four patients (29%) had disc perforation, and nine had bone erosion; among those nine, seven (78%) had type III and two (22%) type II. Histological examination showed inflammation and calcification in the synovial membrane and, and cartilage of the hyaline type in all cases. MRI has advantages in the diagnosis of SC.     

CT features of synovial chondromatosis in the temporomandibular joint

OBJECTIVE: The purpose of this study was to determine the characteristic computed tomography (CT) findings of synovial chondromatosis of the temporomandibular joint (TMJ). STUDY DESIGN: Eight subjects with synovial chondromatosis were examined with axial and coronal CT scans. All lesions were histopathologically confirmed either through an arthroscopic punch biopsy or surgery. CT appearances of the lesions were reviewed and classified. RESULTS: Among the 8 subjects, 7 (87.5%) demonstrated soft tissue swelling, 7 (87.5%) showed loose calcified bodies, and 6 (75%) had bony changes of the articular surfaces. Patterns of the skull base changes as well as intracranial extension of the disease were identified. CONCLUSIONS: Based on the CT findings, synovial chondromatosis of the TMJ is characterized by soft tissue swelling, loose calcified bodies, and bony changes of the skull base. The latter may lead to destruction of the central skull base and intracranial extension.     

Synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion: Disk preservation for spontaneous anatomical recovery

Synovial chondromatosis (SC) of the temporomandibular joint is a pseudoneoplastic condition characterized by benign cartilaginous metaplasia of synovial tissue mesenchymal residues with intra-articular nodule formation. TMJ involvement is rare. Interposition of loose bodies in the articular space can generate pressure, leading to glenoid fossa erosion with intracranial extension.The aim of this study was to present six SC cases with intracranial extension treated using a surgical procedure.All the patients were treated with open surgery. The superior compartment of the TMJ was opened widely to carefully remove the metaplasic mass. Temporal synovectomy was then performed. Attention was paid to preserving the integrity of the articular disc. The exposed dura mater was also preserved. No material was used to reconstruct the gap in the glenoid fossa.A 1-year follow-up showed no swelling or pain. Patients demonstrated good recovery of mouth opening, with improvement over previous mouth limitations. Morphological studies, performed using MRI and CT, showed complete anatomical recovery of the TMJ and total bone reconstruction of the glenoid fossa.Simple removal of intra-articular nodules, with TMJ arthroplasty and articular disk preservation, represents an efficient treatment option for full anatomical and functional recovery in synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion of less than 1 cm².     

颞下颌关节滑膜软骨瘤病:病例报告及文献复习

发生于颞下颌关节的滑膜软骨瘤病非常少见。主要临床表现有:耳前区肿块并可有触痛、开口受限、开口型歪斜、开闭口过程中关节区有杂音等。当关节积液过多时,可穿通关节窝骨板向颅内生长,出现面瘫、耳聋等。X线平片表现为关节活动受限,关节间隙增宽,骨关节面粗糙、增生等,有时可显示钙化程度较高的游离体。CT对于发现游离体相当灵敏,同时也能发现关节腔增宽。MRI对于关节腔积液显示十分清楚。该病的治疗以摘除游离体和切除病变的滑膜为主,术后一般不复发。若在短期内复发,应注意有无恶变的可能。     

Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.     

Synovial chondromatosis of the temporomandibular joint with condylar extension

Synovial chondromatosis is a benign disease that rarely affects the temporomandibular joint (TMJ). It can be seen commonly in the superior joint space and presents with various signs and symptoms according to the stage of progression. Sometimes it presents as a large swelling in the preauricular area with or without cranial extension, and the clinical and radiographic findings may be misdiagnosed as other benign or malignant diseases of TMJ. Therefore, we report an uncommon case of synovial chondromatosis presenting as a large preauricular mass arising from the inferior joint space of the TMJ with bony resorption of the mandibular condyle, which mimicked osteochondroma.     

Synovial chondromatosis of the temporomandibular joint: clinical,surgical and histological aspects

Nine patients with histologically confirmed unilateral synovial chondromatosis of the temporomandibular joint were treated surgically with extirpation of loose bodies and partial synovectomy. In six of them the histological material was available for a systematic examination. The results of treatment were evaluated clinically and with MRI after a follow-up ranging between 1 and 17 years. Our findings suggest that synovial chondromatosis of the temporomandibular affects only the synovial lining of the upper compartment. The histological appearance is that of a benign chronic inflammation varying in severity and with metaplastic activity. The most specific clinical sign of synovial chondromatosis is swelling over the joint. Distension of the lateral capsule and fluid in the joint on the MRI are very suggestive of this diagnosis. Loose bodies also indicate synovial chondromatosis, but they are not always detected on the preoperative MRI. The surgical treatment should be conservative and include thorough removal of the loose bodies and partial synovectomy in areas with marked inflammation.     

Synovial chondromatosis of the temporomandibular joint: a clinical, radiological and histological study

Synovial chondromatosis (SC) is a cartilaginous metaplasy of the mesenchymal remnants of the synovial tissue of the joints. It is characterized by the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). SC mainly affects to big synovial joints such as the knee and the elbow, being uncommon the onset within the TMJ, where 75 cases have been published. The main symptoms are pain, inflammation, limitation of the movements of the jaw and crepitation. Different methods of diagnosis include panoramic radiograph, CT, MR and arthroscopy of the TMJ. We report a new case of unilateral SC of the TMJ, including diagnostic images, treatment performed and histological analysis.     

Synovial chondromatosis of the temporomandibular joint with middle cranial fossa extension

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.