Malignant disease as temporomandibular joint dysfunction: review of the literature and report of case

A case of a patient with a malignant schwannoma, who was originally diagnosed as having internal derangement of the temporomandibular joint (TMJ), is presented. This is only the second reported case of this tumor with TMJ symptoms. The importance of obtaining adequate TMJ radiographs as part of the initial data collection process is stressed. Computed tomography (CT) and magnetic resonance imaging (MRI) scans are suggested if the patient has any of the ominous signs or symptoms mentioned in the text. When a patient is initially diagnosed with TMJ disease, failure to respond to appropriate therapy should alert the clinician that the initial diagnosis may be incorrect.     

Instrument breakage associated with arthroscopy of the temporomandibular joint: report of a case

A case is reported in which instrument breakage occurred in the temporomandibular joint during arthroscopic surgery. The technique used for removal of the broken metal fragment is described.     

Jacob's disease: report of a rare case and literature review

Jacob's disease is a rare condition consisting of pseudojoint formation between enlarged coronoid process and the inner surface of the zygoma. The authors report a 45-year-old female patient who presented with limited mouth opening (5 mm) and swelling of the left zygoma. No temporomandibular joint disease was diagnosed. 3D computed tomography images showed a mushroom-shaped coronoid growth with pseudojoint formation medial and superior to the zygomatic arch. Under general anaesthesia, coronoidectomy was carried out through a combined extraoral and intraoral approach. Histopathological examination revealed normal trabecular bone covered with hyaline cartilage. To the best of the authors’ knowledge this case is the fifth typical mushroom-shaped Jacob's disease; only four similar cases have been reported. A review of the literature revealed only 39 histologically proved cases of Jacob's disease cases up to 2010. Aggressive physical treatment was given to improve function and maximum mouth opening, which had increased to 40 mm at 3 months follow-up. The literature concerning this condition's aetiology, pathogenesis, clinical characteristics, diagnosis, and treatment is reviewed.     

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.     

Treatment of temporomandibular joint ankylosis: a case report

Bony ankylosis of the temporomandibular joint (TMJ) in a male patient was not diagnosed until the patient reached his early teens, at which time the condition was treated with a costochondral graft. At the time of treatment, there was an expectation that further orthognathic surgery would be required to correct the skeletal deformity. However, with the release of the ankylosis and growth of the costochondral graft, a good functional and esthetic result was achieved without further surgery. It is important that family dentists be aware of the clinical signs and symptoms of TMJ ankylosis, to allow early diagnosis and treatment.     

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.     

Plasmacytoma in the temporomandibular joint: a case report

We report a case of a 64-year-old patient in whom limitation of mouth opening was the presenting symptom of plasmacytoma. Intra-oral biopsy confirmed a plasma-cell tumour, with no sign of extension on imaging. He was treated with radiotherapy (4000 cGy) and followed up. The diagnosis of solitary plasmacytoma of bone can be confirmed only when the presence of systemic disease has been excluded by clinical, biological, and radiological investigations. We think that the treatment should consist only of radiotherapy. Long-term follow-up is necessary because of the high risk of development of multiple myeloma, which may be delayed.     

SUNCT syndrome associated with temporomandibular disorders: a case report

This case report relates the association between a rare neuralgiform syndrome (SUNCT) and masticatory myofascial pain (TMD); two different diseases with different diagnosis criteria and treatments. SUNCT syndrome was treated with a balloon microcompression procedure of the trigeminal ganglion, and the myofascial pain with injections and physical therapy. The patient was without pain at a twelve-month follow-up evaluation.     

Condylar hyperplasia associated to synovial chondromatosis of the temporomandibular joint: a case report

Condylar hyperplasia is a slowly developing malformation of the mandible, with elongation of the mandibular neck, that generally results in facial asymmetry. Synovial chondromatosis is a benign chronic disorder characterized by the formation of multiple small nodules of hyaline cartilage as a result of metaplasia of the synovial connective tissue. It affects mostly the large joints, particularly the knee, hip, elbow and ankle. The temporomandibular joint (TMJ) is rarely affected. The case of a 42-year-old male with a history of left preauricular pain and swelling and deviation of the mandible to the left upon opening the mouth is presented. Computed tomography disclosed hyperplasia of the left condyle with loose radiopaque bodies within the joint cavity. The left TMJ was subject to open surgery, which included resection of four loose bodies and a remodeling condylectomy. The histopathological study confirmed the diagnosis of condylar hyperplasia and chondromatosis of the left TMJ.     

Metal fragment in the temporomandibular joint: a case report

A 56-year-old woman was referred for severe pain and restricted jaw movements with a duration of more than 10 years.In the early 1990s a discectomy on the left side had been performed where the disc was extirpated and replaced with a polymeric implant. Due to infection and pain the implant was removed about 2 months later. In the 10-year period thereafter she suffered pain from the joint, pain from the left ear, tinnitus and restricted mouth opening.A computer tomography scan revealed a foreign body, approximately 4mm in size, situated in the medial part of the glenoid fossa. The metallic foreign body was surgically removed. The pain from her left temporomandibular joint decreased and the mouth opening capacity increased. Patch-testing showed that the patient had a potential for contact allergy to nickel, chromium and cobalt. The foreign body was most probably a fractured tip of a surgical awl. Energy dispersive X-ray analysis revealed that the fragment consisted of iron and chromium. The instrument fragment could have caused the symptoms either by an allergic reaction or a direct mechanical effect.     

Meningioma manifested as temporomandibular joint disorder: a case report

Pain in the temporomandibular joint (TMJ) and the surrounding region constitutes a symptom of TMJ disorders. Various dental causes usually stimulate the trigeminal nerve, developing facial pain which triggers trigeminal neuralgia. However, trigeminal neuralgia may also arise from irritation of the endocranial root of the nerve, due to occult damage which has not yet manifested other symptoms, for example a meningioma. In this manner, the actual cause of pain in the ipsilateral half of the face may be interpreted incorrectly and may possibly be attributed to a TMJ dysfunction syndrome. This results in long-term frustration and burdening of the patient. The case of a 47-year-old woman is presented who complained of symptoms of a painful TMJ disorder. She was initially treated with the appropriate dental procedures and, upon continuation of the pain, was examined with CT scanning, which proved to be negative despite the existence of a cerebral lesion. Further investigation with MRI, however, revealed a meningioma of 5 mm size, in the region of the cerebellopontine angle.     

A ganglion of the temporomandibular joint: a case report

Ganglion cysts of the TMJ are rare and accurate preoperative diagnosis is not usually made, although theoretically this might be possible with arthrography. Treatment of the condition is surgical but, if a positive diagnosis can be made, a period of conservative management could be attempted if the cyst is not excessively painful or surgery is contraindicated for any reason.     

Nodular fasciitis of the temporomandibular joint: a case report

Nodular fasciitis is a relatively rare benign lesion of the soft tissue, which often presents in the fascia or deep subcutaneous tissues. It most commonly presents in the upper extremities and trunk and the head and neck region, particularly in younger patients. Its pathogenesis is poorly understood and it is predominantly thought to be a reactive lesion, although some have suggested that it may be a benign neoplasm. Advances in molecular testing and imaging have greatly assisted diagnosis. We discuss the benefits of ubiquitin-specific protease 6 (USP6) gene rearrangement testing and magnetic resonance imaging (MRI) to aid this uncommon diagnosis.     

Vertiginous crisis following temporomandibular joint athrocentesis: a case report

Temporomandibular joint arthrocentesis and arthroscopy have recently exceeded open surgeries for disorders that failed to respond to conservative treatment. The efficacy of arthrocentesis in reestablishing normal mouth opening and reducing pain and dysfunctions is now commonly accepted, but in contrast to arthroscopy, there are no large series studies on arthrocentesis complications. We report the major complication occurred in our experience: a case of a patient that complained of a violent vertigo, without hearing disorders, following the procedure.     

Post-traumatic bifid condyle associated with temporomandibular joint ankylosis: report of a case and review of the literature

Bifid condyle is a rare condition. Most initially reported cases were found in studies conducted on skeletal specimens. While increasing numbers are being reported on living persons, most of them are asymptomatic and have been found on routine dental radiographic examination for other dental complaints. Most of the cases of bifid condyle reported so far have occurred unilaterally and predominantly on the left side. Bifid condyle associated with temporomandibular joint ankylosis is very rare with only 2 cases reported in the English-language literature as far as we know. An additional case of bifid condyle associated with temporomandibular joint ankylosis, involving the right side of mandible, is presented as well as a review of the literature on bifid condyles including those associated with temporomandibular joint ankylosis.