Meng Juanhong, Guo Chuanbin, Yi Biao, Zhao Yanping, Luo Haiyan, Ma Xuchen
Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Mar;109(3):441-8. doi: 10.1016/j.tripleo.2009.09.036. Epub 2010 Jan 22.
Our aim was to study the clinical and radiologic findings of synovial chondromatosis (SC) affecting the temporomandibular joint (TMJ) and provide references for diagnosis and treatment.
Twenty patients confirmed as SC histopathologically were included in the investigation. Nineteen cases were treated with arthrotomy and 1 case with arthroscopy. The clinical manifestations, radiographic findings, histopathologic features, surgical treatment, and differential diagnosis were combined to study this disease. The SC features of TMJ on magnetic resonance (MR) images were summarized on proton density-weighted (PD) and T2-weighted images.
Synovial chondromatosis of TMJ occurred more often in women and on the right. Symptoms included preauricular pain, swelling, limitation of mouth opening, crepitations, and deviation on opening. The detection rate of calcified loose bodies was 30% on conventional radiographs and 53.3% on computerized tomography. Multiple small ring-like or tubular signals could be seen on PD and T2-weighted MR images. SC mainly affected the superior joint space; it could involve the inferior space when a perforated or deformed disc was present. SC could extend into intracranial fossa, infratemporal fossa, and lateral pytergoid muscle.
The characteristic ring-like signals could be found on MR images of the patients with SC of TMJ. This lesion should be differentially diagnosed with TMJ disorders and preauricular masses. Considering its recurrence and the different behavior of SC in different patients, various treatment strategies should be considered.
本研究旨在探讨颞下颌关节滑膜软骨瘤病（SC）的临床及影像学表现，为其诊断及治疗提供参考依据。
选取经组织病理学确诊为SC的20例患者纳入研究。其中19例行关节切开术，1例行关节镜检查。综合分析患者的临床表现、影像学表现、组织病理学特征、手术治疗及鉴别诊断情况，研究该病。总结颞下颌关节滑膜软骨瘤病在磁共振成像（MR）质子密度加权像（PD）和T2加权像上的特征。
颞下颌关节滑膜软骨瘤病多见于女性，右侧发病居多。症状包括耳前疼痛、肿胀、张口受限、摩擦音及张口偏斜。X线平片钙化游离体检出率为30%，计算机断层扫描为53.3%。在PD加权像和T2加权像上可见多个小环状或管状信号。滑膜软骨瘤病主要累及关节上腔；当存在穿孔或变形的关节盘时可累及下腔。滑膜软骨瘤病可延伸至颅内窝、颞下窝及翼外肌。
颞下颌关节滑膜软骨瘤病患者的MR图像上可发现特征性环状信号。本病应与颞下颌关节紊乱病及耳前肿物相鉴别。鉴于其复发情况及不同患者滑膜软骨瘤病的不同表现，应考虑多种治疗策略。
