Kachi Hirokazu, Yoshitake Hiroyuki, Yoda Tetsuya
Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
Int J Surg Case Rep. 2025 Mar;128:111021. doi: 10.1016/j.ijscr.2025.111021. Epub 2025 Feb 6.
Calcium pyrophosphate crystal deposition disease, also known as pseudogout, is a condition in which calcium pyrophosphate dihydrate (CPPD) crystals accumulate in the joint tissues, causing inflammation and arthritis. CPPD crystals are known to accumulate due to trauma; however, pseudogout developing after open temporomandibular joint (TMJ) surgery has not been previously reported.
A 54-year-old male presented to our hospital with complaints of discomfort and swelling in the front of the left ear. Magnetic resonance imaging (MRI) revealed a TMJ tumor, which was removed under general anesthesia, and a pathological diagnosis of synovial chondromatosis (SC) was established. Seven months after the surgery, recurrence was suspected based on an MRI scan. However, the patient had few subjective symptoms; therefore, we decided to continue to observe the patient without specific treatment. Twenty two months after the surgery, the mass was found to have increased in size; therefore, a second surgery was performed. Pathological examination revealed CPPD deposition, which led to the rare diagnosis of CPPD crystal deposition in the left TMJ.
The development of CPPD in this patient may have been triggered by mechanical stimulation from intra-articular free bodies. However, because CPPD was not detected in the original excised specimen, it is more likely that the surgical invasion during the original procedure promoted the deposition of CPPD crystals.
This case demonstrates the rare possibility of CPPD development after TMJ surgery. This emphasizes the importance of long-term follow-up after open TMJ surgery to monitor the possibility of CPPD-related complications.
焦磷酸钙晶体沉积病，也称为假痛风，是一种焦磷酸二水合物（CPPD）晶体在关节组织中积聚，导致炎症和关节炎的病症。已知CPPD晶体会因创伤而积聚；然而，开放性颞下颌关节（TMJ）手术后发生假痛风此前尚未见报道。
一名54岁男性因左耳前部不适和肿胀前来我院就诊。磁共振成像（MRI）显示有一个TMJ肿瘤，在全身麻醉下将其切除，并确立了滑膜软骨瘤病（SC）的病理诊断。手术后七个月，根据MRI扫描怀疑有复发。然而，患者主观症状较少；因此，我们决定在不进行特殊治疗的情况下继续观察该患者。手术后二十二个月，发现肿块增大；因此进行了第二次手术。病理检查显示有CPPD沉积，从而得出了左TMJ罕见的CPPD晶体沉积诊断。
该患者CPPD的发生可能是由关节内游离体的机械刺激引发的。然而，由于在最初切除的标本中未检测到CPPD，更有可能是最初手术过程中的手术侵袭促进了CPPD晶体的沉积。
本病例证明了TMJ手术后发生CPPD的罕见可能性。这强调了开放性TMJ手术后长期随访以监测CPPD相关并发症可能性的重要性。
