Synovial chondromatosis in the inferior compartment of the temporomandibular joint: different stages with different treatments.
OBJECTIVE
To discuss a new classification and the treatment principles of synovial chondromatosis (SC) in the inferior compartment of the temporomandibular joint (TMJ).


METHODS
Five cases of SC in the inferior compartment were treated in an open manner between January 2008 and May 2011. Each case had different clinical and radiologic aspects and was treated with different surgical therapies. SC in the inferior compartment of the TMJ is classified into 3 stages. All patients were evaluated by computed tomography, magnetic resonance imaging, and clinical manifestations preoperatively and postoperatively.


RESULTS
There were 3 kinds of manifestation modes from radiologic findings. Case 1 was in stage 1, in which multiple loose bodies are noted without bony erosion. This patient was treated by removal of loose bodies and affected synovium. Case 2 was in stage 2, in which multiple calcified nodules were conglutinated to the condyle; the condyle was enlarged with pressure erosions. This patient was treated by condylectomy and reconstruction with costochondral graft. Case 3, case 4, and case 5 were all in stage 3, in which the condyle was destroyed as a result of pressure erosions or by direct bony invasion of the mass and the inferior surface of the disc was involved. These patients were treated by condylectomy together with discectomy, as well as reconstruction with costochondral graft and pedicled deep temporal fascial fat flap. No recurrence occurred. The height of the ramus and the occlusion were maintained in the same condition as preoperatively.


CONCLUSIONS
Our new classification of SC in the inferior compartment of the TMJ can better guide clinical treatment.
Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Min-jie
MJ
Chen
Chi
C
Yang
Xie-yi
XY
Cai
Bin
B
Jiang
Ya-ting
YT
Qiu
Xiao-hu
XH
Zhang
D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods; D002114:Calcinosis / Q000145:classification / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D015838:Chondromatosis, Synovial / Q000145:classification* / Q000601:surgery; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D007594:Joint Loose Bodies / Q000145:classification / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008335:Mandibular Condyle / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D000074402:Synovectomy; D019224:Temporomandibular Joint Disc / Q000473:pathology / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000145:classification* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome