title: Pseudogout in the temporomandibular joint with imaging, arthroscopic, operative, and pathologic findings. Report of an unusual case.
abstract: The authors present a case of a 60-year-old woman with a destructive painful condition in the right temporomandibular joint (TMJ) that proved to be calcium pyrophosphate crystal deposits at subsequent biopsy examination. The patient presented with the chief complaints of pain and limitation that had not resolved with splint therapy, medications, and habit control. Magnetic resonance imaging studies showed internal derangement without reduction. Right TMJ arthroscopy with manipulation of the jaw under anesthesia showed unique findings of fronds of synovial tissue in the posterior joint space and areas of white matter. Because there was no long-term improvement in her clinical symptoms, she subsequently underwent arthroplasty of the right joint, with the white material clearly seen at surgery, and the biopsy examination confirmed the clinical and arthroscopic impression of pseudogout. The presentation, diagnosis, pathology, and treatment of pseudogout of the TMJ are discussed.
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: amirlaviv@gmail.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Laviv
authors.affiliation: Assistant Professor, Department of Pathology, Harvard Medical School; Associate Director, Head and Neck Pathology, Massachusetts General Hospital, Boston, MA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sadow
authors.affiliation: Clinical Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine; Attending Oral and Maxillofacial Surgeon, Massachusetts General Hospital, Boston, MA.
authors.forename: David A
authors.initials: DA
authors.lastname: Keith
mesh_terms: D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D001706:Biopsy / Q000379:methods; D002805:Chondrocalcinosis / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008335:Mandibular Condyle / Q000473:pathology; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis; D013524:Surgical Flaps / Q000637:transplantation; D013582:Synovial Fluid; D013583:Synovial Membrane / Q000473:pathology; D013703:Temporal Muscle / Q000637:transplantation; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods