Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.
Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.
*Department of Maxillofacial and Ear Nose and Throat Surgery, Italian Institute of Oncology-Istituto Nazionale Tumori, "Fondazione G. Pascale," Napoli †Unit of Maxillofacial Surgery, Calabrodental ‡Advanced Diagnostic Labs, Marrelli Hospital, Crotone §Unit of Dentistry, IRCCS San Raffaele Scientific Institute, Vita e Salute San Raffaele University, Milano ||Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ALDO MORO, Bari ¶Department of Pathology, Italian Institute of Oncology-Istituto Nazionale Tumori, "Fondazione G. Pascale," Napoli #Biomedical Section, Tecnologica Research Institute, Crotone, Italy.
Franco
F
Ionna
Massimiliano
M
Amantea
Filiberto
F
Mastrangelo
Andrea
A
Ballini
Maria Grazia
MG
Maglione
Corrado
C
Aversa
Rossella
R
De Cecio
Daniela
D
Russo
Massimo
M
Marrelli
Marco
M
Tatullo
D001706:Biopsy; D015838:Chondromatosis, Synovial / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008335:Mandibular Condyle / Q000473:pathology; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D013583:Synovial Membrane / Q000473:pathology; D013701:Temporal Bone / Q000473:pathology; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed