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Arthroscopic Management of Synovial Chondromatosis with Skull Base Perforation: A Case Report and Literature Review

  • Briana Burris
    Affiliations
    Endoscopic Maxillofacial Surgery Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
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  • Fernando P.S. Guastaldi
    Correspondence
    Fernando Pozzi Semeghini Guastaldi, DDS, MSc, PhD, Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, 50 Blossom St, Thier Research Building, 513A, Boston, MA 02114, Tel: +1 617-726-5205.
    Affiliations
    Assistant Professor of Oral and Maxillofacial Surgery, Director, Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
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  • Henrique Hadad
    Affiliations
    Research Fellow, Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
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  • William C. Faquin
    Affiliations
    Director of Head and Neck Pathology, Massachusetts Eye and Ear Infirmary, Divisions of Head and Neck Pathology and Cytopathology, Massachusetts General Hospital, Boston, MA, USA
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  • Joseph P. McCain
    Correspondence
    Corresponding authors: Joseph P. McCain, DMD, FACS, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, 55 Fruit Street, Warren 1201, Boston, MA 02114, Tel: +1 617-726-8222.
    Affiliations
    Director of Endoscopic Maxillofacial Surgery Fellowship, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.oooo.2022.11.009

      Abstract

      Purpose

      Synovial chondromatosis (SC) of the Temporomandibular Joint (TMJ) is a synovial membrane disease characterized by the formation of cartilaginous nodules (CN), that may erode the skull base. Historically, cases with skull base involvement have been treated with open surgery. We report a case of TMJ SC with skull base perforation treated and repaired via minimally invasive TMJ Arthroscopy and describe the advanced endoscopic operative maneuvers performed.

      Case Report

      A 34-year-old male presented with a 4-year history of malocclusion and right TMJ arthralgia. Clinical examination demonstrated malocclusion and direct pressure loading pain. Advanced imaging revealed glenoid fossa erosion and numerous homogenous hypointense lesions within an effusion. The initial surgical plan included diagnostic TMJ arthroscopy followed by conversion to open arthroplasty. Endoscopic operative maneuvers allowed for the accomplishment of the surgical goals, completely arthroscopically. Histopathology confirmed SC and the patient remains on observation, with relief of symptoms.

      Conclusion

      Advanced arthroscopy is a viable treatment option for select cases of TMJ SC with skull base involvement, that allowed for: access to the joint space, retrieval of biopsy specimens and CN; and repair of the skull defect.

      Keywords

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