Synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion: disk preservation for early anatomical recovery

Background: Synovial chondromatosis (SC) of temporo- mandibular joint is a pseudoneoplastic condition characterized by benign cartilaginous metaplasia of mesenchymal residues of synovial tissue with intra articular nodules formation. TMJ involvement is rare. Interposition of loose bodies in the intra- articular space generates a pressure that could lead to glenoid fossa erosion with intracranial extension. Findings: The aim of the study is to present 5 SC cases with intracranial extension approached with articular disk preservation. Methods: Five patients treated from 2009 to 2018, affected by TMJ chondromatosis with intracranial extension were included. Results were compared with literature. Inclusion criteria were: CT showing glenoid fossa erosion, MRI, histological SC confir- mation, and a 2-year-follow-up. Access to superior compartment was obtained. Surgical treatment was performed removing care- fully the mass and preserving articular disk. Medial region was investigated with arthroscopy. Findings: A 2-years-follow-up showed no swelling and pain. Patients showed a good mouth opening recovery and improvement of previous mouth limitation. Morphological study, performed through MRI and CT, showed complete anatomical TMJ recovery and total bone reconstruction of the glenoid fossa. Conclusion: The only removal of intra articular nodules, with TMJ arthroplasty and articular disk preservation, represents a valid treatment proposal for anatomic and functional full recovery in synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion.