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Mund-, Kiefer- und Gesichtschirurgie

, Volume 7, Issue 6, pp 330–334 | Cite as

Freie Gelenkkörper im Kiefergelenk

Diagnostische Kriterien und Wege zur Therapieplanung
  • H. E. UmstadtEmail author
  • B. Kusch
Originalien

Zusammenfassung

Die Osteochondrosis dissecans (OD) und die synoviale Chondromatose (SC) des Kiefergelenks sind seltene Erkrankungen, die mit freien Gelenkkörpern einhergehen. Für die OD wird ursächlich eine traumatische Ursache angenommen. Bei der metaplastischen proliferativen SC lassen sich Gendefekte feststellen, die Chondrosarkomen ähnlich sind. Eine Ursache dieser Veränderungen ist bis dato nicht bekannt. Beide Erkrankungen sind in ihren klinischen Symptomen fast identisch. Präaurikuläre Schwellung, Gesichts- oder Kiefergelenkschmerzen und gelegentliche Kiefergelenkblockaden werden häufig von Patienten berichtet. Die bildgebende Diagnostik mittels Magnetresonanztomographie (MRT) bereitet Schwierigkeiten in der Differenzierung von OD und SC untereinander sowie gegenüber proliferativen intra- und periartikulären Veränderungen. Die Kiefergelenkarthroskopie bietet hier die einzige Möglichkeit einer in vivo-Beurteilung der Gelenkverhältnisse mit der Option einer histopathologischen Untersuchung. Therapeutisch kann so über eine Dissekatentfernung und Synovektomie bei SC sowie die ausschließliche Dissekatentfernung bei OD geurteilt werden.

Schlüsselwörter

Freie Gelenkkörper Osteochondrosis dissecans Synoviale Chondromatose Kiefergelenk Arthroskopie 

Abstract

Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination. Open image in new window Open image in new window Open image in new window Open image in new window Open image in new window Open image in new window

Keywords

Loose bodies in the joint Osteochondrosis dissecans Synovial chondromatosis Temporomandibular joint Arthroscopy 

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Literatur

  1. 1.
    Aydin MA, Kurtay A, Celebioglu S (2002) A case of synovial chondromatosis of the TMJ: treatment based on stage of the disease. J Craniofac Surg 13:670–675PubMedCrossRefGoogle Scholar
  2. 2.
    Bruns J (1997) Osteochondrosis dissecans. Der Orthopäde 26:573–584Google Scholar
  3. 3.
    Cannon CR (1987) Osteochondrosis of the temporomandibular joint presenting as an apparent parotid mass. Ann Otol Rhinol Laryngol 96:330–332PubMedGoogle Scholar
  4. 4.
    Carls FR, Hochstetter A, Engelke W, Sailer HF (1995) Loose bodies in the temporomandibular joint. The advantages of arthroscopy. J Craniomaxillofac Surg 23:215–221PubMedCrossRefGoogle Scholar
  5. 5.
    Cascone P, De Biase A, De Ponte F, Saltarel A (1996) Therapeutic planning in synovial chondromatosis of the temporomandibular joint. J Craniofac Surg 7:352–357PubMedCrossRefGoogle Scholar
  6. 6.
    Davis RI, Foster H, Arthur K, Trewin S, Hamilton PW, Biggart DJ (1998) Cell proliferation studies in primary synovial chondromatosis. J Pathol 184:18–23PubMedCrossRefGoogle Scholar
  7. 7.
    Ercoli C, Boncan RB, Tallents RH, Macher DJ (1998) Loose joint bodies of the temporomandibular joint: a case report. Clin Orthod Res 1:62–67PubMedGoogle Scholar
  8. 8.
    Fava C, Boccardi A (1994) Loose bodies of the temporomandibular joint. A rare pathology. Radiol Med (Torino) 88:553–558Google Scholar
  9. 9.
    Kessler P, Hardt N, Kuttenberger J (1997) Synoviale Kiefergelenkchondromatose mit Einbruch in die mittlere Schädelgrube. Mund Kiefer GesichtsChir 1:353–355PubMedCrossRefGoogle Scholar
  10. 10.
    Kim HG, Park KH, Huh JK (2002) Magnetic resonance imaging characteristics of synovial chondromatosis of the temporomandibular joint. J Orofac Pain 16:148–153PubMedGoogle Scholar
  11. 11.
    Koch S, Kampen WU, Laprell H (1997) Cartilage and bone morphology in osteochondrosis dissecans. Knee Surg Sports Traumatol Arthrosc 5:42–45PubMedCrossRefGoogle Scholar
  12. 12.
    Koyama J, Ito J, Hayashi T, Kobayashi F (2001) Synovial chondromatosis in the temporomandibular joint complicated by displacement and calcification of the articular disk: report of two cases. 22:1203–1206Google Scholar
  13. 13.
    Laack W, Casser HR (1989) Arthroskopische Behandlung der Osteochondrosis dissecans an der medialen Femurrolle. Arthroskopie 2:16–18Google Scholar
  14. 14.
    Lindern JJ, Theuerkauf I, Niederhagen B, Berge S, Appel T, Reich RH (2002) Synovial chondromatosis of the temporomandibular joint: clinical, diagnostic, and histomorphologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:31–38CrossRefGoogle Scholar
  15. 15.
    Lucas JH, Quinn P, Foote J, Baker S, Bruno J (1997) Recurrent synovial chondromatosis treated with meniscectomy and synovectomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:253–258PubMedCrossRefGoogle Scholar
  16. 16.
    Mertens F, Jonson K, Willen H, Rydholm A, Kreicbergs A, Eriksson L, Olsson-Sandin G, et al.(1996) Chromosome rearrangements in synovial chondromatous lesions. Br J Cancer 74:251–254PubMedCrossRefGoogle Scholar
  17. 17.
    Moses JJ, Hosaka H (1993) Arthroscopic punch for definitive diagnosis of synovial chondromatosis of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 75:12–17PubMedCrossRefGoogle Scholar
  18. 18.
    Norman JE, Stevenson AR, Painter DM, Sykes DG, Feain LA (1988) Synovial osteochondromatosis of the temporomandibular joint. J Craniomaxillofac Surg 16:212–220PubMedCrossRefGoogle Scholar
  19. 19.
    Petito AR, Bennett J, Assael LA, Carlotti AE Jr (2000) Synovial chondromatosis of the temporomandibular joint: varying presentation in 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:758–764PubMedCrossRefGoogle Scholar
  20. 20.
    Piacentini C, Marchetti C, Callegari A, Setti M, Bernasconi G, Baciliero U, Menghini P, et al.(1995) Endoarticular loose bodies and calcifications of the disk of the temporomandibular joint: morphological features and chemical composition. Scanning Microsc 9:789–796PubMedGoogle Scholar
  21. 21.
    Plath T, Dallenbach H, Ohnesorge I, Hoffmeister B (1997) Synoviale Chondromatose (Chondrometaplasie). Beitrag zur Differentialdiagnose von Kiefergelenkerkrankungen. Mund Kiefer GesichtsChir 1:349–352PubMedCrossRefGoogle Scholar
  22. 22.
    Sato J, Segami N, Suzuki T, Yoshikate Y, Nishikawa K (2002) The expression of fibroblast growth factor-2 and fibroblast growth factor receptor-1 in chondrocytes in synovial chondromatosis of the temporomandibular joint. Report of two cases. Int J Oral Maxillofac Surg 31:532–536PubMedCrossRefGoogle Scholar
  23. 23.
    Schellhas KP, Wilkes CH, Fritts HM, Omlie MR, Lagrotteria LB (1989) MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle. AJR Am J Roentgenol 152:551–560PubMedGoogle Scholar
  24. 24.
    Shibuya T, Kino K, Yoshida S, Amagasa T (2002) Arthroscopic removal of nodules of synovial chondromatosis of the temporomandibular joint. Cranio 20:304–306PubMedGoogle Scholar
  25. 25.
    Thompson K, Schwartz HC, Miles JW (1986) Synovial chondromatosis of the temporomandibular joint presenting as a parotid mass: possibility of confusion with benign mixed tumor. Oral Surg Oral Med Oral Pathol 62:377–380PubMedCrossRefGoogle Scholar
  26. 26.
    Yildiz ST, Demir A, Kaya A (2001) Synovial chondromatosis of the temporomandibular joint extending to temporalis, masticator, and parotid spaces. J Comput Assist Tomogr 25:126–129PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Klinik für Mund-, Kiefer- und GesichtschirurgiePhilipps-Universität MarburgMarburgGermany
  2. 2.Klinik für Mund-, Kiefer- und GesichtschirurgiePhilipps-Universität MarburgMarburgGermany

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