Anesthesia/facial pain

Tophaceuos Calcium Pyrophosphate Dihydrate Deposition Disease of the Temporomandibular Joint: The Preferential Site?

The involvement of temporomandibular joint (TMJ) in pseudogout is a rare condition. When present can also involve and invade the infratemporal fossa and middle cranial fossa mimetizing benign and malignant tumors. This paper reports a case of a 63 years old female patient with TMJ pseudogout with middle cranial fossa invasion, such as the treatment and follow-up of the patient and show the difficulty to make the diagnosis in view of the difficulty in differentiating pseudogout from tumors.

This report presents a case of extensive tophaceous pseudogout involving the temporomandibular joint (TMJ), causing erosion into the middle cranial fossa. Pseudogout is a benign metabolic arthropathy caused by calcium pyrophosphate dihydrate crystal deposition within joints and peri-articular tissue. Pseudogout more frequently occurs in large joints such as the knee, wrist, symphysis pubis, and shoulder. Tophaceous pseudogout involving the TMJ is rare, with only seven cases involving erosion into the middle cranial fossa reported previously. Despite skull base erosion being a rare consequence of this erosive disease, this case highlights the importance of appropriate investigation and multidisciplinary team management.

Chondrocalcinosis is a metabolic disorder characterized by non-infectious joint inflammation with intra- or periarticular calcification. Temporomandibular (TMJ) chondrocalcinosis is rare and not usually included in the differential diagnosis of TMJ and facial pain disorders.

A 67-year-old woman presented with a calcified mass in the right TMJ between the condyle and glenoid fossa, eroding into the floor of the middle cranial fossa due to calcium pyrophosphate deposition in the TMJ. She underwent surgical excision of the mass with immediate econstruction with a custom-made prosthesis. On follow-up, there was complete clinical resolution, with no evidence of recurrence. Literature related to surgical treatment of chondrocalcinosis of TMJ and its treatment was reviewed. Surgery is the most commonly used treatment. A custom-made device allowed us to bridge the defect caused by the destructive disease process.

Custom-made prostheses can be considered a safe and effective solution in erosive forms of chondrocalcinosis, replacing the TMJ to restore functionality and correct the anatomical defect.

Chondrocalcinosis is a non-infectious, inflammatory arthropathy which is typically characterized by intra-articular deposition of calcium pyrophosphate dihydrate crystals. The occurrence of chondrocalcinosis in the temporomandibular joint is uncommon. This report describes the case of a 51-year-old female with periarticular chondrocalcinosis of the left temporomandibular joint. Disease progression and prolonged complaints of pain and limitation of mouth opening were indications for surgical treatment. The placement of an alloprosthesis of the left temporomandibular joint was performed simultaneously with a unilateral sagittal split ramus osteotomy of the right side of the mandible, to correct the class 2 malocclusion in this patient. In this case, an initial clinical diagnosis of synovial chondromatosis was made. Postoperative histopathological analysis changed the diagnosis to chondrocalcinosis. The deposition of calcium pyrophosphate dihydrate crystals was located in the outer joint capsule, which is an atypical localization of chondrocalcinosis of the temporomandibular joint.