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In open surgery of the TMJ using a modified preauricular temporal approach, the reference point separated from the patient provided us a surgical field without interference. TMJ = temporomandibular joint.
Source publication
Rationale:
Real-time three-dimensional navigation systems can provide useful information for operators during surgery. The authors report a case of synovial chondromatosis of the temporomandibular joint treated by open surgery under the guidance of a real-time 3-dimensional navigation system with a 3-point rigid cranial fixation device.
Patient c...
Context in source publication
Context 1
... bodies in the upper joint space were confirmed when the authors opened the TMJ capsule. The authors confirmed the surgical field through the navigation image after all of the visible loose bodies were removed, revealing the remaining loose bodies in the area where the authors' instruments had not reached (Figs. 2 and 3). Then, the authors tried to remove the remaining loose bodies under the guidance of the navigation image while the mandible was moved in order to make space for removing them. ...
Citations
... The CT and X-ray imaging features of SC of the TMJ in Milgram's stage 1 are normal or widened joint space. 33 MRI could reveal that the capsule is "dumbbell" dilated, and a moderate signal intensity region in the expanded joint space is present in T2WI. 34 Milgram's stage 1 SC should be distinguished from synovitis, suppurative arthritis, and synovial cysts. ...
Objective: To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ).
Methods: Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint", and found 181 cases.
Results: There was no specific difference in the symptoms of SC in the TMJ in different Milgram's stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram's stage.
Conclusions: The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.
Keywords: Synovial chondromatosis; imaging; surgery; temporomandibular joint; treatment.
... 因关节镜及开放手术所见的 TMJSC 病变特征明显， 许多学者[5,9] 认为，关节镜或开放手术所见的 SC 病 变与病理检查结果基本符合，一般不需要关节镜 下取活检即可确诊。本组病例关节镜下检查亦与 术后病理检查结果完全符合。而 MRI 检查 TMJSC 最常见的假阳性病例--慢性滑膜炎等，一般不 需要开放手术；若此时不进行关节镜的检查诊断， 直接开放手术会造成较大的损伤，属过度治疗； 如关节镜证实为慢性滑膜炎的，于关节镜术中即 可 在 关 节 腔 内 灌 洗 以 及 注 射 透 明 质 酸 钠 等 保 守 治疗。 虽然 SC 是一种滑膜软骨化生性病变，并不属 于肿瘤，但由于其类似肿瘤学的行为 (侵犯破坏 关 节 囊 及 骨 质 、 关 节 内 多 发 肿 物 影 响 关 节 功 能 等)，所以大多数学者主张对 SC 采用手术治疗。 无疑是较开放手术更优的手术方法[11][12][13] ；但关节镜 下摘除瘤体的手术操作难度较大，故在临床上不 易实施，Cai 等[13] 详细介绍了他们实施该术式的操 作方法。本组研究由于技术水平和器械的限制， 暂未能实施该技术。不管关节镜还是开放手术， Lee 等[12] 认为 TMJSC 手术后很少复发，可能与手 术改善了颞下颌关节腔的内环境有关。 由于早期手术操作不熟练，特别是由于髁突 的阻挡，妨碍了内侧游离体的清除；所以对病例 3，笔者将髁突颈部截断以方便清除内侧沟病变； 但由于该手术较繁琐，且创伤较大，随着临床操 作水平的提高，便放弃了此术式。为了能彻底清 除病变，Matsuda 等[14] 采用实时 3D-CT 影像进行导 ...
Objectives:
To evaluate the value of arthroscopy in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint (TMJSC).
Methods:
The cases of 16 patients preliminarily diagnosed with TMJSC by magnetic resonance imaging (MRI) from July 2011 to December 2018 were analyzed retrospectively. If the diagnosis was confirmed by arthroscopy, the opening operation was performed. The preoperative MRI, arthroscopy and opening operation, postoperative pathology and postoperative MRI of confirmed cases were analyzed, and clinical follow-up was performed to evaluate the curative effect of open surgery. The degree of mouth opening and visual analogue scale (VAS) scores for pain pre-operation and during follow-up of the confirmed cases were analyzed by t-test.
Results:
Fourteen cases of TMJSC were diagnosed by arthroscopy, consistent with the postoperative pathological diagnosis. Postoperative MRI examination showed that articular cavity lesions basically disappeared. Ten patients with synovial chondromatosis were followed-up (follow-up rate, 71.4%) from 6 months to 7 years and 8 months (average follow-up time, 17.6 months); no recurrence was found, and clinical symptoms improved by varying degrees. Before operation and at follow-up, t-test results of opening degree difference were t=7.757, P<0.05; t-test results of VAS were t=-3.274, P<0.05.
Conclusions:
Arthroscopy is essential in the diagnosis and treatment of TMJ synovial chondromatosis.
... Therefore, forensic dental examination has played an important role in personal identification (PI), even in large-scale accidents and disasters. Digitalization in medical and dental examinations and treatments has progressed, providing clinicians with great support in diagnoses and surgical procedures [2][3][4] . However, in forensic dental examination, PI has essentially been based on traditional visual comparisons of the antemortem dental records and radiographs with those obtained by postmortem dental examinations 5 . ...
Forensic dental examination has played an important role in personal identification (PI). However, PI has essentially been based on traditional visual comparisons of ante- and postmortem dental records and radiographs, and there is no globally accepted PI method based on digital technology. Although many effective image recognition models have been developed, they have been underutilized in forensic odontology. The aim of this study was to verify the usefulness of PI with paired orthopantomographs obtained in a relatively short period using convolutional neural network (CNN) technologies. Thirty pairs of orthopantomographs obtained on different days were analyzed in terms of the accuracy of dental PI based on six well-known CNN architectures: VGG16, ResNet50, Inception-v3, InceptionResNet-v2, Xception, and MobileNet-v2. Each model was trained and tested using paired orthopantomographs, and pretraining and fine-tuning transfer learning methods were validated. Higher validation accuracy was achieved with fine-tuning than with pretraining, and each architecture showed a detection accuracy of 80.0% or more. The VGG16 model achieved the highest accuracy (100.0%) with pretraining and with fine-tuning. This study demonstrated the usefulness of CNN for PI using small numbers of orthopantomographic images, and it also showed that VGG16 was the most useful of the six tested CNN architectures.
... A real-time 3D navigation system might only be useful in elective surgery under general anesthesia, because the unpredictable movements of patients affect the accuracy of the navigation image. [3,9] In conclusion, the selection of adequate surgical procedures and instruments will prevent the occurrence of iatrogenic foreign bodies. If migration accidents occur, their positions should first be confirmed by imaging examinations. ...
Rationale:
Tooth extraction is a common dental surgical procedure. There is a possibility that various complications often occur during third molar tooth extractions.
Patient concerns:
The authors report herein 2 cases of migration of a high-speed dental hand-piece bur during mandibular third molar extraction-one case with the iatrogenic foreign body migrating into the mandibular body and another case with the iatrogenic foreign body migrating into the floor of mouth are reported.
Diagnosis:
The patient was diagnosed with the iatrogenic foreign body associated with mandibular third molar extraction by imaging examinations.
Interventions:
The authors performed elective surgery to remove the foreign body under general anesthesia in Case 1, and performed emergency surgery to remove the foreign body under local anesthesia in Case 2.
Outcomes:
The foreign bodies were removed, and complete removal of the foreign bodies was confirmed by postoperative x-ray examination. The patients' postoperative courses were uneventful.
Lessons:
The selection of adequate surgical procedures and instruments will prevent the occurrence of iatrogenic foreign bodies. If migration accidents occur, their positions should first be confirmed by imaging examinations. Dentists and/or oral surgeons should perform removal operations considering the degree of emergency based on the results of imaging examinations.
Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.
