Arthroscopic management of synovial chondromatosis with skull base perforation: A case report and literature review

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.