PMC8684526_01
Facial photograph from the first examination. There is no visible facial deformation.
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Movement of the left mandibular condyle was poor, and there was pain as well as joint sounds when widely opening the mouth but no occlusal abnormality (Figure 1).
Panoramic radiograph from the first examination. The left mandibular condyle is flattened, and radiopaque images are seen near the superior joint cavity.
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Panoramic radiography showed that the left mandibular condyle was flattened, with a radiopaque image near the superior joint cavity (Figure 2).
CT images from first examination: (a) axial image, (b) coronal image, and (c, d) 3D image. Deformation of the left mandibular condyle is seen, with many small, granular nodules in the area of the left TMJ, some of which are calcified.
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CT showed that the left mandibular condyle was flattened, and small and granular nodules were observed in the joint capsule of the left TMJ, some of which were calcified (Figure 3).
MR image and bone scintigraphy from the first examination. (a, b) T1-weighted image; (c) T2-weighted image. In the left TMJ, T1-weighted images show deformity of the left mandibular condyle and anterior disc displacement without reduction, and T2-weighted images show areas of small, nodular hypointensity around the left mandibular condyle. (d) Bone scintigraphy. An accumulation is seen in the area of the left TMJ.
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T1-weighted MRI of the left TMJ showed deformity of the left mandibular condyle and anterior disc displacement without reduction, and T2-weighted MRI showed fine nodular areas of hypointensity in the superior joint cavity (Figures 4(a)-4(c)). Bone scintigraphy showed accumulation at an area matching the left TMJ (Figure 4(d)).
Intraoperative findings: (a) skin incision line (arrowhead); (b) numerous white loose bodies exposed after incision of the joint capsule.
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A closed drain was placed in the wound, and the incision was sutured to complete the operation (Figure 5).
Panoramic radiograph approximately 2 years after the surgery. There are no findings suggesting recurrence.
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Image findings have also not indicated any recurrence (Figures 6 and 7).
CT and MR images approximately 2 years after the surgery: (a, b) CT images:(a) axial image and (b) coronal image; (c, d) MR images, T1-weighted image. None of the images suggest recurrence.
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Image findings have also not indicated any recurrence (Figures 6 and 7).
Extracted specimens. A total of 386 white, bone-like, hard, loose bodies of 2-5 mm in diameter were removed.
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Histopathological findings: (a) hematoxylin-eosin staining x1.25, low magnification; (b) hematoxylin-eosin staining x200, high magnification of AI; (c) hematoxylin-eosin staining x200, high magnification of AII. Cartilage tissue with growth of chondrocytes forming round or irregular small masses surrounded by fibrous tissue. Fibrosis and ossification are observed in some areas.
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There were no signs of malignancy, which is consistent with synovial chondromatosis (Figure 9).