Diagnosis of Temporomandibular Joint Arthrosis 1. Arthrographic Differentiation

Arthrotomography of the temporomandibular joint was performed on 207 joints of 148 patients by puncturing inferior and superior joint compartments and injecting water-soluble contrast medium under fluoroscopy. Symptoms of these subjects were arthralgia, noise and hypomobility of the temporomandibular joint. In the results, 16 joints (7.7%) were normal, 31 joints (15.0%) with reducible anterior disk displacement (click), 143 joints (69.1%) with non-reducible anterior disk displacement (closed-lock), and 17 joints (8.2%) with stenosis or adhesion of the joint compartment. Among the all joints, 13 joints (6.3%) associated with discal perforation. These findings indicated several intra-capsular organic changes, moreover has a significance in differential diagnosis and treatment for the patients with temporomandibular joint arthrosis

Diagnosis of Temporomandibular Joint Arthrosis 2. Arthroscopic Differentiation

Arthroscopy was performed on 43 joints of 34 patients with painful locking of the temporomandibular joint. The subjects were 32 joints with closed-lock (non-reducible anterior disk displacement) and 11 joints with osteoarthrosis, consisted of 8 males and 26 females, from 15 to 69 years old with an average of 38.5 years. In closed-lock joints, synovitis on the posterior pouch, fibrillation of the eminence, fibrous adhesion from the anterior pouch to medial capsule were observed. On the other hand, joints of osteoarthrosis disclosed extensive synovitis, fibrillation and adhesion. Discal perforation was indicated in only one joint with closed-lock and 5 joints with osteoarthrosis arthroscopically. These arthroscopic findings could clarify the intra-capsular pathosis of two TMJ disorders, also differentiate them each other

Giant cell reparative granuloma of the mandibular condyle: A rare presentation and literature review

Giant cell reparative granuloma (GCRG) is an extremely rare occurrence in the mandibular condyle. Here we describe the case of a 41-year-old man with a GCRG of the right mandibular condyle. Clinical, radiographic, and magnetic resonance imaging was unable to confirm the pathologic process. Surgery was performed, during which 20 mm of vertical height of the condylar head and neck was resected, including the articular discs. A vertical ramus sagittal osteotomy was performed to reposition the neo-condyle into the fossa for reconstruction of the joint. The patient's condition has been stable for 18 months with no evidence of recurrence of the tumor. He has 42 mm of intermaxillary opening with no arthralgia or marked change in occlusion. Histopathologic evaluation of the resected specimen revealed a tumor situated in the superior area of the condyle that contained an abundance of multinucleated cells with eosinophilic collagenous tissue and hemorrhage around the fissure, indicating a diagnosis of GCRG. There are only seven other reported cases of GCRG occurring in the mandibular condyle. The differential diagnoses in these cases were brown tumor (hyperparathyroidism) and cherubism, which were excluded by blood tests, physical signs, and diagnostic imaging, including technetium bone scans and computed tomography. Surgical intervention with resection of the condyle and reconstruction using bone grafts or sliding ramus osteotomy is recommended in such cases. Keywords: Giant cell reparative granuloma, Mandibular condyle, Vertical sliding ramus osteotomy, Differential diagnosi