Maxillofacial Plastic and Reconstructive Surgery

  • Volume 40
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  • Pages.19.1-19.6
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  • 2018
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Calcium pyrophosphate dihydrate deposition disease in the temporomandibular joint: diagnosis and treatment

  • Kwon, Kwang-Jun (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University) ;
  • Seok, Hyun (Department of Oral and Maxillofacial Surgery, Chungbuk National University Hospital) ;
  • Lee, Jang-Ha (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University) ;
  • Kim, Min-Keun (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University) ;
  • Kim, Seong-Gon (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University) ;
  • Park, Hyung-Ki (Gangwon Regional Division, Korea Institute of Industrial Technology) ;
  • Choi, Hang-Moon (Department of Oral and Maxillofacial Radiology, College of Dentistry, Gangneung-Wonju National University)
  • Received : 2018.05.24
  • Accepted : 2018.07.09
  • Published : 2018.12.31
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Abstract

Background: Calcium pyrophosphate dihydrate deposition disease (CPDD) is a rare disease in the temporomandibular joint (TMJ) space. It forms a calcified crystal mass and induces a limitation of joint movement. Case presentation: The calcified mass in our case was occupied in the left TMJ area and extended to the infratemporal and middle cranial fossa. For a complete excision of this mass, we performed a vertical ramus osteotomy and resected the mass around the mandibular condyle. The calcified mass in the infratemporal fossa was carefully excised, and the segmented mandible was anatomically repositioned. Scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS) microanalysis was performed to evaluate the calcified mass. The result of SEM/EDS showed that the crystal mass was completely composed of calcium pyrophosphate dihydrate. This result strongly suggested that the calcified mass was CPDD in the TMJ area. Conclusions: CPDD in the TMJ is a rare disease and is difficult to differentially diagnose from other neoplasms. A histological examination and quantitative microanalysis are required to confirm the diagnosis. In our patient, CPDD in the TMJ was successfully removed via the extracorporeal approach. SEM/EDS microanalysis was used for the differential diagnosis.

Keywords

References

  1. Abdelsayed RA, Said-Al-Naief N, Salguerio M, Holmes J, El-Mofty SK (2014) Tophaceous pseudogout of the temporomandibular joint: a series of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 117:369-375 https://doi.org/10.1016/j.oooo.2013.12.007
  2. Mccarty DJ, Kohn NN, Faires JS (1962) The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the pseudogout syndrome: I. Clinical Aspects Ann Intern Med 56:711-737 https://doi.org/10.7326/0003-4819-56-5-711
  3. Canhao H, Fonseca J, Leandro M, Romeu J, Pimentao J, Costa JT, Queiroz MV (2001) Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy. Clin Rheumatol 20:119-122 https://doi.org/10.1007/s100670170081
  4. Nakagawa Y, Ishibashi K, Kobayashi K, Westesson PL (1999) Calcium pyrophosphate deposition disease in the temporomandibular joint: report of two cases. J Oral Maxillofac Surg 57:1357-1363 https://doi.org/10.1016/S0278-2391(99)90877-7
  5. Marsot-Dupuch K, Smoker WR, Gentry LR, Cooper KA (2004) Massive calcium pyrophosphate dihydrate crystal deposition disease: a cause of pain of the temporomandibular joint. Am J Neuroradiol 25:876-879
  6. Meng J, Guo C, Luo H, Chen S, Ma X (2011) A case of destructive calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: a diagnostic challenge. Int J Oral Maxillofac Surg 40:1431-1437 https://doi.org/10.1016/j.ijom.2011.05.007
  7. Ishida T, Dorfman HD, Bullough PG (1995) Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease). Hum Pathol 26:587-593 https://doi.org/10.1016/0046-8177(95)90161-2
  8. Laviv A, Sadow PM, Keith DA (2015) Pseudogout in the temporomandibular joint with imaging, arthroscopic, operative, and pathologic findings. Report of an unusual case. J Oral Maxillofac Surg 73:1106-1112 https://doi.org/10.1016/j.joms.2014.12.041
  9. Aoyama S, Kino K, Amagasa T, Kayano T, Ichinose S, Kimijima Y (2000) Differential diagnosis of calcium pyrophosphate dihydrate deposition of the temporomandibular joint. Br J Oral Maxillofac Surg 38:550-553 https://doi.org/10.1054/bjom.2000.0313
  10. Srinivasan V, Wensel A, Dutcher P, Newlands S, Johnson M, Vates GE (2012) Calcium pyrophosphate deposition disease of the temporomandibular joint. J Neurol Surg Rep 73:006-008 https://doi.org/10.1055/s-0032-1329190
  11. Bae S, Park MS, Han JW, Kim YJ (2017) Correlation between pain and degenerative bony changes on cone-beam computed tomography images of temporomandibular joints. Maxillofac Plast Reconstr Surg 39:19 https://doi.org/10.1186/s40902-017-0117-1
  12. Park SH, An JH, Han JJ, Jung S, Park HJ, Oh HK, Kook MS (2017) Surgical excision of osteochondroma on mandibular condyle via preauricular approach with zygomatic arch osteotomy. Maxillofac Plast Reconstr Surg 39:32 https://doi.org/10.1186/s40902-017-0129-x
  13. Naqvi AH, Abraham JL, Kellman RM, Khurana KK (2008) Calcium pyrophosphate dihydrate deposition disease (CPPD)/pseudogout of the temporomandibular joint-FNA findings and microanalysis. Cytojournal 5:8 https://doi.org/10.1186/1742-6413-5-8
  14. Shidham V, Chivukula M, Basir Z, Shidham G (2001) Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. Mod Pathol 14:806-810 https://doi.org/10.1038/modpathol.3880394
  15. Kudoh K, Kudoh T, Tsuru K, Miyamoto Y (2017) A case of tophaceous pseudogout of the temporomandibular joint extending to the base of the skull. Int J Oral Maxillofac Surg 46:355-359
  16. Strobl H, Emshoff R, Kreczy A (1998) Calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:349-351 https://doi.org/10.1016/S1079-2104(98)90055-5
  17. Woodford R, Chaudhary N, Wolf A, Lownie S, Armstrong JE (2015) A modified retromaxillary approach to the infratemporal fossa: three case studies. J Oral Maxillofac Surg 73:769-780 https://doi.org/10.1016/j.joms.2014.10.025
  18. Guinto G, Abello J, Molina A, Gallegos F, Oviedo A, Nettel B, Lopez R (1999) Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space. Neurosurgery 45:1385-1398 https://doi.org/10.1097/00006123-199912000-00025
  19. Obwegeser HL (1985) Temporal approach to the TMJ, the orbit, and the retromaxillary-infracranial region. Head Neck Surg 7:185-199 https://doi.org/10.1002/hed.2890070302
  20. Makiguchi T, Yokoo S, Kosugi K (2015) Transparotid approach for the treatment of condylar osteochondroma and ankylosis of the temporomandibular joint. J Craniofac Surg 26:e582-e584 https://doi.org/10.1097/SCS.0000000000002130
  21. MacIntosh RB, Khan F, Waligora BM (2015) Chondrosarcoma of the temporomandibular disc: behavior over a 28-year observation period. J Oral Maxillofac Surg 73:465-474 https://doi.org/10.1016/j.joms.2014.09.020

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