Early Stage of Secondary Synovial Chondromatosis in the Temporomandibular Joint-A Case Report and Literature Review

早期顳顎關節腔繼發性滑膜軟骨瘤－病例報告及文獻回顧

唐櫻翠(Ying-Chui Hong) ； 林冠州(Kuan-Chou Lin) ； 周珊如(Shan-Ju Chou)

《臺灣口腔顎面外科學會雜誌》 31卷2期 (2020/06) Pp. 113-123

摘要

Synovial chondromatosis (SC) is a common pathological condition in large joints but rare in temporomandibular joint (TMJ). SC is characterized by formation of cartilaginous bodies within the joint space that resulted from abnormal proliferation of synovial membrane. Primary SC has unknown etiology, secondary SC may be associated with trauma, inflammation, joint degeneration or embryological disturbances. The pathogenesis of SC remains unclear, some studies proposed association with insulin-like growth factors I and II (IGF-I, II) and their binding proteins, insulin-like growth factors binding proteins 1 to 6 (IGFBP-1 to 6). Bone morphogenic proteins (BMPs) may also play a role in pathobiology of SC. Apart from diagnostic imaging modalities such as computer tomography (CT) scan, magnetic resonance imaging (MRI) and arthroscopy, laboratory work-ups were also recommended to facilitate in the differential diagnosis. There were Up-regulations of chondrocalcin, aggrecan, Interleukin-6 (IL-6), vascular endothelial growth factor A (VEGF-A) and type II collagen C-propeptides reported in several studies. Surgical treatment should be conservative and include thorough removal of the loose bodies and partial excision of hyperplastic or inflamed synovial membrane. The purpose of this article is to present a case of early stage SC of right TMJ in a 55-year-old woman who was treated with excision and ablation via open surgical procedure.

關鍵字

Synovial chondromatosis ； Temporomandibular joint

並列摘要

滑膜軟骨瘤在大型是大關節腔的常見疾病，但較罕見於顳顎關節腔。典型的滑膜軟骨瘤會因為滑液膜的異常增生而產生許多類軟骨質顆粒堆積在關節腔内。原發性滑膜軟骨瘤沒有確切病因，而繼發性滑膜軟骨瘤可能於外傷、發炎、退化或是胚胎時期的影響有關。目前尚未有明確的致病機轉，部分學者認為可能與胰島素樣生長因子1、2以及其結合蛋白1至6相關。骨塑型蛋白也可能有一定的角色。除了幫助診斷的影像檢查，如電腦斷層、核磁共振及關節鏡，也建議採用一些實驗室檢驗以協助鑑別診斷。舉例像是增加的軟骨鈣素、聚蛋白聚醣、介白素-6、A型血管內皮生長因子以及第二型膠原蛋白C前都有被報導過。手術介入應兼具保守、軟骨瘤全切除，以及發炎或增生的滑液膜局部切除。此文章將報導一位55歲女性的右側顳顎關節腔出現早期滑膜軟骨瘤並接受手術處理之病例。

並列關鍵字

滑膜軟骨瘤 ； 顳顎關節