Radiological and clinical differential diagnostics of CPPD in the temporomandibular joint extending into the cranium: Insights from the literature and a rare clinical case

Anne-Laure Vandevelde , Maarten Verbist , Jonas Ver Berne , Joris Geusens , Steven De Vleeschouwer , Reinhilde Jacobs , Robin Willaert , Michel Bila
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Abstract

Calcium pyrophosphate deposition disease (CPPD) in the temporomandibular joint (TMJ) is rare but occasionally appears locally destructive. Various radiological techniques are available for differential diagnosis. We present the case of a 66-year-old man with long-standing, painful, unilateral TMJ swelling. Radiological imaging showed a mass with calcifications, erosion of the articular roof and invasion of the middle cranial fossa. Differential diagnoses included CPPD, tenosynovial giant cell tumor, synovial chondromatosis, chondrosarcoma, and osteochondroma. A biopsy confirmed CPPD, followed by resection of the lesion and immediate TMJ reconstruction with a patient-specific prosthesis. Benign and malignant TMJ lesions extending into the cranium are uncommon and their radiological differentiation remains challenging. Therefore, we performed a scoping review focusing on TMJ imaging allowing differential diagnosis of CPPD.
颞下颌关节延伸至颅骨的CPPD的放射学和临床鉴别诊断:来自文献和罕见临床病例的见解
焦磷酸钙沉积病(CPPD)在颞下颌关节(TMJ)是罕见的,但偶尔出现局部破坏性。各种放射学技术可用于鉴别诊断。我们提出的情况下,66岁的男子长期,痛苦,单侧颞下颌关节肿胀。影像学显示肿块伴钙化,关节顶糜烂,中颅窝受累。鉴别诊断包括CPPD、腱鞘巨细胞瘤、滑膜软骨瘤病、软骨肉瘤和骨软骨瘤。活检证实CPPD,随后切除病变并立即用患者特异性假体重建TMJ。良性和恶性TMJ病变延伸到头盖骨是罕见的,其放射鉴别仍然具有挑战性。因此,我们进行了一项范围审查,重点是TMJ成像,以便鉴别诊断CPPD。
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