Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

Sinovite vilonodular pigmentada da articulação temporomandibular: uma revisão integrativa / Pigmented villonodular synovitis of the temporomandibular joint: an integrative review / Sinovitis villonodular pigmentada de la articulación temporomandibular: una revisión integradora

Objetivo: Avaliar os casos nos quais os pacientes apresentassem SVNP na ATM, incluindo aspectos clínicos, imaginológicos, histopatológicos e tratamento. Metodologia: Trata-se de uma revisão integrativa com dados obtidos nas bases de dados SciELO, PubMed, Medline e Lillacs entre 1982 e 2021, através dos descritores: "Case report", "Temporomandibular Joint", "Pigmented Villonodular Synovitis". Critérios de inclusão: estudos de relato de caso, textos completos disponíveis, idiomas de publicação em inglês, português ou espanhol. Critérios de exclusão: estudos sem presença de aspectos clínicos, relatos não localizados na ATM, artigos de metanálise, revisão sistemática e de literatura, ensaios clínicos, capítulos de livro, dissertações e teses. Dos 156 resultados, apenas 23 compuseram a revisão. Resultados: Como tratamento, a ressecção total através da cirurgia aberta é recomendada. Os sintomas mais comuns foram: dor na mastigação, trismo, dor pré auricular, dormência, parestesia, perca auditiva e inchaço da glândula parótida. Conclusão: Os aspectos imaginológicos revelam erosão de fossa glenóide e côndilo, histopatologicamente, células gigantes com depósito de hemossiderina, e o tratamento recomendado, ressecção via cirurgia aberta com posterior curetagem... (AU)

Objective: To evaluate the cases in which patients presented PVNS in the TMJ, including clinical, imaging, histopathological and treatment aspects. Methodology: This is an integrative review with data obtained from the SciELO, PubMed, Medline and Lillacs databases between 1982 and 2021, using the descriptors: "Case report", "Temporomandibular Joint", "Pigmented Villonodular Synovitis". Inclusion criteria: case report studies, full texts available, languages of publication in English, Portuguese or Spanish. Exclusion criteria: studies without the presence of clinical aspects, reports not located in the TMJ, meta analysis articles, systematic and literature reviews, clinical trials, book chapters, dissertations and theses. Of the 156 results, only 23 made up the review. Results: As a treatment, total resection through open surgery is recommended. The most common symptoms were: chewing pain, trismus, pre-auricular pain, numbness, paresthesia, hearing loss and parotid gland swelling. Conclusion: The imaging findings reveal erosion of the glenoid fossa and condyle, histopathologically, giant cells with hemosiderin deposits, and the recommended treatment, resection via open surgery with subsequent curettage... (AU)

Objetivo: Evaluar los casos en que los pacientes presentaron SVNP en la ATM, incluyendo aspectos clínicos, imagenológicos, histopatológicos y tratamiento. Metodología: Se trata de una revisión integradora con datos obtenidos de las bases de datos SciELO, PubMed, Medline y Lillacs entre 1982 y 2021, utilizando los descriptores: "Caso clínico", "Articulación temporomandibular", "Sinovitis villonodular pigmentada". Criterios de inclusión: estudios de casos clínicos, textos completos disponibles, idiomas de publicación en inglés, portugués o español. Criterios de exclusión: estudios sin aspectos clínicos, informes no localizados en la ATM, artículos de metanálisis, revisiones sistemáticas y de literatura, ensayos clínicos, capítulos de libros, disertaciones y tesis. De los 156 resultados, 23 conformaron la revisión. Resultados: Como tratamiento se recomienda la resección total mediante cirugía abierta. Los síntomas más frecuentes fueron: dolor masticatorio, trismus, dolor preauricular, entumecimiento, parestesia, hipoacusia e inflamación de glándula parótida. Conclusión: Los hallazgos imagenológicos revelan erosión de fosa glenoidea y cóndilo, histopatológicamente células gigantes con depósitos de hemosiderina y el tratamiento recomendado, resección abierta con posterior curetaje... (AU)

Morphological determination of glenohumeral joint and acromioclavicular joint with computed tomography / Determinación morfológica de la articulación glenohumeral y la articulación acromioclavicular con tomografía computarizada

SUMMARY: Although acute and chronic pathologies of the glenohumeral and acromioclavicular joints are frequently encountered in the population, the anatomy and morphometry are not fully known. The aim of this study is to determine the measurements of morphometric parameters according to age groups and sex in a large series of Turkish population. Nine hundred and forty-one shoulders computed tomography (CT) images were screened and those of subjects with healthy anatomical structure were included. Humeral head diameter (HDD) was measured on CT images. Measurements were made using 3D-CT images of: width (GW) and height (GH) of the glenoid cavity; width (CW) and height (CH) of the distal clavicular joint surface; and width (AW) and height (AH) of the acromial joint surface. Data were compared, stratified by age and sex. Images of 223 patients (118 men, 105 women) were analyzed. The following mean measurements were determined: HDD, 41.77±3.77 mm; GH, 34.66±3.26 mm; GW, 25.50±2.90 mm; CW, 14.85±3.51 mm; CH, 8.49±2.27 mm; AW, 12.97±2.94 mm; AH, 7.01±1.77 mm. When startified by sex, HDD (p<0.001), GH (p<0.001), GW (p<0.001), CW (p<0.001), CH (p=0.002), AW (p<0.001) and AH (p<0.001) measurements were significantly different and mean values were greater in men. Similarly for age, significant differences were found for GH (p=0.028), CW (p<0.001), AW (p<0.001), AH (p<0.001). The parametric values we have obtained in the Turkish population we measure differ from the measurements made in different populations according to age groups and sex. Knowing these features will contribute to treatment planning, implant and prosthesis applications.

Aunque las patologías agudas y crónicas de las articulaciones glenohumeral y acromioclavicular son frecuentes en la población, la anatomía y morfometría no se conocen por completo. El objetivo de este estudio fue determinar las medidas de los parámetros morfométricos según grupos de edad y sexo en una serie de individuos de población turca. Se examinaron 941 imágenes de tomografía computarizada (TC) de hombro y se incluyeron las de sujetos con una estructura anatómica sana. El diámetro de la cabeza humeral (HDD) se midió en imágenes de TC. Las mediciones se realizaron utilizando imágenes 3D-CT de: ancho (GW) y altura (GH) de la cavidad glenoidea; anchura (CW) y altura (CH) de la superficie articular clavicular; y anchura (AW) y altura (AH) de la superficie articular acromial. Los datos fueron comparados, estratificados por edad y sexo. Se analizaron imágenes de 223 pacientes (118 hombres, 105 mujeres). Se determinaron las siguientes medidas medias: HDD, 41,77±3,77 mm; GH, 34,66 ± 3,26 mm; GW, 25,50±2,90 mm; CW, 14,85±3,51 mm; CH, 8,49±2,27 mm; AW, 12,97±2,94 mm; AH, 7,01±1,77 mm. Cuando se inicia por sexo, HDD (p<0,001), GH (p<0,001), GW (p<0,001), CW (p<0,001), CH (p=0,002), AW (p<0,001) y AH (p <0,001) las mediciones fueron significativamente diferentes y los valores medios fueron mayores en los hombres. De igual forma para la edad se encontraron diferencias significativas para GH (p=0,028), CW (p<0,001), AW (p<0,001), AH (p<0,001). Los valores paramétricos que hemos obtenido en la población turca difieren de las medidas realizadas en diferentes poblaciones según grupos de edad y sexo. El conocimiento de estas características contribuirá a la planificación del tratamiento, aplicaciones de implantes y prótesis.

Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability / Validação clínica do conceito de glenoid track na instabilidade glenoumeral anterior

Abstract Objective To evaluate the correlation of the glenoid track and glenoidal bone loss with the recurrence dislocation rate and the Rowe score. Methods Retrospective study that assessed the glenoid track and glenoidal bone loss through preoperative magnetic resonance imaging. Patients undergoing primary arthroscopic repair of anterior Bankart were included. Patients with glenoidal bone loss greater than 21%, rotator cuff tear, scapular waist fracture, and posterior or multidirectional instability were not included. Rowe score were the primary outcome, and the recurrence rate was the secondary outcome. Results One hundred and two patients were included. Postoperative recurrent instability was reported by 8 patients (7.8%). Four patients (50%) in the group with recurrence presented glenoidal bone loss greater than 13.5% against 24 (25.5%) in the group without recurrence (p= 0.210), with a negative predictive value of 94.6%. Three patients (37.5%) in the recurrence group were considered off-track, against 13 (13.8%) in the group without recurrence (p= 0.109), with a negative predictive value of 94.2%. Patients with absolute glenoid track value ≤ 1.5 mm had worse results in relation to the recurrence group, with 6 patients (75%) presenting recurrence (p= 0.003). Conclusion Off-track injury and glenoidal bone loss greater than the subcritical are not related to the recurrence rate and Rowe score, despite the high negative predictive value. The cut of the absolute value of the glenoid track at 1.5 mm had a significant relationship with the recurrence rate.

Resumo Objetivo Avaliar a correlação do conceito de glenoid track e da perda óssea da cavidade glenoidal com a taxa de recidiva de luxação e pontuação na escala de Rowe. Métodos Estudo retrospectivo que aferiu o glenoid track e a perda óssea da cavidade glenoidal por ressonância magnética pré-operatória. Foram incluídos pacientes submetidos a reparo artroscópico primário de Bankart anterior. Não foram incluídos pacientes com perda óssea da cavidade glenoidal maior que 21%, rotura do manguito rotador, fratura de cintura escapular, instabilidade posterior ou multidirecional. A pontuação pela escala de Rowe foi o desfecho primário, e a taxa de recidiva foi o desfecho secundário. Resultados Cento e dois pacientes foram incluídos. A recidiva foi relatada por 8 pacientes (7,8%). Quatro pacientes (50%) do grupo com recidiva apresentaram lesão da cavidade glenoidal maior que 13,5% contra 24 (25,5%) do grupo sem recidiva (p= 0,210), com valor preditivo negativo de 94,6%. Três pacientes (37,5%) do grupo com recidiva foram considerados off-track, contra 13 (13,8%) do grupo sem recidiva (p= 0,109), com valor preditivo negativo de 94,2%. Pacientes com valor absoluto do glenoid track menor ou igual a 1,5 mm tiveram piores resultados em relação ao grupo com recidiva, sendo que 6 pacientes (75%) apresentaram recidiva (p= 0,003). Conclusão Lesão off-track e perda óssea da cavidade glenoidal maior que a subcrítica não apresentam relação significativa com a taxa de recidiva e a pontuação de Rowe, apesar do alto valor preditivo negativo. O corte do valor absoluto do glenoid track em 1,5 mm apresentou relação significativa com a taxa de recidiva.

Sex determination from glenoid cavity by computed tomography in Turkish population / Determinación del sexo de la cavidad glenoidea mediante tomografía computarizada en la población turca

SUMMARY: The aim of this study is to contribute to sex determination studies from the scapula in the Turkish population and compare with previous studies. This study was performed with 200 scapulae (100 males and 100 females). The age range of the patients was between 18-93 years old. Computed tomography scans were used and length of glenoid cavity (LGC), breadth of glenoid cavity (BGC), depth of glenoid cavity (DGC), perimeter (PM) and volume (VL) were measured. Randomly selected 20 scapulae were measured three times for examine the intra-rater reliability from those measurements. Gender logistic regression analysis was conducted to find the significant variables at sex determination from the scapula. The most effective parameter in determining sex from scapula was found to be VL (88.5%). The effects of LGC, PM, BGC and DGC at sex determination from scapula were found to be 83%, 82.5%, 79.5%, 66%, respectively. The combination of VL and PM (89.5%) was found to be the most effective combination at sex determination from the scapula. The intraclass correlation values of all measurements were found to be at high reliability. According to the literature, PM and DGC along with the VL in Turkish population, were not used previously for sex determination from the scapula. A combination of the VL and PM was found to be the most effective parameters at sex determination from scapula in the Turkish population. There are few studies on the sex determination from scapula in the Turkish population. This study will guide anthropologists, forensic scientists and anatomists at sex determination studies from scapula and surgeons by morphometrically in clinical situations related to the scapula.

RESUMEN: El objetivo de este estudio fue contribuir a la determinación del sexo a partir de la escápula en la población turca y comparar con estudios previos. Esta investigación se realizó con 200 escápulas (100 hombres y 100 mujeres). El rango de edad de los pacientes estaba entre de 18 años y 93 años. Escaner de tomografía computada se usó para medir en la cavidad glenoidea los siguientes parámetros: longitud (LCG), ancho (ACG), profundidad (PCG), perímetro (PG) y volumen (VCG). Se midieron 20 escápulas seleccionadas tres veces al azar para examinar la confiabilidad intraevaluador de estas mediciones. Se realizó un análisis de regresión logística de género para encontrar las variables significativas en la determinación del sexo a partir de la escápula. El parámetro más eficaz para determinar el sexo a partir de la escápula resultó ser VCG (88,5%). Los efectos de LCG, PG, ACG y PCG en la determinación del sexo a partir de la escápula fueron del 83 %, 82,5 %, 79,5 % y 66 %, respectivamente. La combinación de VCG y PG (89,5%) resultó ser la combinación más efectiva en la determinación del sexo a partir de la escápula. Se encontró que los valores de correlación intraclase de todas las mediciones tenían una alta confiabilidad. De acuerdo con la literatura, PG y PCG junto con el VCG en la población turca, no se han utilizado previamente para la determinación del sexo a partir de la escápula. Se determinó que una combinación de VCG y PG son los parámetros más efectivos en la determinación del sexo a partir de la escápula. Existe escasa información sobre la determinación del sexo a partir de la escápula en la población turca. Este estudio guiará a los antropólogos, forenses y anatomistas en los estudios de determinación del sexo de la escápula y sera útil para los cirujanos en situaciones clínicas relacionadas con la escápula.

Arthroscopy Limits on Anterior Shoulder Instability / Limites da artroscopia na instabilidade anterior do ombro

Abstract Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track, the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.

Resumo Muito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica. Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação. Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva. O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI / A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

Estimating glenoid fossa width for instability - related bone loss with CT scan in a Chilean sample / Estimación del ancho de la fosa glenoidea para la pérdida ósea relacionada con inestabilidad con tomografía computarizada en una muestra chilena

SUMMARY: Glenoid fossa bone loss has been associated with recurrence and failure after glenoid labrum repair for shoulder instability. Quantification of glenoid fossa bone loss is critical for the successful treatment of glenohumeral instability. The aim of this paper was to estimate a linear regression model based on glenoid height in CT scan adjusted for age and sex to calculate glenoid fossa width in a healthy Chilean sample. CT scans of 101 shoulders were reviewed. The mean age was 51.96 years (SD 19.16; range, 15-88 years) with 53 females and 48 male patients. Studies with signs of bone loss, instability, fracture, or arthritis were excluded. After 3D-CT reconstruction, the height and width of each glenoid fossa was measured using the Owens methodology. All landmarks for the 2 measurements were placed on the most lateral surface of the glenoid fossa margin. Measurements for all shoulders were recorded by 3 observers and repeated on a subset (n = 20) of shoulders, under blinded conditions, by the same observer, at least 2 weeks after the initial measurements. Descriptive statistics, intraclass correlation and regression coefficients were calculated with Stata BE 17® software. A p- value of 0.05 was considered significant. A linear regression model was estimated resulting in the formula "Width = 10.97 + 0.02 * Age + 0.41 * Height - 1.95 * Sex (1=Female, 0=Male)". This model presented all coefficients with p <0.05 and an adjusted R2 of 0.73. Furthermore, it fulfilled the assumption of linearity, normal distribution of errors, independence of errors, and homoscedasticity. Regarding the intraobserver correlation, ICC was 0.76 for height and 0.91 for width; the interobserver ICC was 0.93 for height and 0.86 for width. A 3D-CT specific formula was developed to predict glenoid fossa width based on height with sufficient accuracy to be clinically valuable.

RESUMEN: La pérdida de hueso de la fosa glenoidea se ha asociado con recurrencia y falla después de la reparación del labrum glenoideo por inestabilidad del hombro. La cuantificación de la pérdida ósea glenoidea es fundamental para el tratamiento exitoso de la inestabilidad glenohumeral. El objetivo de este trabajo fue estimar un modelo de regresión lineal basado en la altura glenoidea en una tomografía computarizada ajustada por edad y sexo para calcular el ancho de la fosa glenoidea en una muestra chilena sana. Se revisaron las tomografías computarizadas de 101 hombros. La edad media fue de 51,96 años (DE 19,16; rango, 15- 88 años) con 53 mujeres y 48 hombres. Se excluyeron los estudios con signos de pérdida ósea, inestabilidad, fractura o artritis. Después de la reconstrucción 3D-CT, se midió la altura y el ancho de cada fosa glenoidea utilizando la metodología de Owens. Todos los puntos de referencia para las 2 mediciones se colocaron en la superficie más lateral del margen glenoideo. Las mediciones de todos los hombros fueron registradas por 3 observadores y repetidas en un subconjunto (n = 20) de hombros, en condiciones ciegas, por el mismo observador, al menos 2 semanas después de las mediciones iniciales. La estadística descriptiva, la correlación intraclase y los coeficientes de regresión se calcularon con el software Stata BE 17®. Se consideró significativo un valor de p de 0,05. Se estimó un modelo de regresión lineal que resultó en la fórmula "Ancho = 10,97 + 0,02 * Edad + 0,41 * Altura - 1,95 * Sexo (1 = Mujer, 0 = Hombre)". Este modelo presentó todos los coeficientes con p <0.05 y un R2 ajustado de 0.73. Además, cumplió con los supuestos de linealidad, distribución normal de errores, independencia de errores y homocedasticidad. En cuanto a la correlación intraobservador, el CCI fue de 0,76 para la altura y 0,91 para la anchura; el ICC interobservador fue de 0,93 para la altura y 0,86 para la anchura. Se desarrolló una fórmula específica de 3D-CT para predecir el ancho glenoideo en función de la altura con suficiente precisión para ser clínicamente valiosa.

Correlación de la morfología de la glenoides y la cobertura del acromion con rupturas de manguito rotador / Correlation of glenoid morphology and acromial coverage with rotator cuff tears

Introducción El objetivo de este estudio fue determinar si existen diferencias en el ángulo crítico del hombro medido por resonancia magnética en pacientes con ruptura de manguito rotador en comparación con pacientes sanos, así mismo, determinar la fiabilidad intraobservador del ángulo crítico del hombro. Se midieron diferentes variables en la resonancia magnética las cuales incluían: la extensión lateral del acromion, la altura acromial, la versión de la glenoides, el ángulo lateral del acromion y la inclinación glenoidea. Materiales y métodos Se evaluaron dos grupos de pacientes, el grupo control con un total de 16 pacientes y el grupo con ruptura de manguito rotador con 15 pacientes. Se midió en resonancia magnética el ángulo crítico del hombro, inclinación glenoidea, versión de la glenoides, altura acromial, extensión lateral del acromion y el ángulo lateral del acromion. Se utilizó la prueba T de student para comparación de medias y el coeficiente de correlación de Pearson para la asociación entre variables. Así mismo se utilizó el coeficiente de correlación intraclase para la valoración de la fiabilidad intraobservador. Resultados Se obtuvo un resultado de 0.961 en el coeficiente de correlación intraclase para la fiabilidad intraobservador del ángulo crítico del hombro. En la comparación de medias para el ángulo crítico del hombro entre el grupo control y el grupo con ruptura de manguito rotador se obtuvo un resultado de 32.3°(3.6) vs 35.01°(2.4) con una diferencia estadisticamente significativa(p=0.02). De igual manera se obtuvieron diferencias significativas en la inclinación glenoidea y la versión de la glenoides en ambos grupos (81.56°DE 4.04 vs 77.11° DE 3.84; p=0.004) y (-4.47° DE 4.56 vs -1.58°DE 3.94; p=0.04). Discusión Existen diferencias significativas en la medición del ángulo crítico del hombro medido por resonancia magnética en pacientes sanos y pacientes con ruptura de manguito rotador.

Background The purpose of this study was to determine if there is a difference between the critical shoulder angle measured by MRI in patients with rotator cuff tear and healthy patients, also to evaluate the intraobserver reliability in this measure. Other variables were included as well, lateral acromial extension, acromial height, glenoid version, glenoid inclination and lateral acromial angle. Materials and methods Two groups were evaluated, the control group consisted in a total of 16 patients and the group with rotator cuff tear consisted of 15 patients. The critical shoulder angle, glenoid inclination, glenoid version, acromial height, lateral acromial extension and lateral acromial angle were measured on MRI. A student T test was used for comparison of means between both groups, Pearson correlation coefficient was used for evaluating the association between variables. The intraobserver reliability was evaluated using the intraclass correlation coefficient. Results A result of 0.961 was obtained for the intraobserver reliability using the intraclass correlation coefficient for the critical shoulder angle. For the comparison of means of the critical shoulder angle in the control group and the rotator cuff tear group a result of 32.3° (3.6) vs. 35.01° (2.4) was obtained with a statistically significant difference of p=0.02. Likewise, statistically significant differences were obtained in the glenoid inclination and glenoid version in both groups (81.56° SD 4.04 vs 77.11° SD 3.84; p=0.004) and (−4.47° SD 4.56 vs −1.58° SD 3.94; p=0.04). Discussion Critical shoulder angle measured by MRI is statistically significant different in control group and in rotator cuff tear group.

Glenoid size and orientation in the Chilean population / Tamaño y orientación glenoidea en la población chilena

Glenoid morphology is a key factor in determining the success of shoulder surgery. The purpose of this experimental study was to precisely determine the anatomical size and orientation of the glenoid in the Chilean population. 122 CT scans from asymptomatic Chilean patients were obtained. The mean age was 43.8 years (SD 12.3; range, 17-53 years) with 63 female and 59 male patients. For each of the scapulae, were obtained the glenoid version and inclination, maximum glenoid width and height, superior glenoid width, glenoid surface area, glenoid vault depth, and maximum scapular width. The glenoid size showed an average width of 26 ± 2.7 mm, a height of 40.3 ± 3.5 mm and a vault depth of 26.5 ± 3.7 mm. There were significant differences between men and women. The glenoid orientation showed an average of -13.9 ± 4.8° of retroversion and a superior inclination of 11.1 ± 4.7°. Significant differences between men and women were seen only for version. We conclude, that in this Chilean sample the morphological parameters of the glenoid correspond to the published literature, however, some characteristics in this cohort must be further confirmed using other methods.

La morfología glenoidea es un factor clave para determinar el éxito de la cirugía de hombro. El propósito de este estudio experimental fue determinar con precisión el tamaño anatómico y la orientación de la glenoides en la población chilena. Se obtuvieron 122 tomografías computarizadas de pacientes chilenos asintomáticos. La edad media fue de 43,8 años (DE 12,3; rango, 17-53 años) con 63 pacientes femeninos y 59 masculinos. Para cada una de las escápulas, se obtuvieron la versión glenoidea y la inclinación, el ancho y la altura glenoidea máxima, el ancho glenoideo superior, el área de superficie glenoidea, la profundidad de la bóveda glenoidea y el ancho escapular máximo. El tamaño glenoideo mostró un ancho promedio de 26 ± 2,7 mm, una altura de 40,3 ± 3,5 mm y una profundidad de bóveda de 26,5 ± 3,7 mm. Hubo diferencias significativas entre hombres y mujeres. La orientación glenoidea mostró un promedio de -13,9 ± 4,8 ° de retroversión y una inclinación superior de 11,1 ± 4,7 °. Se observaron diferencias significativas entre hombres y mujeres solo para la versión. Concluimos que en esta muestra chilena los parámetros morfológicos de la glenoides corresponden a la literatura publicada, sin embargo, algunas características de esta cohorte deben confirmarse aún más utilizando otros métodos.

Comparative Evaluation of Coracoid Graft Dimensions in the Latarjet Surgery for Anterior Glenohumeral Instability / Avaliação comparativa das dimensões do enxerto do coracoide na cirurgia de Latarjet para instabilidade glenoumeral anterior

Abstract Objectives The aim of the present study was to describe the dimensions of the coracoid grafts in our Latarjet surgeries and compare them with the results described in the literature. In addition, the feasibility of the 7-millimeter rule was verified. Methods Individuals with anterior glenohumeral instability with or without bone loss participated in the present study. The dimensions of 31 coracoid process grafts of patients who were submitted to the Latarjet surgical technique were measured with an analogical caliper and recorded for posterior analysis. Results The dimensions of the coracoid graft did not show statistically significant differences related to gender. The graft width obtained from our sample presented similarities with the dimensions reported in the literature. However, the length and thickness were smaller when compared to the reference study (Young et al, 2013).15 The 7-millimeter rule was considered feasible regarding the graft dimensions obtained from our sample. Conclusion The coracoid graft dimensions were similar to the dimensions described in the literature regarding width, but the same was not found for length and thickness; and the 7-millimeter rule was feasible regarding the graft dimensions obtained from our sample.

Resumo Objetivo O objetivo deste estudo foi descrever as dimensões do processo coracoide em nossas cirurgias de Latarjet e compará-las com os resultados descritos na literatura. Além disso, a viabilidade da regra dos 7 milímetros foi verificada. Métodos Indivíduos com instabilidade glenoumeral anterior com ou sem erosão óssea participaram deste estudo. As dimensões de 31 enxertos de processo coracoide de pacientes operados pela técnica de Latarjet foram mensuradas com um paquímetro analógico e registradas para análise posterior. Resultados As dimensões do processo coracoide não demonstraram diferença estatisticamente significativa de acordo com o sexo. A largura do enxerto obtida em nossa amostra apresentou semelhança com as dimensões descritas na literatura. No entanto, o comprimento e a espessura foram um pouco menores quando comparados com o estudo de referência (Young et al, 2013).15 A regra dos 7 milímetros foi considerada viável com as dimensões do enxerto obtidas em nossa amostra. Conclusão As dimensões do enxerto do coracoide foram similares às descritas na literatura em relação à largura, mas o mesmo não foi encontrado quanto ao comprimento e espessura; e a regra dos 7 milímetros demonstrou viabilidade com as dimensões do enxerto obtidas em nossa amostra.

Bloques gemelos en el tratamiento del síndrome de clase II división 1 con trastornos temporomandibulares / Twin blocks in the treatment of class II division 1 syndrome with temporomandibular disorders

Introducción: Diversos estudios evidencian que las desarmonías del esqueleto provocan disfunciones temporomandibulares, pues la oclusión dentaria condiciona la posición de los cóndilos en la cavidad glenoidea. Los requisitos del tratamiento ortodóncico incluyen lograr una oclusión estable y equilibrada, una estética facial óptima y el funcionamiento saludable de la articulación temporomandibular. Objetivo: Describir los resultados obtenidos con los bloques gemelos en pacientes con síndrome de clase II, división 1, con trastornos temporomandibulares. Métodos: Se realizó un estudio descriptivo en los pacientes que ingresaron a la consulta de ortodoncia del policlínico "Juan Manuel Páez Inshausty", con edades entre 11 y 14 años, con síndrome de clase ΙΙ, división 1 y trastornos temporomandibulares, en el período comprendido entre febrero 2017 y enero 2018. Se describen 8 pacientes, con el análisis del índice de Helkimo al inicio y a los seis meses de instalados los bloques gemelos básicos. Resultados: Predominaron los pacientes leves con un 62,5 por ciento y el 87,5 por ciento presentó alteración en el funcionamiento de la articulación temporomandibular. A los 6 meses de tratamiento, se encontró que 7 estaban asintomáticos y solo un paciente persistía con alteraciones de la función de la articulación temporomandibular. Conclusiones: La mayoría de los pacientes pasaron a estar asintomáticos a los seis meses del tratamiento con los bloques gemelos(AU)

Introduction: Several studies show that disharmonies of the skeleton cause temporomandibular dysfunctions, since the dental occlusion determines the position of the condyles in the glenoid cavity. The requirements of orthodontic treatment includes achieving stable and balanced occlusion, optimal facial aesthetics and healthy functioning of the temporomandibular joint. Objective: To describe the results obtained with the twin blocks in patients with class II syndrome, division 1, with temporomandibular disorders. Methods: A descriptive study was carried out in the patients who entered the orthodontic clinic of the "Juan Manuel Páez Inshausty" polyclinic, aged between 11 and 14 year old, with class II syndrome, division 1 and temporomandibular disorders, in the period included between February 2017 and January 2018. 8 patients are described, with the analysis of the Helkimo index at the beginning and six months after the basic twin blocks were installed. Results: Mild patients predominated with 62.5 percent and 87.5 percent presented alteration in the temporomandibular joint function. After 6 months of treatment, 7 were found to be asymptomatic and only one patient persisted with alterations in temporomandibular joint function. Conclusions: Most patients became asymptomatic six months after treatment with the twin blocks

Can we use the contralateral glenoid cavity as a reference for the measurement of glenoid cavity bone loss in anterior shoulder instability?: a comparative analysis of 3D CT measurements in healthy subjects / ¿Podemos utilizar la cavidad glenoidea contralateral como referencia para la medición de la pérdida ósea de la cavidad glenoidea en la inestabilidad del hombro anterior?: un análisis comparativo de mediciones 3D TC en sujetos sanos

The purpose of this study was to compare the glenoid cavity measurements in healthy subjects. 100 adult subjects without shoulder pathology who had pulmonary computed tomography for any reason, were included in the study. Lung CT images were three-dimensionally rendered and glenoid cavity enface images were obtained. On these images, the glenoid cavity superior-inferior long axis and anterior-posterior equator, as well as the equatorial anterior and posterior radii, were measured. Dominant and nondominant glenoid cavity measurements were compared using the t-test in dependent groups. The long axis of the dominant glenoid cavity was 38.15 ± 3.5 mm, whereas it was 37.87 ± 3.3 mm on the non-dominant side (p = 0.068). The mean width of the glenoid cavity was 28.60 ± 3.3 mm in dominant glenoids cavities and 28.00 ± 2.9 mm in the non-dominant side (p = 0.0001). The equatorial anterior and posterior radii were significantly different between the two sides (p = 0.010, p = 0.001, respectively). The ratio of length to equator was different between the two sides (p = 0.012). The difference in equatorial lengths was 0.98 ± 0.8 mm (range, 0-4.2 mm). The mean difference between the long axis of the glenoid cavity was 1.2 ± 0.9 mm (range 0-4.6 mm). The equator on 69 individuals was larger on the dominant side. Glenoid cavity long axis was larger on the dominant side of 61 individuals. Glenoids cavities are not equal and not symmetrical to each other or influenced by hand dominancy. Measurements based on the assumption that both glenoids cavities are equal may be misleading.

El propósito de este estudio fue comparar las mediciones de las cavidades glenoideas en sujetos sanos. Se incluyeron en el estudio 100 sujetos adultos sin patología de hombro que tenían tomografía computarizada pulmonar. Las imágenes de CT de pulmón se representaron tridimensionalmente y se obtuvieron imágenes de la faceta de la cavidad glenoidea. En estas imágenes, se midieron el eje largo glenoideo superior e inferior y el ecuador anteroposterior, así como los radios ecuatoriales anterior y posterior. Las mediciones de las cavidades glenoideas dominantes y no dominantes se compararon usando la prueba t en grupos dependientes. El eje largo de la cavidad glenoidea dominante fue 38,15 ± 3,5 mm, mientras que fue 37,87 ± 3,3 mm en el lado no dominante (p = 0,068). El ancho medio de la cavidad glenoidea fue de 28,60 ± 3,3 mm en las glenoides dominantes y de 28,00 ± 2,9 mm en el lado no dominante (p=0,0001). Los radios ecuatoriales anterior y posterior fueron significativamente diferentes entre los dos lados (p=0,010; p=0,001, respectivamente). La relación de longitud al ecuador fue diferente entre los dos lados (p=0,012). La diferencia en las longitudes ecuatoriales fue de 0,98 ± 0,8 mm (rango, 0-4,2 mm). La diferencia media entre el eje largo de la cavidad glenoidea fue de 1,2 ± 0,9 mm (rango 0-4,6 mm). El ecuador en 69 individuos era más grande en el lado dominante. En 61 individuos el eje largo de cavidad glenoidea fue más grande en el lado dominante. Las cavidad glenoideas no son iguales ni simétricas entre sí ni están influenciadas por la dominancia de la mano. Las mediciones basadas en la suposición de que ambas cavidades glenoideas son iguales pueden ser engañosas.

Novel condylar repositioning method for 3D-printed models / 대한악안면성형재건외과학회지

BACKGROUND: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. METHODS: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. RESULTS: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. CONCLUSIONS: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.

Cambio de posición del cóndilo dentro de la cavidad glenoidea en pacientes clase ii esqueletal con mordida profunda / Change of position of condyle within glenoidal cavity in patientsclass II skeletal with deep bite

Objetivo: El propósito de esta investigación es determinar el cambio de posición del cóndilo dentro de la cavidad glenoidea en pacientes clase II Esqueletal con mordida profunda después de la utilización de un plano de mordida anterior fijo acrílico y metálico. Materiales y Métodos: Se tomará una muestra del 20% de un universo de 100 pacientes de Clínica de la Escuela de Postgrado de la Facultad de Odontología de la Universidad de Guayaquil para demostrar los cambios que se producen en la articulación temporomandibular como consecuencia de la nueva posición adoptada por el cóndilo debido a la nueva postura mandibular por el uso del plano de mordida. Estos pacientes serán evaluados a través de radiografías cefalométricas que serán tomadas en el transcurso del uso de los planos de mordida anterior hasta el momento que se ha conseguido el contacto del segmento posterior de las piezas dentarias donde se tomará en consideración el cambio de posición del cóndilo y de esta manera determinar la estabilidad que se desea conseguir en el tratamiento. Resultados: Todos los pacientes que utilizaron plano de mordida anterior metálico obtuvieron en el 100% el cambio de posición del cóndilo mandibular, llegando a la norma de 32+-2; mientras que el 69,23% de los pacientes que utilizaron el plano de mordida anterior acrílico tuvieron un cambio positivo y el 30,77% fue negativo. Conclusiones: Por lo tanto se concluye que con el plano de mordida anterior metálico se obtiene mayor exactitud en el cambio de posición del cóndilo mandibular.

The purpose of this investigation is to determine the change of position of the condyle within the glenoid cavity in class II patients with deep bite after the use of a fixed anterior Acrylic and Metallic bite plane, which will be done with a sample of the 20% of a universe of 100 patients from Clinic of the Postgraduate School of the Faculty of Dentistry of the University of Guayaquil to demonstrate the changes that occur in the temporomandibular joint resulting from the new position adopted by the condyle due to the new mandibular posture by the use of the bite plane. These patients will be evaluated through cephalometric radiographs that will be taken in the course of the use of the anterior bite planes until the contact of the posterior segment of the dental pieces has been achieved where the change of position of the condyle will be taken into account And thus determine the stability to be achieved in the treatment. The results that presented the patients in the change of position of the mandibular condyle that they used plane of previous bite Metallic was positive in 100% of them, arriving at the norm of 32 + -2; While 69.23% of patients who used the anterior acrylic bite plane had a positive change and 30.77% were negative; Therefore it is concluded that with the Metallic anterior bite plane, greater accuracy is obtained in the position change of the mandibular condyle.

Extension of a Scapular Fracture into the Glenoid Cavity after Low-voltage Electric Shock

We, herein, present a patient with no history of trauma who developed shoulder pain after undergoing low-voltage electric shock. According to the computed tomography, there was a multi-segmental fracture that extended into the glenoid cavity of the left scapula. A good outcome was obtained after open reduction and internal fixation. Emergency physicians should be aware of the possibility of scapular fracture extending into the glenoid cavity, especially in patients with shoulder pain after electrical injury.

Arthroscopic-assisted Reduction and Percutaneous Screw Fixation for Glenoid Fracture with Scapular Extension

BACKGROUND: To evaluate the clinical and functional outcomes of arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension, and investigate the radiologic and clinical benefits from the results. METHODS: We evaluated patients treated with arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension from November 2008 to September 2015. Fractures with displacement exceeding one-fourth of the anterior-articular surface or more than one-third of the posterior-articular surface in radiographic images were treated by surgery. Clinical assessment was conducted based on range of motion, Rowe score, and Constant score of injured arm and uninjured arm at last follow-up. RESULTS: Fifteen patients with Ideberg classification grade III, IV, and V glenoid fracture who underwent arthroscopic-assisted reduction using percutaneous screw fixation were retrospectively enrolled. There were no differences in clinical outcomes at final follow-up compared to uninjured arm. Bone union was seen in all cases within five months, and the average time to bone union was 15.2 weeks. Ankylosis in one case was observed as a postoperative complication, but the symptoms improved in response to physical therapy for six months. There was no failure of fixation and neurovascular complication. CONCLUSIONS: We identified acceptable results upon radiological and clinical assessment for the arthroscopic-assisted reduction and percutaneous fixation. For this reason, we believe the method is favorable for the treatment of Ideberg type III, IV, and V glenoid fractures. Restoration of the articular surface is considered to be more important than reduction of fractures reduction of the scapula body.

The Dimensions of the Scapula Glenoid in Japanese Rotator Cuff Tear Patients

BACKGROUND: Reverse total shoulder arthroplasty has become a widely accepted surgical procedure in Japan since the time when the implants were approved for use in 2014. There is a doubt, however, as to whether the implants designed for Western people are suitable for Japanese people, particularly for females of relatively small stature. The purpose of this study was to investigate the glenoid dimension, with special focus on the length after glenoid reaming, in Japanese rotator cuff tear patients. METHODS: Fifty-six shoulders of 55 patients (35 males and 20 females; mean age, 63.8 years) were studied. Using the three-dimensional computed tomography images of the entire scapula before shoulder surgery, we measured the glenoid height and width, and calculated the correlation between these measurements and the patient's height. Further, we measured the anteroposterior length of the scapular neck at the subchondral bone and the length at 15 mm medial to the subchondral bone, to simulate both the glenoid width after reaming (width of the ‘virtual reamed surface’) and the space available for the end of the center post of a standard glenoid baseplate. RESULTS: The average glenoid height and width were 35.8 mm and 28.1 mm in males and 30.8 mm and 23.4 mm in females, respectively. There was a significant correlation between patient height and glenoid size (glenoid height, r = 0.69; width, r = 0.75; p < 0.01). The mean value of the width of the virtual reamed surface was 27.0 mm in males and 22.5 mm in females. The mean anteroposterior length at 15 mm medial to the subchondral bone was 12.4 mm in males and 9.5 mm in females; the length was shorter than 8 mm in 6 female shoulders. CONCLUSIONS: There was a significant correlation between patient height and glenoid size. Considering that the common diameter of the commercially available baseplates and their center posts is greater than 25 mm and 8 mm, respectively, these prosthetic parts would be too large, especially for the Japanese female glenoid. Given that the current results of Japanese shoulder dimensions are similar to those of Asian people, ‘Asian size implants’ should be developed.

Temporomandibular joint synovial chondromatosis extending to the temporal bone: a report of two cases

Synovial chondromatosis is a rare benign lesion originating from the synovial membrane. It presents as adhesive or non-adhesive intra-articular cartilaginous loose bodies. Although the causes of synovial chondromatosis have not been fully elucidated, inflammation, external injury, or excessive use of joints have been suggested as possible causes. Synovial chondromatosis has been reported to occur most frequently at large joints that bear weights, with a rare occurrence at the temporomandibular joint (TMJ). When synovial chondromatosis develops at TMJ, clinical symptoms, including pain, joint sounds, and mouth opening may common. Moreover, synovial chondromatosis rarely spreads to the mandibular condyle, glenoid cavity, or articular eminence of TMJ. The goal of this study was to discuss the methods of surgery and other possible considerations by reviewing cases of patients who underwent surgery for synovial chondromatosis that extended to the temporal bone.

Temporomandibular joint synovial chondromatosis extending to the temporal bone: a report of two cases

Synovial chondromatosis is a rare benign lesion originating from the synovial membrane. It presents as adhesive or non-adhesive intra-articular cartilaginous loose bodies. Although the causes of synovial chondromatosis have not been fully elucidated, inflammation, external injury, or excessive use of joints have been suggested as possible causes. Synovial chondromatosis has been reported to occur most frequently at large joints that bear weights, with a rare occurrence at the temporomandibular joint (TMJ). When synovial chondromatosis develops at TMJ, clinical symptoms, including pain, joint sounds, and mouth opening may common. Moreover, synovial chondromatosis rarely spreads to the mandibular condyle, glenoid cavity, or articular eminence of TMJ. The goal of this study was to discuss the methods of surgery and other possible considerations by reviewing cases of patients who underwent surgery for synovial chondromatosis that extended to the temporal bone.