Diagnosis and treatment of synovial chondromatosis of the TMJ: a clinical case.

Synovial chondromatosis is a rare, benign, chronic, progressive and proliferative lesion that usually affects large joints. This disease is characterized by the development of cartilaginous nodules within the space of synovial joints, tendon sheaths or cases; the nodules subsequently degrade, detach and form free-floating, calcified bodies within the joint space. In 1933, Axhausen described the first case of synovial chondromatosis affecting the temporomandibular joint. The aetiology still remains unknown, but a history of trauma and inflammation is often found. Clinical symptoms of chondromatosis affecting the TMJ are often characterized by swelling, pain, headache, crepitation, malocclusion and joint dysfunction. The big challenge concerning synovial chondromatosis is to suspect and establish a correct diagnosis. These nonspecific initial signs and symptoms may mimic other nonspecific TMJ's diseases and can easily lead to a delay in diagnosis or a misdiagnosis. Here we present a case of synovial chondromatosis of the TMJ and the appropriate diagnostic and treatment performed.

Single-step nasal reconstruction with osteocutaneous forearm flap after total rhinectomy.

PURPOSE: Nasal defects resulting from tumor excision can be classified according to tissues involved, such as skin, cartilage, and bone. Although in the case of "simple" defects, reconstruction with loco-regional flap eventually associated with cartilage grafts can lead to satisfactory results; in the case of total or partial rhinectomy, a minimum of 3 and a maximum of 7 operations have to be performed in the current series to achieve an acceptable end result. We present the case of a total rhinectomy reconstruction in a single-step procedure with an osteocutaneous forearm free flap (RFOFF). CLINICAL REPORT: A 50-year-old man underwent total rhinectomy to excise a pathologically proven T4aN0 moderately differentiated squamous cell carcinoma of the nose; contemporary single-step reconstruction with an RFOFF was performed. Adjuvant radiotherapy was performed. RESULT: At 18 months of follow-up, the patient is free of disease and no postirradiation flap damage has been experienced; the flap notably did not appear to be bulky. CONCLUSIONS: We believe that the RFOFF is morphologically and functionally better than other flaps owing to its capability to adapt to the new environments of the nasal cavity, and to avoid, when possible, a three-dimensional reconstruction of the same.

One-stage reconstruction of a defect of the oral commissure and of the cheek with a radial forearm free flap.

Several reconstructive methods have been proposed for complex clinical cases. These methods are based on composite graft tissue flaps which allow to obtain modest aesthetic-functional results. Only recently, revascularized flaps (fasciocutaneous free flap of radial) have been used. In this work, the authors present a clinical report of cheek mucosal carcinoma extended to the omolateral lip commissure, which has required the full thickness removal of the cheek, the lip commissure, and part of both lips; the use of a bileft free fasciocutaneous flap of radial (to reconstruct with a single flap both the cutaneous and mucosal deficits) has allowed for adequate reconstruction with good aesthetic and functional results.