A 40-year-old woman was referred to our service from the Neurology Department, where she was being studied for chronic headache.
After performing cranial MRI within the diagnostic process of its pathology, it is derived from the incidental finding of an expansive process in the pterygomaxillary region with extension to temporal eminence and articular cavity.
In the clinical interview conducted in our consultation, the patient reported having said right hemicrane headache since childhood.
His sudden habit was highlighted as an interesting antecedent, without presenting articular symptoms until that moment.
She did not remember previous trauma to the joint.
The patient presented a slight swelling at the level of the right TMJ and crepitation of the joint opening and consolidation during oral opening of about 40mm, without latero deviation or pain in the right TMJ.
The rest of the facial, cervical and intraoral examination was normal.
Imaging tests included an orthopantomography that showed only doubtful joint bone degenerative changes.
CT identified irregularities in the articular surface of the glenoid cavity together with an intraosseous lesion in the right temporal eminence.
MRI showed a 3 × 1x1cm soft tissue tumor that surrounded the mandibular condyle. This tumor was located in the lateral border condyle and middle floor of the temporal bone gap and produced a temporal bone gap in the bony cavity.
None of the two imaging tests performed determined the existence of intra-articular lesions suggestive of chondromas or considered CS as a diagnostic possibility.
The radiological report determined, as possible differential diagnoses, villous-nodular synovitis, a chondrosarcoma of the TMJ or a giant cell tumor.
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With the diagnosis of a tumor in the infratemporal region, TMJ region and extending to the muscles of the pterygomaxillary region, the patient underwent surgery to perform a biopsy of the lesion and subsequent histopathological study.
It was decided to approach the tumor by means of an arthrotomy of the TMJ through a preauricular approach.
Once the articular cavity is exposed, the extreme external dilation of the articular capsule is observed.
The opening of the same showed, along with the drainage of a significant amount of synovial fluid, the exit of multiple nodules with chondroid consistency.
With the intraoperative diagnosis of SC, joint cleaning, synovectomy and removal of all intra-articular nodules or free bodies were performed.
The articular disc was preserved since no significant lesions were found in it.
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The pathology study reported mature cartilaginous tissue compatible with CS.
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The patient remains asymptomatic and has no signs of clinical or radiological recurrence after a 4-year follow-up period.
