A Lesion in the Right TMJ: A Case of Report of Synovial Chondromatosis of the Temporomandibular Joint

Background:
This case relates to a 42 year old female patient who had attended in June 2025 regarding a 4 year history of intermittent shooting pain and restriction of mouth opening. The patient’s medical history included scalp folliculitis but otherwise fit and well. The symptoms the patient experienced included a sudden onset of pain, jaw locking, inability to open wide and left ear tinnitus with no history of previous trauma.
Key Findings:
Key examination findings demonstrated that maximum incisal opening of 34 mm with left lateral excursion of 10 mm, right lateral excursion of 14 mm and protrusion of 7 mm. The MRI scan demonstrated a large lesion in the right TMJ extending into the pterygoid space. CBCT demonstrated the presence of calcification and advised that the presentation was consistent with synovial chondromatosis. A CT Angiogram was also undertaken since the MRI also appeared to suggest some blood vessels in the lesion itself, this showed the right internal maxillary artery was displaced medially, draped along the posteromedial aspect of the lesion with no obvious arterial invasion. The patient underwent intra-articular arthroplasty of right-sided TMJ surgery and excision of right TMJ lesion with TMJ disc replacement. During the procedure, a substantial number of loose cartilaginous bodies were revealed and removed.
Significance of this case
This case report highlights the challenges in diagnosis with a period of conservative management for 4 years when a surgical route was the required treatment modality in this instance. The case reports highlights the management of the rare occurrence of synovial chondromatosis in the TMJ and the considerations for surgical management and long term rehabilitation of this patient. The case report highlights the patient journey from GMP or GDP to OMFS and offers insights into the differential diagnosis of synovial chondromatosis as it relates to TMJ pathology.