BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyrophosphate dihydrate crystals,but it is invasive.Pseudogout of the temporomandibular joint(TMJ)is uncommon,and it rarely invades th...BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyrophosphate dihydrate crystals,but it is invasive.Pseudogout of the temporomandibular joint(TMJ)is uncommon,and it rarely invades the skull base or penetrates into the middle cranial fossa.The disease has no characteristic clinical manifestations and is easily misdiagnosed.CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa.A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region.Another patient,a 52-year-old man with a mass in the left TMJ for 6 years,was admitted to the hospital.Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area.Both patients underwent excision of the lesion.The lesion was pathologically diagnosed as tophaceous pseudogout.The symptoms in these patients were relieved after surgery.CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction.A pathological examination is the gold standard for diagnosing this disease.Surgical treatment is currently the recommended treatment,and the prognosis is good after surgery.展开更多
BACKGROUND A 48-year-old female presented with sudden-onset right-sided aural fullness,low-frequency hearing loss,and tinnitus.Medical history included right-sided tempo-romandibular joint disorder(TMJD)with crepitati...BACKGROUND A 48-year-old female presented with sudden-onset right-sided aural fullness,low-frequency hearing loss,and tinnitus.Medical history included right-sided tempo-romandibular joint disorder(TMJD)with crepitation,and retro-orbital headaches.The patient was diagnosed with atypical Meniere’s disease(MD)and received in-tratympanic steroids,prednisone,betahistine,and began a low-sodium diet;how-ever,the patient’s symptoms worsened.CASE SUMMARY The patient sought physical therapy for TMJD;testing revealed reduced motion and dysfunction with vertical opening,lateral excursion of the mandible to the right,and tenderness to palpation.Treatment included soft tissue mobilization of right facial structures and temporal fossa,intraoral massage of the right pterygoid musculature,and massage of right neck structures.After 4 weeks,the patient noticed subjective improvement in hearing and decreased headaches.After 11 weeks,an audiogram showed that the hearing loss had recovered.The patient has continued the daily at-home intraoral/neck massage therapy and maintained normal hearing over 4 years to date.The temporal relationship between physical therapy and recovery of hearing loss suggests muscular or inflammatory etiology as at least partially causative of this patient’s symptoms.The mechanism of healing may have been due to decreased inflammation,improved blood flow,restored function of cranial nerves,or some combination of these and other unknown factors.CONCLUSION This report suggests that orofacial physical and massage therapy may be an effective treatment for the cochlear symptoms associated with MD.展开更多
文摘BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyrophosphate dihydrate crystals,but it is invasive.Pseudogout of the temporomandibular joint(TMJ)is uncommon,and it rarely invades the skull base or penetrates into the middle cranial fossa.The disease has no characteristic clinical manifestations and is easily misdiagnosed.CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa.A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region.Another patient,a 52-year-old man with a mass in the left TMJ for 6 years,was admitted to the hospital.Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area.Both patients underwent excision of the lesion.The lesion was pathologically diagnosed as tophaceous pseudogout.The symptoms in these patients were relieved after surgery.CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction.A pathological examination is the gold standard for diagnosing this disease.Surgical treatment is currently the recommended treatment,and the prognosis is good after surgery.
文摘BACKGROUND A 48-year-old female presented with sudden-onset right-sided aural fullness,low-frequency hearing loss,and tinnitus.Medical history included right-sided tempo-romandibular joint disorder(TMJD)with crepitation,and retro-orbital headaches.The patient was diagnosed with atypical Meniere’s disease(MD)and received in-tratympanic steroids,prednisone,betahistine,and began a low-sodium diet;how-ever,the patient’s symptoms worsened.CASE SUMMARY The patient sought physical therapy for TMJD;testing revealed reduced motion and dysfunction with vertical opening,lateral excursion of the mandible to the right,and tenderness to palpation.Treatment included soft tissue mobilization of right facial structures and temporal fossa,intraoral massage of the right pterygoid musculature,and massage of right neck structures.After 4 weeks,the patient noticed subjective improvement in hearing and decreased headaches.After 11 weeks,an audiogram showed that the hearing loss had recovered.The patient has continued the daily at-home intraoral/neck massage therapy and maintained normal hearing over 4 years to date.The temporal relationship between physical therapy and recovery of hearing loss suggests muscular or inflammatory etiology as at least partially causative of this patient’s symptoms.The mechanism of healing may have been due to decreased inflammation,improved blood flow,restored function of cranial nerves,or some combination of these and other unknown factors.CONCLUSION This report suggests that orofacial physical and massage therapy may be an effective treatment for the cochlear symptoms associated with MD.
