PURPOSE: The authors evaluated a cohort of 37 patients with histologically verified synovial chondromatosis (SC) between 2013 and 2022. METHODS: The cohort consisted of 37 patients (26 women, 11 men). 36 patients had unilateral involvement, while one patient had bilateral involvement. The average age of the patients was 54.77 years. The authors used the Milgram histopathological classification. They evaluated SC localisation, clinical symptoms, diagnostics and treatment (including recurrence incidence) in this cohort. RESULTS: In 31 patients (83.7%) SC affected only the upper joint space in one patient (2.7%) the lower space, and in five patients (13.6%) both spaces. 12 patients (32%) were Milgram Stage 1 (presence of synovial metaplasia without loose bodies), eight patients (22%) were Stage 2 (presence of synovial changes, loose bodies), and 17 patients (46%) were Stage 3 (presence of loose bodies, no synovial changes). Pain was the dominant clinical symptom (32 patients, 86.4%). Treatment consisted of arthroscopy and open surgery. Two patients underwent primary reconstruction and total TMJ replacement. Treatment was successful in 89.2% of cases (33 patients), with four (10.8%) patients suffering recurrence. CONCLUSION: As this patient cohort shows, pain was the dominant symptom in patients with SC. Magnetic resonance imaging is fundamental in the diagnosis of SC, demonstrating pathological findings even in patients for whom an initial X-ray was negative. These were mainly patients with Milgram Stages 1 and 2 without calcification, loose bodies or pathological changes of the bone structures. This is why the authors recommend MRI for any patient experiencing pain for more than three months, and if this reveals an effusion, joint distension or intraarticular soft tissue mass, they will always indicate arthroscopy. Thorough follow-up of patients is recommended, although SC recurrence is not very frequent. The authors recommend follow-up one, three and six months after surgery, and then annually for the first five years after surgery. They recommend follow-up MRI one, two and five years after surgery.

Department Oral Maxillofacial Surgery Faculty Hospital Prague Charles University Prague U Nemocnice 2 str Prague 2 Staré Město 128 08 Czech Republic

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Brabyn PJ, Capote A, Munoz-Guerra MF, Zylberberg I, Rodrıguez-Campo FJ, Naval-Gı L (2018) Arthroscopic management of synovial chondromatosis of the Temporomandibular Joint. Case Ser Syst Rev J Maxillofac Oral Surg 17(4):401–440 DOI

Burris B, Guastaldi FPS, Hadad H, Faquin WC, McCain JP (2022) Arthroscopic management of synovial chondromatosis with skull base perforation: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 000:e1e10

Gross AJ, Houston KR, Hudson JW, McCoy JM (2020) A Multidisciplinary Approach to Synovial Chondromatosis of the Temporomandibular Joint with Cranial Base involvement: a brief review of the Literature and Case Report. J Oral Maxillofac Surg 78:1759–1765 PubMed DOI

Jia M, Xu Y, Shao B, Guo Z, Hu L, Pataer L, Abass K, Ling B, Gong Z (2022) Diagnostic magnetic resonance imaging in synovial chondromatosis of the temporomandibular joint British. J Oral Maxillofac Surg 60:140–144 DOI

Jang BG, Huh KH, Kang JH, Kim JE, Yi WJ, Heo MS, Lee SS (2021) Imaging features of synovial chondromatosis of the temporomandibular joint: a report of 34 cases. Clin Radiol 76:627 .e1e627.e11 DOI

Maffia F, Vellone V, De Quarto C, Anastasi MR, Cascone P (2019) Synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion: Disk preservation for spontaneous anatomical recovery. J Craniomaxillofac Surg 47:1898–1902 PubMed DOI

Milgram JW (1977) Synovial chondromatosis: a histopathologic study of thirty cases. J Bone Joint Surg 59:792–801 PubMed DOI

Chen M, Yang C, Cai X, Jiang B, Qiu Y, Zhang X (2012) Synovial chondromatosis in the Inferior Compartment of the Temporomandibular Joint: different stages with different treatments. J Oral Maxillofac Surg 70:e32–e38 PubMed DOI

Machado GG, Zambon CE, da Silva de Lima JM, Paiva GLA, c de Oliveira Martins, de Melo Peres MPS (2023) Synovial chondromatosis of the temporomandibular joint—clinical, surgical, and imaging findings of a Milgram stage III case series oral surg oral Med oral pathol. Oral Radiol 135:e94 e101 DOI

Meng J, Guo C, Yi Zhao Y, Luo H, Ma X (2010) Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:441–448 PubMed DOI

Morales RJ, Cabrales RA (2020) Synovial chondromatosis affecting the temporomandibular joint: a case report and literature review. Oral Maxillofacial Surg Cases 6:100144 DOI

McCain JP, de la Rua H (1989) Arthroscopic observation and treatment of synovial chondromatosis of the temporomandibular joint. Int J Oral Maxillofac Surg 18:233–236 PubMed DOI

Sato J, Notani KI, Goto J, Shindoh M, Kitagawa Y (2010) Synovial chondromatosis of the temporomandibular joint accompanied by loose bodies in both the superior and inferior joint compartments: case report. Int J Oral Maxillofac Surg 39:86–88 PubMed DOI

Jenzer AC, Trotta R, Hechler BL, Powers DB (2023) Synovial chondromatosis: a Case Report and Review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol

Wittkop B, Davies AM, Mangham DC (2002) Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review. Eur Radiol 12(8):2112–2119 PubMed DOI

Wilms CT, Heim N, Teschke M, Reich RR, Gotz W (2017) Synovial chondromatosis of the temporomandibular joint: immunohistochemical examinations regarding the role of insulin-like growth factors and their binding proteins in the etiology of this disease. J Craniomaxillofac Surg 45:198–202 PubMed DOI

Wake M, Hamada Y, Kumagai K, Tanaka N, Ikeda Y, Nakatani Y, Suzuki R, Fukui N (2013) Up-regulation of interleukin-6 and vascular endothelial growth factor-A in the synovial fluid of temporomandibular joints affected by synovial chondromatosis. Br J Oral Maxillofac Surg 51:164–169 PubMed DOI

Lee ML, Zhu YM, Zhang DD, Deng YQ, Gu Y (2019) Synovial chondromatosis of the Temporomandibular Joint: a clinical and arthroscopic study of 16 cases. J Craniomaxillofac Surg 47:607–610 PubMed DOI

Cai XY, Yang C, Chen MJ, Jiang B, Wang BL (2010) Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint. Int J Oral Maxillofac Surg 39:1236–1239 PubMed DOI

Gonzalez-Perez LM, Congregado-Cordoba J, Salinas-Martın MV (2011) Temporomandibular joint synovial chondromatosis with a traumatic etiology. Int J Oral Maxillofac Surg 40:330–334 PubMed DOI

Sanroman JF, Lopez AC, Badiola IA, Ferro MF, de Sanchez AL (2008) Indications of arthroscopy in the treatment of synovial chondromatosis of the temporomandibular joint: report of 5 new cases. J Oral Maxillofac Surg 66:1694–1699 DOI

Deutor García L, García Medina B, Martínez-Sahuquillo Rico A (2021) Synovial chondromatosis of the temporomandibular joint. Tech Details Arthroscopic Manage Br J Oral Maxillofacial Surg 59:1102–1103 DOI

Bai G, Yang C, Qiu Y, Chen M (2017) Open surgery assisted with arthroscopy to treat synovial chondromatosis of the temporomandibular joint. Int J Oral Maxillofac Surg 46(2):208–213 PubMed DOI

Gonzalez LV, López JP, Orjuela MP, Mejía M, Gallo-Orjuela DM, Granizo López RM (2023) Diagnosis and management of temporomandibular joint synovial chondromatosis: a systematic review. J Craniomaxillofac Surg 51(9):551–559 PubMed DOI

Souza BD, Dimitroulis G (2007) A case of recurrence of synovial chondromatosis of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:59–61 DOI

Ogilvie-Harris DJ, Saleh K (1994) Generalized synovial chondromatosis of the knee: a comparison of removal of the loose bodies alone with arthroscopic synovectomy. Arthroscopy 10:166–170 PubMed DOI

Tomar L, Arya RC, Govil G (2022) Synovial Chondromatosis-Induced Monoarticular knee arthritis: challenges with arthroscopic synovectomy on late presentation. Cureus 14(10):e30332 PubMed PMC

Van der Valka MR, Veltmana ES, Assinkb J, Veena MR (2019) Synovial chondromatosis of the hip, a case report and literature review. J Orthop 16:249–253 DOI

Pinto AA Jr, Costa Fe, de Sousa R, Chagas SF, do Carmo MR, de Lacerda MA (2015) Synovial chondromatosis of the Temporomandibular Joint successfully treated by surgery. Head Neck Pathol 9(4):525–529 PubMed DOI PMC

Han ZX, Chen MJ, Yang C, Dong MJ (2017) Recurrent synovial chondromatosis of the temporomandibular joint: report of two cases. Br J Oral Maxillofac Surg 55:965–967 PubMed DOI