The Korean Journal of Oral and Maxillofacial Pathology (대한구강악안면병리학회지)

Korean Academy of Oral and Maxillofacial Pathology (대한구강악안면병리학회)
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Histological Observation of Osteochondrosis Dissecans Occurred in Mandibular Condyle

하악과두에 생긴 박리성 뼈연골증의 조직학적 관찰

  • Choung, Pill Hoon (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Kim, Soung Min (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Lee, Suk Keun (Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, and Institute of Oral Science)
  • 정필훈 (서울대학교 치과대학원 구강악안면외과 및 치학연구소) ;
  • 김성민 (서울대학교 치과대학원 구강악안면외과 및 치학연구소) ;
  • 이석근 (강릉원주대학교 치과대학 구강병리학교실 및 구강과학연구소)
  • Received : 2018.10.04
  • Accepted : 2018.10.19
  • Published : 2018.10.31
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Abstract

A 57 years old female complained of severe pain on the right temporomandibular joint (TMJ) area. Her right condyle had been partly resected under surgical operation 13 years ago due to condyle hypertrophy, thereafter she felt dull pain on TMJ area and recently the lesion became severely swelled and painful leading to cancer phobia. The present radiological views showed slightly enlarged and sclerosed condyle with increased radiopacity, but its articular sliding function was almost disable during mouth opening. The patient's TMJ lesion was carefully managed with conservative physiotherapy and pain treatment. The microsection of condyle head obtained from the previous operation was re-evaluated histologically, and it was finally diagnosed as osteochondrosis dissecans (OCD), exhibiting hyperplastic proliferation of cartilage in condyle head and marked vascular dilatation in epiphyseal zone. This abnormal cartilage tissue was distinguishable from normal cartilage tissue found in the peripheral cartilaginous cap of the same microsection. The involved cartilage cap showed thick hypertrophic chondrocyte zone with horizontal and vertical clefts accompanying diffuse hyaline degeneration. The superficial fibrous zone of cartilage cap was thickened and frequently peeled off, while lower hypertrophic zone of cartilage cap was highly cellular and proliferative. Consequently, the endochondral ossification became aberrant and resulted pre-mature apoptosis of many hypertrophic chondrocytes, followed by diffuse and mild inflammatory reaction in the underlying marrow tissue. Therefore, it was suggested that this hypertrophic condyle lesion, OCD, be differentiated depending on radiological and histological features from ordinary condyle hyperplasia, osteochondroma, and osteoarthritis, and that the pathological confirmation of OCD may provide a reliable modality for dental and medical treatment of chronic and painful TMJ lesion.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

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