Pseudogout of bilateral temporomandibular joints: Report of a suspected case

Abstract

Pseudogout rarely occurs in the temporomandibular joint (TMJ). Here, we report a case of suspected pseudogout in bilateral TMJs. A 64-year-old male was admitted to the gastroenterology department for biliary stricture and developed swelling and pain in the right TMJ when chewing, as well as exhibited restricted mouth-opening and malocclusion of the bilateral molar regions, and so was referred to our department for further evaluation. Upon initial examination, a diffuse, slightly firm swelling with mild tenderness was observed in the right TMJ region, but there was no redness of the overlying skin. The mouth-opening between the upper and lower left central incisors was 26 mm. Occlusal contact was limited to the anterior teeth, with a separation of 2-3 mm in the bilateral molar regions. Computed tomography (CT) revealed irregular fluid-like calcifications in the bilateral TMJ spaces, suggesting pseudogout. Simultaneously, the patient experienced swelling and pain in his left wrist, which showed similar calcifications on imaging. He was diagnosed with pseudogout of the left wrist at our orthopedic department. Treatment involved management of symptoms with anti-inflammatory and analgesic medications as well as steroids, leading to the alleviation of acute attacks. A follow-up CT scan six months later showed reduced calcification in the bilateral TMJ spaces. Since then, there has been no recurrence of symptoms in the TMJ region, but careful long-term observation is necessary.