Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol

This prospective clinical study aimed to establish a new classification system for TMJ internal derangement based on MRI in correlation with clinical findings contributing to a nonsurgical treatment protocol. A consecutive sample of 435 internal derangement patients was enrolled in the study. Clinical and MRI studies were used to establish the new classification system. A total of 747 joints were classified according to our staging system and received treatment according to the associated nonsurgical treatment protocol. The primary outcome variables were maximum voluntary mouth opening and visual analogue scale pain scores. The secondary outcome variable was joint sound. Statistical analysis of the differences between pretreatment and posttreatment measurements showed an increase in mouth opening throughout the study period (P < 0.001 at 12 m posttreatment). Statistical analysis of the VAS scores showed a statistically significant decrease in all study groups during all study periods, with P < 0.0001 at 12 months posttreatment. Statistical analysis of joint sounds showed significant improvement during all study periods. The new classification system is a simple, & reasonable including a detailed description of all the pathologic changes of the joint. The nonsurgical treatment protocol was Simple, effective and specific depending on the pathological changes in joint.

Lymphangioma of popliteal fossa masquerading as Baker’s cyst

Background Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection. Case presentation A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells. Conclusion Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.