Temporomandibular Joint Septic Arthritis

Septic arthritis of the temporomandibular joint in adults: Systematic review

BACKGROUND

Septic arthritis of the temporomandibular joint (SATMJ) is acute or chronic bacterial or fungal infection involving temporomandibular joint (TMJ) space. It is a disease with high mortality in whole body joints, and about three-fourths of survivors have residual malfunctioning of the affected joint.

OBJECTIVE

The aim of this review was to search systematically, evaluate and then summarize scientific literature about etiology, signs and symptoms, diagnosis, treatment and prognosis of the SATMJ in adults.

METHODS

After registration at PROSPERO this systematic review was conducted and reported according to the PRISMA checklist. The following databases were systematically searched: MEDLINE, EBSCO, The Cochrane Central Register of Controlled Trials (Central), SCIndex, Scopus, Google Scholar and Registry of clinical studies with human participants.

RESULTS

In total 37 studies with 91 patients were included in the review. Dominant signs and symptoms of SATMJ were pain and trismus, while fever was infrequent. The most frequent isolates from the TMJ were Staphylococcus aureus and Streptococci; however, less than 20% of patients had data about susceptibility of the isolates to antibiotics. Combination of third generation cephalosporin and metronidazole was the most frequently prescribed empirically, and antibiotics especially active against S. aureus (glycopeptides and anti-staphylococcal beta-lactams) were under-prescribed. Administration of antibiotics was prolonged (median over 30 days), although two weeks are sufficient treatment for SATMJ if right choice of antibiotics was made. There was high rate of repeated surgical interventions (53.5%), which were linked to higher risk of long-term functional defects.

CONCLUSIONS

The SATMJ is serious infection that requires early empiric administration of antibiotics with good coverage of Gram-positive bacteria, and subsequent correction of antibiotic therapy according to susceptibility of isolates. Appropriate antibiotic therapy decreases risk of long-term functional disorders.

"Multidisciplinary management of post- infective osteoarthritis and secondary condylar resorption of temporomandibular joint: a case report in a 9 years-old female patient and a review of literature"

Background

Osteoarthritis and condylar resorption of temporomandibular joint (TMJ) has rarely been reported in children as consequence of otologic disease. We describe the management of a case in a 9-year-old female as long-term complication of an otomastoiditis and review the literature currently available on this topic.

Case presentation

A nine-years-old female patient referred to Emergency Room of Bambino Gesù Children’s Research Hospital, IRCCS (Rome,Italy) for an acute pain in the left preauricular area and reduced mandibular movements. In the medical history an otomastoiditis and periorbital cellulitis was reported at the age of six with complete remission of symptoms after antibiotic treatment. No recent history of facial trauma and no previous orthodontic treatment were reported. She was referred to a pediatric dentist that conducted a clinical examination according to the Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) and was diagnosed with bilateral myalgia of the masticatory muscles and arthralgia at the level of the left TMJ. Then, a complete diagnostic path was performed that included multidisciplinary examinations by a rheumatologist, infectious disease specialist, ear nose and throat (ENT) doctor, a maxillofacial surgeon and a medical imaging specialist. Differential diagnosis included juvenile idiopathic arthritis, idiopathic condylar resorption, trauma, degenerative joint disease, neurological disease. Finally, unilateral post-infective osteoarthritis of the left TMJ with resorption of mandibular condyle was diagnosed. The patient went through a pharmacological therapy with paracetamol associated to counselling, jaw exercises and occlusal bite plate. After 1 month, the patient showed significant reduction of orofacial pain and functional recovery that was confirmed also one-year post-treatment. The novelty of this clinical case lies in the accurate description of the multidisciplinary approach with clinical examination, the differential diagnosis process and the management of TMD with conservative treatment in a growing patient.

Conclusions

Septic arthritis of temporomandibular joint and condylar resorption were described as complications of acute otitis media and/or otomastoiditis in children. We evidenced the importance of long-term follow-up in children with acute media otitis or otomastoiditis due to the onset of TMJ diseases. Furthermore, in the multidisciplinary management of orofacial pain the role of pediatric dentist is crucial for the diagnostic and therapeutic pathway to avoid serious impairment of mandibular function.

Management of Septic Arthritis of the Temporomandibular Joint in Dogs

Septic arthritis of the temporomandibular joint (TMJ) in dogs and other mammals is a rare condition. It is typically associated with notable pain, swelling, and difficulty in opening the mouth. Unlike degenerative TMJ disease, septic arthritis requires urgent intervention. The etiology of the condition may include penetrating trauma, an extension of local infection, such as otitis media, or the hematogenous spread of a pathogen. However, the precise cause may not always be identified. Diagnostic imaging with Computed Tomography (CT), cone-beam CT (CBCT), and/or Magnetic Resonance Imaging (MRI) are helpful for honing the definitive diagnosis and formulating a treatment plan. Subsequently, exploratory surgery may be required to obtain samples for culture and sensitivity and histology and to lavage the joint. In this “methods” article, we provide a detailed description of our approach to diagnosis and management of septic TMJ arthritis in four dogs.

Septic Arthritis of the Temporomandibular Joint: A Systematic Review

PURPOSE

The purpose of this study was to describe the characteristics of the patient history, clinical findings, laboratory tests, treatment, and long-term function of septic arthritis of the temporomandibular joint (SATMJ).

METHODS

All articles in the English literature related to SATMJ were queried using PubMed, Embase, and the Cochrane Library (1950 to July 1, 2020). The reference lists were reviewed for additional articles.

RESULTS

A preliminary search of the literature returned 241 results, of which 37 met inclusion criteria, with an additional article from reference review. There were 93 total cases, with a mean age of 35.7 years (0.1 to 85). Symptoms mostly consisted of pain in the temporomandibular joint/preauricular region (n = 84, 90.3%), trismus (n = 73, 78.5%), and facial/preauricular swelling (n = 68, 73.1%). Most patients had no systemic symptoms (n = 80, 86.1%). The mean degree of mouth opening was 13.1 mm (5 to 35). Diagnosis was made with the following imaging modalities: radiograph (n = 48, 51.6%), CT scan (n = 35, 37.6%), MRI (n = 25, 26.9%), and ultrasound (n = 3, 3.2%). Staphylococcus aureus (n = 19, 20.4%) was most commonly isolated. About 92 patients (98.9%) received antibiotics and 85 patients underwent surgery (eg, arthrocentesis, arthroscopy, etc.), of which 15 patients (17.6%) required repeat surgery. Most long-term outcomes were favorable. Sequelae occurred in 26 of 85 patients (30.6%) with documented follow-up.

CONCLUSIONS

SATMJ should be suspected in the presence of trismus, jaw pain, and preauricular swelling. Management includes prompt evaluation and treatment with broad-spectrum antibiotics. Surgery is not always indicated but can be life-saving in severe cases.

Septic arthritis of the temporomandibular joint in an unvaccinated adolescent

Septic arthritis of the temporomandibular joint (TMJ) is a rare condition, particularly in the paediatric population. Our case involves a 15-year-old unvaccinated Amish man with acute pain and trismus of the TMJ. The diagnosis was reached after history, clinical examination, radiographic and laboratory examinations were performed. The patient improved after a minimally invasive surgical procedure and medical therapy. Failure to recognise and treat septic arthritis in a timely fashion can result in serious sequalae. Infectious aetiologies should be kept on the differential for any patient with acute TMJ pain.

Otogenic temporomandibular septic arthritis in a child: a case report and a review of the literature

Background

Acute otitis media is one of the most common infectious diseases in the paediatric age and although its complications such as acute mastoiditis have become rare thanks to improvements in therapeutic approaches, possible serious complications such as septic arthritis of the temporomandibular joint may develop. A prompt diagnosis and adequate treatment are essential to achieving the best outcome and avoiding serious sequelae. We describe a case occurring in a previously healthy 6-year-old female and review the literature currently available on this topic.

Case presentation

The patient presented a right temporomandibular septic arthritis with initial mandibular bone involvement secondary to acute otitis media. She presented with torcicollis, trismus, right preauricular swelling over the temporomandibular joint and was successfully treated with antibiotic treatment alone.

Conclusions

Septic arthritis of the temporomandibular joint is a rare complication of acute otitis media or acute mastoiditis in children. It should be suspected in patients presenting with trismus, preauricular swelling or fever. No guidelines on the diagnosis and treatment of this infectious disease are currently available.