Septic Arthritis of the Temporomandibular Joint: Case Reports and Review of the Literature

Abstract

Background Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. Objective We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency medicine physicians. Case Reports In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned one milliliter of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharge home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than three weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; twenty months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. Conclusion Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.

Septic Arthritis of the Temporomandibular Joint without an Apparent Source of Infection: A Case Report

“…However, the source of infection sometimes remains unknown as in the present case. Staphylococcus aureus, Staphylococcus saprophyticus, Neisseria gonorrhea, Streptococcus viridans, and Haemophilusinfluenzae have been reported as common infecting organisms in septic arthritis of the TMJ [1] [8] [10]. In our case, however, Propionibacterium species and Veillonella species were identified by culture of the joint aspirate.…”

An Unusual Masticator Space Infection Initially Presenting as Temporomandibular Joint Dislocation: A Case Report

“…After accurate interpretation and prompt treatment, the patients satisfactorily recovered and were discharged [5]. Although odontogenic infection is the most common etiology for MSI, other possible etiologies are bacterial or viral pharyngitis, retropharyngeal abscess, peritonsillar abscess, acute otitis media, mastoiditis, parotitis, submandibular sialadenitis and lymphadenopathy, which should be included in the differential diagnosis [6]. In addition, some unusual etiologies exist.…”

Septic Arthritis of the Temporomandibular Joint—Unusual Presentations

“…These 2 cases required contrast-enhanced CT and MRI scans, modalities used almost universally. [3][4][5][6][7][8][9][10][11] Cai et al 4 noted joint space widening and decreased condylar movement using plain radiography for their first 33 patients, but after 2003 they performed MRI scans for the remaining 7 patients. MRI and CT scans visualize bone and soft tissue with excellent resolution and are noninvasive.…”

“…There have been occasional reports involving Staphylococcus saprophyticus, Neisseria gonorrhea, Streptococcus viridans, and Haemophilus influenza. [2][3][4] Owing to the high community prevalence of MRSA, vancomycin or sulfonamides are needed for SATMJ treatment. Goldschmidt et al 13 recommended antibiotic therapy for a 30-day total course, modulated by the patient's clinical response.…”