Severe septic arthritis of the temporomandibular joint with pyogenic orofacial infections: A case report and review of the literature

Abstract

Septic arthritis of the temporomandibular joint (SATMJ) is a rare entity that has only been reported a few dozen times worldwide. However, SATMJ is an acute infectious disease and associated with a high risk for misdiagnosis, which results in severe complications for patients. The present study reported a case of an 83-year-old female patient with severe pyogenic orofacial infections caused by right-side SATMJ, which was not cured by abscess incision drainage and anti-microbial treatment. Finally, the clinical signs were resolved by condylectomy and debridement of the erosive septic TMJ, after which the function of the TMJ was completely restored. In conclusion, a timely and correct diagnosis with early treatment is critical to preventing acute complications and late sequelae of SATMJ. In addition, literature associated with this topic was reviewed and discussed.

A case of septic arthritis of the temporomandibular joint with necrotic peri-articular infection and Lemierre’s syndrome: an unusual presentation

“…Subtle local and systemic manifestations of septic arthritis of the TMJ may lead to a delay in diagnosis, and it may also be underreported [ 2 ]. In their case report from 2017, Xiao et al describe a patient with a more severe infection, including extensive abscess formation requiring open surgical drainage as well as condylectomy [ 8 ]. It is, however, our impression that the majority of cases presented in the literature have a less severe course of disease.…”

“…A resultant hematoma could subsequently have been infected, either by hematogenous seeding or, less likely, contiguous spread from nearby structures. Joint trauma is considered a predisposing factor for hematogenous spread [ 2 , 8 , 12 ]. Six of the patients in the study by Cai and colleagues had a recent history of this, either by dislocation or blunt trauma to the TMJ [ 1 ].…”

“…Blood samples showed increased inflammatory markers with leucocytes at 18.8 cells per μL (3.5-10.0), sedimentation rate 58 mm (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), and C-reactive protein of 251 mg/L (< 4). Platelet count was low at 98 cells per μL (145-390), and creatinine was elevated at 172 μmol/L (60-105).…”

Clinical features and differential diagnosis of orofacial pain

“…De exemplu, cefaleea de tip tensional sau migrena sunt diagnosticate greșit ca sinuzită cronică sau disfuncţie temporo-mandibulară, nevralgiile trigeminale sau cefalea în ciorchine sunt confundate cu patologia dentară [10,13,19]. Prin urmare, un diagnostic eronat va duce la stabilirea unui plan de tratament incorect, fapt care denotă o progresie a patologiei respective și apariţia unor complicaţii care vor necesita ulterior o abordare mult mai complexă și de lungă durată [4,17].…”

“…For example, tension-type headache or migraine are misdiagnosed as chronic sinusitis or temporo-mandibular dysfunction, trigeminal neuralgia or cluster headache are confused with dental pathology [10,13,19]. Therefore, a misdiagnosis will lead to the establishment of an incorrect treatment plan, which indicates a progression of that pathology and the emergence of complications that will subsequently require a much more complex and long-term approach [4,17].…”