Differential Diagnosis and Treatment of Septic Arthritis in the Temporomandibular Joint: A Case Report and Literature Review

Abstract

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon disease caused by microbial pathogens through hematogenous infection, local spread, or iatrogenic infection. As the symptoms have an insidious onset, the early stage of septic arthritis is often confused with other diseases. A 49-year-old man was referred for increasing preauricular pain, swelling, and restricted mouth opening. He had been initially diagnosed as having a conventional temporomandibular joint disorder and trigeminal neuralgia and had been treated for the same. Imaging studies including panoramic view, lateral tomography, computed tomography with contrast enhancement, and magnetic resonance imaging were performed. Erosive bone change with displacement of the involved condyle, diffuse swelling of adjacent soft tissue, and fluid collection in the joint space were noted. Needle aspiration of the joint space and bacterial culture confirmed the diagnosis of septic arthritis of the TMJ and he was treated with antibiotic therapy and surgical drainage. Clinicians should always consider the diagnosis of septic arthritis of the TMJ in patients with preauricular pain or swelling.

Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

“…The signs that are found are mostly fever and signs of inflammation-edema, erythema, and pain in peri-auricular area. The signs of dysfunction are trismus, asymmetry of bite, and posterior subluxation of the mandible [6,9,10].…”

“…Needle aspiration has both diagnostic and therapeutic relevance, by providing bacteriological diagnostic confirmation and decompression of TMJ articulation [9].…”

“…Complications of septic arthritis of TMJ are infectious, functional, and esthetic, including ankyloses of TMJ, osteomyelitis, and facial asymmetry [9,10,15]. Among pediatric patients, facial asymmetry due to deficient mandibular growth caused by injury to the growth plate under the fibrocartilage covering the condylar head is a redoubtable complication [15].…”