Infectious arthritis and the temporomandibular joint. A review

Management of Septic Arthritis of the Temporomandibular Joint in Dogs

“…In contrast, septic arthritis of the TMJ is considered a "high inflammatory" arthritis and is presented with a pronounced pain and dysfunction (i.e., limitation in the range of motion), stiffness, swelling, and potentially the presence of a draining tract. Septic TMJ is typically caused by bacteria, fungi, viruses, or parasites (6,7,25,26).…”

“…While it may be difficult to assert the precise initiating cause of septic arthritis of the TMJ, we observed and reported, from a literature point of view, the following four potential scenarios: local dissemination of infection from adjacent anatomical structures, such as the inner ear/tympanic bulla that acts as a continuous focus of infection; trauma (i.e., direct inoculation by a dog bite); penetrating stick injury to the pharyngeal area; or migration of microorganisms from a distant site via hematogenous spread (1-3, 18, 19, 27-29). Regardless of the source and cause, once infection of the joint is established, articular destruction ensues and typically progresses rapidly (6,30). The rapid proliferation of bacteria within the synovial fluid and membrane-induced activation of the inflammatory cascade result in the influx of macrophages, neutrophils, and synoviocytes, as well as in the accumulation of various high levels of pro-inflammatory cytokines and chemotactic molecules (6,31,32).…”

“…Septic arthritis of the temporomandibular joint (TMJ) is a rare condition that occurs by seeding pathogens, typically bacteria, by hematogenous route or by direct spread into the joint (1)(2)(3)(4)(5)(6). Unlike osteoarthritis of the joint that is considered "low inflammatory" arthritis, septic TMJ arthritis is considered a "high-inflammatory" arthritis and exhibits distinct biological and clinical behavior (6,7). The development of TMJ septic arthritis is dependent on various factors, such as the pathogen (i.e., bacteria, fungi, or parasite) and its ability to colonize the joint and host-related factors (6).…”

“…Unlike osteoarthritis of the joint that is considered "low inflammatory" arthritis, septic TMJ arthritis is considered a "high-inflammatory" arthritis and exhibits distinct biological and clinical behavior (6,7). The development of TMJ septic arthritis is dependent on various factors, such as the pathogen (i.e., bacteria, fungi, or parasite) and its ability to colonize the joint and host-related factors (6).…”

“…Affected individuals typically exhibit periauricular pain, pain when opening and closing the mouth, swelling, redness, and occasionally purulent discharge (6,(8)(9)(10). Diagnosis of TMJ septic arthritis requires a physical examination and advanced diagnostic imaging, namely CT, cone-beam CT (CBCT), and, occasionally, MRI.…”