Septic arthritis in the temporomandibular joint

Abstract

Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male.Case Report:A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia's and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV) Ceftriaxone and IV Vancomycin via home infusion.Conclusion:Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.

Temporomandibular Joint Septic Arthritis

“… 8 , 12 If initial CT imaging is negative and clinical suspicion remains high, magnetic resonance imaging should be performed. 15 …”

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

“…Once SATMJ is suspected, joint aspiration is recommended to confirm it. The aspirated fluid and turbidity are required to be grossly examined for color as well as subjected to Gram staining, culture and sensitivity analysis ( 29 , 38 ). Owing to their relatively high accuracy and the high rate of the occurrence of bacteria in the synovial fluid, cultures are considered to be a credible method to definitively diagnose SATMJ, but not gonococcal arthritis.…”

“…An increasing body of evidence suggested that the detection of pathogens by microbiological culture is important for selecting a suitable and efficient antibiotic therapy ( 5 , 10 , 13 , 27 , 29 , 30 , 38 , 40 ). Although empiric antibiotic therapy may not be effective against certain pathogens, systemic antibiotics should be applied if a provisional diagnosis of SATMJ has been made, and a negative result of definitive bacterial culture should not delay early vigorous treatment.…”

“…Therefore, empiric antibiotics should be given until the pathogenic examinations are performed. The antibiotic treatment regime should be modified according to the culture and the sensitivity results, if they are available ( 5 , 10 , 13 , 27 , 29 , 30 , 38 , 40 ). It is generally advised that antibiotic therapy should be vigorous and the length of treatment should be at least 30 days ( 10 , 34 ).…”

Management of Septic Arthritis of the Temporomandibular Joint in Dogs

“…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).…”