Septic arthritis of the temporomandibular joint leading to an epidural abscess

Abstract

Septic arthritis of the temporomandibular joint (TMJ) is rare, but patients with this diagnosis are at high risk for significant morbidity. We present a case of a 15-year-old man who presented with increasing trismus for 3 days. He had only minimal discomfort and swelling of the right cheek and temporal region, and pericoronitis of an impacted wisdom tooth was suspected. Under intravenous antibiotics, pain subsided, but trismus and a slight swelling remained. CT scan showed septic arthritis of the TMJ with an abscess formation penetrating into the epidural space. Immediate drainage and craniotomy were performed. Under intravenous antibiotics, the patient made a full recovery. The source of infection remained undetermined. To our knowledge, this is the first reported case of septic arthritis of the TMJ spreading into the epidural space.

Peritonsillar abscess due to temporomandibular joint septic arthritis: an uncommon cause of a common disease

“…Gayle et al has reported such unusual complication with involvement of masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base 4. Wittig et al has reported a case of epidural abscess after septic arthritis of temporomandibular abscess which was managed by craniotomy and drainage 5. Doving et al reported cerebral abscess and Lemierre’s syndrome in a man in his early 70s and managed successfully with aggressive treatment 6.…”

“…Majority of these cases respond to treatment but distant spread can occur rarely depending on the general condition of the host and virulence. Unusual spread has been found in the deep neck spaces, epidural space and cerebrum 4–6…”

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

“…In addition to severe locoregional findings, our patient developed an intracranial abscess. Cerebral abscesses are rare complications of maxillofacial infections, including septic arthritis of the TMJ, with streptococci being the most common reported etiology [ 6 , 9 , 10 ]. Streptococci were also the offending bacterial agent in our case.…”

“…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).…”

“…Septic arthritis of the TMJ is caused by hematogenous spread, iatrogenic inoculation, and contiguous spread from adjacent structures or trauma [ 1 , 5 ]. Streptococci, staphylococci, Haemophilus influenzae , and Neisseria gonorrhoeae are the most common etiologies [ 1 , 2 , 6 ]. Suggested therapies include antibiotics, needle aspiration, arthrotomy, and arthroscopy with lavage [ 3 ].…”