title: Septic arthritis of the temporomandibular joint: case reports and review of the literature.
abstract: BACKGROUND
  Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity.
  
  
  OBJECTIVE
  We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency physicians.
  
  
  METHODS
  In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned 1 mL of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharged home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than 3 weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later she underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; 20 months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint.
  
  
  CONCLUSIONS
  Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Eryka A
authors.initials: EA
authors.lastname: Gayle
authors.forename: Sean M
authors.initials: SM
authors.lastname: Young
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: McKenna
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D001178:Arthroplasty; D002648:Child; D003646:Debridement; D004322:Drainage; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D008297:Male; D010146:Pain / Q000382:microbiology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014081:Tooth Extraction / Q000009:adverse effects; D014313:Trismus / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Emergency Department (ED); adult; pediatric; septic arthritis; temporomandibular joint; trismus
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