title: Management of temporomandibular joint Coccidioidomycosis.
abstract: OBJECTIVE
  The aim of this report was to present the first known case of coccidioidomycosis involving the temporomandibular joint, review the literature regarding dissemination to the mandible, and to provide treatment recommendations for this challenging condition.
  
  
  METHODS
  Coccidioidomycosis of the mandibular condyle was identified in a 30-year-old Somali male residing in Arizona. Due to the difficulty of surgical access and the anticipated temporomandibular joint morbidity of radical condylar debridement, primary medical management was performed.
  
  
  RESULTS
  Marked symptomatic improvement was observed after 10 days of IV antifungal therapy. Resolution of the abscess with residual bony destruction was observed on CT scan. Based on the results of this patient and review of the literature, an algorithm is presented to help guide management of coccidioidomycosis dissemination to the mandible.
  
  
  CONCLUSIONS
  Prolonged antifungal therapy should be attempted for initial management of a Coccidioides abscess involving the condyle with early surgical intervention reserved for the more easily accessible and less functionally compromising portions of the mandible.
authors.affiliation: a Division of Plastic Surgery , Mayo Clinic , Rochester , MN , USA.
authors.forename: Ziyad S
authors.initials: ZS
authors.lastname: Hammoudeh
authors.affiliation: a Division of Plastic Surgery , Mayo Clinic , Rochester , MN , USA.|b Plastic Surgery , Maricopa Integrated Health System , Phoenix , AZ , USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lettieri
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D003047:Coccidioidomycosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008134:Long-Term Care; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D000666:Amphotericin B; D015725:Fluconazole
keywords: Coccidioidomycosis; Condyle; Infection; Mandible; TMJ; Temporomandibular joint