Temporomandibular joint septic arthritis: a report of thirteen cases and a systematic review of the literature.

IF 3.2 3区 医学 Q2 RHEUMATOLOGY
Florent Barry, Matthias Schlund, Jean-François Guignardat, Pierre-Antoine Dubreuil, Constance Delmotte, Joël Ferri, Romain Nicot
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引用次数: 0

Abstract

Introduction: Temporomandibular joint (TMJ) septic arthritis is a rare frequently misdiagnosed condition with non-specific symptoms. We present our experience of thirteen cases of TMJ septic arthritis and perform a systematic review of the literature to collate the multiple characteristics of this condition.

Material and method: A total of 133 cases of TMJ septic arthritis in humans across 62 studies were analyzed by searching PubMed, Cochrane Library, DOAJ and ClinicalTrials.gov using the following search terms: "TMJ septic arthritis," "Temporomandibular septic arthritis," "TMJ infectious arthritis," and "Temporomandibular infectious arthritis."

Results: We identified three routes of TMJ septic arthritis dissemination: the hematogenous route, direct inoculation, and local contiguity. Joint and rheumatic pathologies and immunomodulatory diseases are risk factors. The most frequently causative bacterial genus is Staphylococcus, followed by Streptococcus. Causative bacteria can be identified by bacteriological analysis. Magnetic resonance imaging, computed tomography (CT), and scintigraphy can be used for diagnosis, but CT is the gold standard in an emergency setting. Blood tests often reveal a high C-reactive protein concentration and high leukocyte counts. Signs and symptoms include preauricular swelling and trismus, and, less commonly, fever, ipsilateral hemifacial pain, joint disorder, and malocclusion with mandibular deviation. Timely treatment is key to avoid short and long-term complications, because proteolytic enzymes from granulocytes can cause irreversible damage within 7 days. Antibiotic therapy, arthroplasty, and physiotherapy are commonly used treatment modalities.

Conclusion: TMJ septic arthritis can be misdiagnosed due to its non-specific clinical manifestations. Complications can occur; thus, timely and effective treatment is key.

颞下颌关节化脓性关节炎:十三例病例报告及文献系统回顾。
摘要:颞下颌关节(TMJ)脓毒性关节炎是一种罕见且常被误诊的疾病,其症状无特异性。我们报告了13例颞下颌关节脓毒性关节炎的病例,并对文献进行了系统的回顾,以整理这种疾病的多种特征。材料和方法:通过检索PubMed、Cochrane Library、DOAJ和ClinicalTrials.gov,通过以下检索词:“TMJ脓毒性关节炎”、“颞下颌脓毒性关节炎”、“TMJ感染性关节炎”和“颞下颌感染性关节炎”,对62项研究中133例人类TMJ脓毒性关节炎进行分析。结果:我们确定了TMJ脓毒性关节炎的三种传播途径:血液途径、直接接种途径和局部邻近途径。关节和风湿病以及免疫调节疾病是危险因素。最常见的致病菌属是葡萄球菌,其次是链球菌。病原细菌可通过细菌学分析鉴定。磁共振成像、计算机断层扫描(CT)和闪烁成像可用于诊断,但CT是紧急情况下的金标准。血液检查经常显示高c反应蛋白浓度和高白细胞计数。体征和症状包括耳前肿胀和牙关紧闭,少数情况下有发热、同侧半面疼痛、关节紊乱和错颌畸形。及时治疗是避免短期和长期并发症的关键,因为粒细胞的蛋白水解酶可在7天内造成不可逆的损伤。抗生素治疗、关节置换术和物理治疗是常用的治疗方式。结论:TMJ脓毒性关节炎临床表现不明确,易误诊。并发症可能发生;因此,及时有效的治疗是关键。
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来源期刊
Rheumatology International
Rheumatology International 医学-风湿病学
CiteScore
7.30
自引率
5.00%
发文量
191
审稿时长
16. months
期刊介绍: RHEUMATOLOGY INTERNATIONAL is an independent journal reflecting world-wide progress in the research, diagnosis and treatment of the various rheumatic diseases. It is designed to serve researchers and clinicians in the field of rheumatology. RHEUMATOLOGY INTERNATIONAL will cover all modern trends in clinical research as well as in the management of rheumatic diseases. Special emphasis will be given to public health issues related to rheumatic diseases, applying rheumatology research to clinical practice, epidemiology of rheumatic diseases, diagnostic tests for rheumatic diseases, patient reported outcomes (PROs) in rheumatology and evidence on education of rheumatology. Contributions to these topics will appear in the form of original publications, short communications, editorials, and reviews. "Letters to the editor" will be welcome as an enhancement to discussion. Basic science research, including in vitro or animal studies, is discouraged to submit, as we will only review studies on humans with an epidemological or clinical perspective. Case reports without a proper review of the literatura (Case-based Reviews) will not be published. Every effort will be made to ensure speed of publication while maintaining a high standard of contents and production. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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