Cai Xie-Yi, Yang Chi, Zhang Zhi-Yuan, Qiu Wei-Liu, Chen Min-Jie, Zhang Shan-Yong
Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China.
J Oral Maxillofac Surg. 2010 Apr;68(4):731-8. doi: 10.1016/j.joms.2009.07.060. Epub 2009 Dec 2.
Septic arthritis of the temporomandibular joint is an uncommonly reported entity. The aim of the present study was to review the cases treated at our clinic, analyze the characteristics of this disease and the responses to management, and recommend a protocol for managing suspected cases.
A total of 40 consecutive patients were included from 1995 to 2007. Their demographics, predisposing factors, clinical manifestations, radiologic findings, joint fluid analysis results, treatment, and outcomes were reviewed.
The 40 patients included 26 men and 14 women, with an average age of 36 years. Original infections were found in 15 patients (local spread in 4 and hematogenous dissemination from a distant site in 11). All patients complained of trismus and tenderness in the temporomandibular joint. Sudden malocclusion was found in 33 patients. Joint space widening and limitation of condyle movement were demonstrated by plain film in 33 patients. Increased joint effusion was confirmed by magnetic resonance imaging in 7 patients. Joint fluid was obtained from 35 patients. A high level of neutrophils and fibrin were found under microscopy with hematoxylin-eosin staining. Staphylococcus saprophyticus and S. aureus were cultured from 5 patients. Arthrocentesis under low pressure was applied to 35 patients, and arthroscopy was used in 9 patients. Major sequelae occurred in 11 patients, including fibrosis in 2 and postinfectious osteoarthritis in 9.
Septic arthritis of the temporomandibular joint mainly arises from hematogenous spread, but the original infection is often occult. Antibiotic therapy, arthrocentesis under low pressure, and joint immobilization are recommended for patients in the acute stage. The common sequela is osteoarthritis.
颞下颌关节化脓性关节炎是一种报道较少见的疾病。本研究的目的是回顾在我们诊所治疗的病例，分析该疾病的特征及对治疗的反应，并推荐疑似病例的管理方案。
纳入1995年至2007年连续就诊的40例患者。回顾了他们的人口统计学资料、易感因素、临床表现、影像学检查结果、关节液分析结果、治疗方法及预后。
40例患者中，男性26例，女性14例，平均年龄36岁。15例患者发现有原发感染（4例为局部扩散，11例为远处部位血行播散）。所有患者均主诉颞下颌关节张口受限和压痛。33例患者出现突然咬合不正。33例患者X线平片显示关节间隙增宽及髁突运动受限。7例患者磁共振成像证实关节积液增加。35例患者获取了关节液。苏木精-伊红染色显微镜检查发现中性粒细胞和纤维蛋白水平较高。5例患者培养出腐生葡萄球菌和金黄色葡萄球菌。35例患者采用低压关节穿刺术，9例患者采用关节镜检查。11例患者出现主要后遗症，包括2例纤维化和9例感染后骨关节炎。
颞下颌关节化脓性关节炎主要源于血行播散，但原发感染往往隐匿。急性期患者建议采用抗生素治疗、低压关节穿刺术及关节制动。常见后遗症是骨关节炎。
