Wittig Joern, Borumandi Farzad, Gaggl Alexander, Hachleitner Johannes
Oral and Maxillofacial Surgery, University Hospital Salzburg, Salzburg, Austria.
BMJ Case Rep. 2018 Jun 11;2018:bcr-2017-223563. doi: 10.1136/bcr-2017-223563.
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.
颞下颌关节（TMJ）化脓性关节炎较为罕见，但确诊为此病的患者出现严重发病的风险很高。我们报告一例15岁男性患者，其出现牙关紧闭加重3天。他仅有右脸颊和颞部轻微不适及肿胀，怀疑为阻生智齿冠周炎。在静脉使用抗生素治疗后，疼痛缓解，但牙关紧闭和轻微肿胀仍存在。CT扫描显示颞下颌关节化脓性关节炎并伴有脓肿形成，脓肿穿透至硬膜外间隙。立即进行了引流和开颅手术。在静脉使用抗生素治疗下，患者完全康复。感染源仍未明确。据我们所知，这是首例报告的颞下颌关节化脓性关节炎蔓延至硬膜外间隙的病例。
