Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and MD Candidate.
Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician.
J Oral Maxillofac Surg. 2021 Jun;79(6):1214-1229. doi: 10.1016/j.joms.2021.01.004. Epub 2021 Jan 14.
The purpose of this study was to describe the characteristics of the patient history, clinical findings, laboratory tests, treatment, and long-term function of septic arthritis of the temporomandibular joint (SATMJ).
All articles in the English literature related to SATMJ were queried using PubMed, Embase, and the Cochrane Library (1950 to July 1, 2020). The reference lists were reviewed for additional articles.
A preliminary search of the literature returned 241 results, of which 37 met inclusion criteria, with an additional article from reference review. There were 93 total cases, with a mean age of 35.7 years (0.1 to 85). Symptoms mostly consisted of pain in the temporomandibular joint/preauricular region (n = 84, 90.3%), trismus (n = 73, 78.5%), and facial/preauricular swelling (n = 68, 73.1%). Most patients had no systemic symptoms (n = 80, 86.1%). The mean degree of mouth opening was 13.1 mm (5 to 35). Diagnosis was made with the following imaging modalities: radiograph (n = 48, 51.6%), CT scan (n = 35, 37.6%), MRI (n = 25, 26.9%), and ultrasound (n = 3, 3.2%). Staphylococcus aureus (n = 19, 20.4%) was most commonly isolated. About 92 patients (98.9%) received antibiotics and 85 patients underwent surgery (eg, arthrocentesis, arthroscopy, etc.), of which 15 patients (17.6%) required repeat surgery. Most long-term outcomes were favorable. Sequelae occurred in 26 of 85 patients (30.6%) with documented follow-up.
SATMJ should be suspected in the presence of trismus, jaw pain, and preauricular swelling. Management includes prompt evaluation and treatment with broad-spectrum antibiotics. Surgery is not always indicated but can be life-saving in severe cases.
本研究旨在描述颞下颌关节（TMJ）感染性关节炎（SATMJ）的患者病史、临床发现、实验室检查、治疗和长期功能的特征。
使用 PubMed、Embase 和 Cochrane 图书馆（1950 年至 2020 年 7 月 1 日）检索与 SATMJ 相关的所有英文文献。并对参考文献进行了额外文章的综述。
初步文献检索返回 241 项结果，其中 37 项符合纳入标准，另外 1 项来自参考文献综述。共有 93 例患者，平均年龄为 35.7 岁（0.1 至 85 岁）。症状主要包括颞下颌关节/耳前区疼痛（n=84，90.3%）、牙关紧闭（n=73，78.5%）和面部/耳前肿胀（n=68，73.1%）。大多数患者无全身症状（n=80，86.1%）。张口度平均为 13.1mm（5 至 35）。以下影像学检查方式做出诊断：X 线（n=48，51.6%）、CT 扫描（n=35，37.6%）、MRI（n=25，26.9%）和超声（n=3，3.2%）。金黄色葡萄球菌（n=19，20.4%）最常被分离。约 92 例患者（98.9%）接受了抗生素治疗，85 例患者接受了手术（如关节穿刺术、关节镜检查等），其中 15 例（17.6%）需要再次手术。大多数长期预后良好。85 例有记录随访的患者中，26 例发生了后遗症。
出现牙关紧闭、颌痛和耳前肿胀时应怀疑 SATMJ。治疗包括及时进行广谱抗生素评估和治疗。并非所有患者都需要手术，但在严重情况下手术可能是救命的。
