Department of Oral and Maxillofacial Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan.
Departments of Neurosurgery, University of Yamanashi, Chuo City, Yamanashi, Japan.
Medicine (Baltimore). 2023 Jul 7;102(27):e34177. doi: 10.1097/MD.0000000000034177.
Infections that spread to the pterygomandibular muscle can be misdiagnosed as temporomandibular disorder (TMD) because of the resulting difficulty in opening the mouth. Importantly, infection of the pterygomandibular space can extend to the skull base in the early stages, and a delay in therapeutic intervention can lead to severe complications.
A 77-year-old Japanese man with trismus after pulpectomy was referred to our department. This case report describes a rare instance of meningitis with septic shock caused by an odontogenic infection, initially misdiagnosed as TMD due to similar symptoms, leading to life-threatening complications.
The patient was diagnosed with sepsis and meningitis resulting from cellulitis in the pterygomandibular space caused by iatrogenic infection after pulpectomy of the right upper second molar.
After emergency hospitalization, the patient developed septic shock and required blood purification. Subsequently, abscess drainage and extraction of the causative tooth were performed. However, the patient developed hydrocephalus secondary to meningitis and underwent ventriculoperitoneal shunting to alleviate the condition.
The infection was controlled and the patient level of consciousness improved following treatment for hydrocephalus. The patient was transferred to a hospital for rehabilitation on the 106th day of hospitalization.
Infections of the pterygomandibular space may be misdiagnosed as TMD, owing to the main symptoms of restricted mouth opening and pain on mouth opening. A prompt and appropriate diagnosis is crucial because these infections can lead to life-threatening complications. A detailed interview, along with additional blood tests and computed tomography (CT) scans, can aid in making an accurate diagnosis.
由于张口困难，扩散到翼下颌肌的感染可能被误诊为颞下颌关节紊乱（TMD）。重要的是，翼下颌间隙的感染在早期可向颅底扩展，如果治疗干预延迟，可能会导致严重的并发症。
一名 77 岁的日本男性，因牙髓切除术后出现牙关紧闭，被转至我科。本病例报告描述了一例罕见的牙源性感染引起的脑膜炎伴感染性休克，由于症状相似，最初被误诊为 TMD，导致危及生命的并发症。
该患者被诊断为由于牙髓切除术后第二磨牙右上牙的医源性感染引起的翼下颌间隙蜂窝织炎导致的败血症和脑膜炎。
紧急住院后，该患者发生感染性休克，需要血液净化。随后进行脓肿引流和患牙拔除。然而，由于脑膜炎继发脑积水，患者接受了脑室-腹腔分流术以缓解病情。
感染得到控制，患者的意识水平在脑积水治疗后得到改善。患者于住院第 106 天转至康复医院。
翼下颌间隙感染可能被误诊为 TMD，因为其主要症状为张口受限和张口时疼痛。由于这些感染可能导致危及生命的并发症，因此及时、恰当的诊断至关重要。详细的访谈以及额外的血液检查和计算机断层扫描（CT）可以帮助做出准确的诊断。
