Barry Florent, Schlund Matthias, Guignardat Jean-François, Dubreuil Pierre-Antoine, Delmotte Constance, Ferri Joël, Nicot Romain
Department of Oral and Maxillofacial Surgery, U1008 - Advanced Drug Delivery Systems, Univ. Lille, CHU Lille, INSERM, Lille, F-59000, France.
Département universitaire de Chirurgie Maxillofaciale et Stomatologie Hôpital Roger Salengro, CHU de Lille, Boulevard du Professeur Emile Laine, Lille, 59037, France.
Rheumatol Int. 2025 Jan 13;45(1):28. doi: 10.1007/s00296-024-05754-7.
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.
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."
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.
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（TMJ）化脓性关节炎是一种罕见且常被误诊的疾病，症状不具有特异性。我们介绍13例TMJ化脓性关节炎的诊治经验，并对文献进行系统综述，以梳理该疾病的多种特征。
通过在PubMed、Cochrane图书馆、DOAJ和ClinicalTrials.gov中检索以下关键词：“TMJ化脓性关节炎”“颞下颌化脓性关节炎”“TMJ感染性关节炎”和“颞下颌感染性关节炎”，分析了62项研究中总共133例人类TMJ化脓性关节炎病例。
我们确定了TMJ化脓性关节炎的三种传播途径：血行传播、直接接种和局部蔓延。关节和风湿性疾病以及免疫调节疾病是危险因素。最常见的致病细菌属是葡萄球菌，其次是链球菌。致病细菌可通过细菌学分析确定。磁共振成像、计算机断层扫描（CT）和闪烁扫描可用于诊断，但在紧急情况下，CT是金标准。血液检查通常显示C反应蛋白浓度升高和白细胞计数升高。体征和症状包括耳前肿胀和牙关紧闭，较少见的有发热、同侧半侧面部疼痛、关节紊乱以及伴有下颌偏斜的错牙合。及时治疗是避免短期和长期并发症的关键，因为粒细胞产生的蛋白水解酶可在7天内造成不可逆损伤。抗生素治疗、关节成形术和物理治疗是常用的治疗方式。
TMJ化脓性关节炎因其非特异性临床表现可能被误诊。可能会出现并发症，因此及时有效的治疗是关键。
