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The Chinese Journal of Dental Research

Year 2003
Volume 6 , Issue 4

Pages: 39 - 43

Septic Arthritis of the Temporomandibular Joint

Chi Yang/Xieyi Cai/Zhiyuan Zhang/Weiliu Qui/Qi Ha/Xudong Wang

Objective: To investigate the clinical characteristics and the procedure of early diagnosis and treatment of septic arthritis of the temporomandibular joint (TMJ). Materials and Methods: This study involved 33 consecutive patients (32 adults and 1 child) diagnosed with TMJ septic arthritis from 1995 to 2002. Physical examinations, joint fluid analyses, radiographic imaging, and laboratory studies were performed in all cases. All 33 patients were treated with antibiotic therapy, resting of the jaw and local therapies. Therapeutic effects were judged according to joint cavitiy puncture, mouth opening, and jaw pain and function. Sequelae were evaluated after follow-up. Results: Infection of the JMJ was mostly hematogenous, and the original infectious sites could not be found in many cases. The obvious inflammatory symptoms of TMJ and severe morbidity were not detected in most of the cases (28/33), and a high level of polymorphonuclear cells, and some fibro-protein or cartilage fragments were seen in the synovial fluid. Microorganisms were found with Gram staining in 15 cases, but the culture of bacteria only succeeded in 5 cases. S. saprophyticus and S. aureus were the most common bacteria to be isolated. The overall success rate of the treatment was 100%. The sequelae were mild, and most of the cases had only postinfectious osteoarthritis. Conclusion: Some new characteristics of TMJ septic arthritis have been found, such as occult original infectious sites, atypical and mild symptoms, and slight sequelae. Joint fluid analysis is necessary for diagnosis. Low-pressure arthrocentesis is recommended for treatment in acute septic arthritis. TMJ arthroscope can be recommended to those who have not got good results by arthrocentesis or have sequelae already.



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