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Merrill RL, Goodman D, Chamani G, Shabani M. A case of conversion disorder presenting as chronic trismus. SPECIAL CARE IN DENTISTRY 2024; 44:130-135. [PMID: 37026440 DOI: 10.1111/scd.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
Trismus can be the symptom of several diseases. For the most part, the inability to open the mouth is due to an articular disorder but occasionally, the cause may be extra-articular. In this case, being reported, non-articular hysterical trismus caused the jaw to lock in an 11-year-old boy for 3 months. During this period the jaw was completely locked and the locking was associated with moderate to severe pain. After three sessions of therapy the patient was able to open his mouth 33 mm and his eating was back to normal. Conversion disorders often present with dramatic physical presentation including trismus and jaw lock. This report highlights the importance of complete history taking and a thorough clinical examination to make a correct diagnosis in a patient with trismus.
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Affiliation(s)
| | - Donald Goodman
- Clinician, UCLA Orofacial Pain Department, Los Angele, USA
| | - Goli Chamani
- Department of Oral Medicine, Orofacial Pain Clinic, Kerman School of Dentistry, Kerman, Iran
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
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Ângelo DF, Mota B, Sanz D, Pimentel J. Septic arthritis of the temporomandibular joint managed with arthroscopy: a case report. Int J Oral Maxillofac Surg 2023; 52:1278-1281. [PMID: 37479607 DOI: 10.1016/j.ijom.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023]
Abstract
Septic arthritis of the temporomandibular joint (SATMJ) is an uncommon bacterial or fungal infection of the joint space. A 68-year-old man with underlying diabetes mellitus and a history of liver transplant, who was on immunosuppressants, presented to the oral and maxillofacial surgery department of the authors´ institution in Portugal. His main symptoms were arthralgia in the right temporomandibular joint, malocclusion, pre-auricular swelling and erythema. After clinical, laboratory, and imaging evaluations, diagnoses of chronic suppurative otitis media and SATMJ were made. The patient was managed with arthroscopy of the right temporomandibular joint, which allowed joint fluid collection for microbiological examination, lavage, and biopsy. The biopsy sample was positive for Pseudomonas aeruginosa. After surgery, targeted intravenous antibiotic treatment (amikacin) was given for 30 days. No recurrence of any complaints was reported after 12 months of follow-up.
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Affiliation(s)
- D F Ângelo
- Instituto Português da Face, Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - B Mota
- Centro Hospitalar Universitário Lisboa Norte (CHUNL), Lisbon, Portugal
| | - D Sanz
- Instituto Português da Face, Lisbon, Portugal
| | - J Pimentel
- Instituto Português da Face, Lisbon, Portugal
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Jovanović M, Milosavljević M, Zdravković D, Živić M, Veličković S, Janković S. Septic arthritis of the temporomandibular joint in adults: Systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:465-472. [PMID: 34628098 DOI: 10.1016/j.jormas.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/19/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Septic arthritis of the temporomandibular joint (SATMJ) is acute or chronic bacterial or fungal infection involving temporomandibular joint (TMJ) space. It is a disease with high mortality in whole body joints, and about three-fourths of survivors have residual malfunctioning of the affected joint. OBJECTIVE The aim of this review was to search systematically, evaluate and then summarize scientific literature about etiology, signs and symptoms, diagnosis, treatment and prognosis of the SATMJ in adults. METHODS After registration at PROSPERO this systematic review was conducted and reported according to the PRISMA checklist. The following databases were systematically searched: MEDLINE, EBSCO, The Cochrane Central Register of Controlled Trials (Central), SCIndex, Scopus, Google Scholar and Registry of clinical studies with human participants. RESULTS In total 37 studies with 91 patients were included in the review. Dominant signs and symptoms of SATMJ were pain and trismus, while fever was infrequent. The most frequent isolates from the TMJ were Staphylococcus aureus and Streptococci; however, less than 20% of patients had data about susceptibility of the isolates to antibiotics. Combination of third generation cephalosporin and metronidazole was the most frequently prescribed empirically, and antibiotics especially active against S. aureus (glycopeptides and anti-staphylococcal beta-lactams) were under-prescribed. Administration of antibiotics was prolonged (median over 30 days), although two weeks are sufficient treatment for SATMJ if right choice of antibiotics was made. There was high rate of repeated surgical interventions (53.5%), which were linked to higher risk of long-term functional defects. CONCLUSIONS The SATMJ is serious infection that requires early empiric administration of antibiotics with good coverage of Gram-positive bacteria, and subsequent correction of antibiotic therapy according to susceptibility of isolates. Appropriate antibiotic therapy decreases risk of long-term functional disorders.
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Affiliation(s)
- Milica Jovanović
- University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
| | - Marko Milosavljević
- University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia.
| | - Dejan Zdravković
- University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
| | - Miloš Živić
- University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
| | - Stefan Veličković
- University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
| | - Slobodan Janković
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia
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Arzi B, Vapniarsky N, Fulton A, Verstraete FJM. Management of Septic Arthritis of the Temporomandibular Joint in Dogs. Front Vet Sci 2021; 8:648766. [PMID: 33855056 PMCID: PMC8039310 DOI: 10.3389/fvets.2021.648766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (TMJ) in dogs and other mammals is a rare condition. It is typically associated with notable pain, swelling, and difficulty in opening the mouth. Unlike degenerative TMJ disease, septic arthritis requires urgent intervention. The etiology of the condition may include penetrating trauma, an extension of local infection, such as otitis media, or the hematogenous spread of a pathogen. However, the precise cause may not always be identified. Diagnostic imaging with Computed Tomography (CT), cone-beam CT (CBCT), and/or Magnetic Resonance Imaging (MRI) are helpful for honing the definitive diagnosis and formulating a treatment plan. Subsequently, exploratory surgery may be required to obtain samples for culture and sensitivity and histology and to lavage the joint. In this “methods” article, we provide a detailed description of our approach to diagnosis and management of septic TMJ arthritis in four dogs.
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Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Natalia Vapniarsky
- Department of Pathology, Microbiology and Immunology School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Amy Fulton
- Aggie Animal Dental Center, Mill Valley, CA, United States
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Omiunu A, Talmor G, Nguyen B, Vakil M, Barinsky GL, Paskhover B. Septic Arthritis of the Temporomandibular Joint: A Systematic Review. J Oral Maxillofac Surg 2021; 79:1214-1229. [PMID: 33716006 DOI: 10.1016/j.joms.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ariel Omiunu
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and MD Candidate.
| | - Guy Talmor
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Brandon Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Mayand Vakil
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Resident Physician
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and MD Candidate
| | - Boris Paskhover
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; and Assistant Professor, Facial Plastics & Reconstructive Surgery
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Dias Ferraz A, Spagnol G, Alves Maciel F, Monteiro Pinotti M, De Freitas RR. Septic arthritis of the temporomandibular joint: Case series and literature review. Cranio 2019; 39:541-548. [PMID: 31478470 DOI: 10.1080/08869634.2019.1661943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Septic arthritis of the temporomandibular joint (SATMJ) is a relatively uncommon condition in the adult population and can result in significant morbidity. This study reviewed seven cases of SATMJ, including their management and complications.Clinical Presentation: A retrospective study was performed on seven cases that developed SATMJ documented from 2011 to 2017. Seven cases demonstrated SATMJ that resulted in joint destruction and complications, such as mandibular osteomyelitis, vertebral osteomyelitis, bone erosion, ankylosis, and death. The management of these seven cases was presented, as well as the treatment outcomes.Clinical Relevance: SATMJ should be treated aggressively, as it may cause severe damage to the TMJs and adjacent tissues, which could lead to loss of function, malocclusion, and potentially fatal complications.
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Affiliation(s)
- Alexandre Dias Ferraz
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Guilherme Spagnol
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Fernando Alves Maciel
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Manuela Monteiro Pinotti
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Thomas N, Harper D, Aronovich S. Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease? Br J Oral Maxillofac Surg 2018; 56:96-100. [DOI: 10.1016/j.bjoms.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
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Temporomandibular Joint Septic Arthritis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1648. [PMID: 29464173 PMCID: PMC5811303 DOI: 10.1097/gox.0000000000001648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022]
Abstract
Infection of the temporomandibular joint (TMJ) is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.
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Araz Server E, Onerci Celebi O, Hamit B, Yigit O. A rare complication of tonsillitis: septic arthritis of the temporomandibular joint. Int J Oral Maxillofac Surg 2017; 46:1118-1120. [DOI: 10.1016/j.ijom.2017.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/14/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
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Severe septic arthritis of the temporomandibular joint with pyogenic orofacial infections: A case report and review of the literature. Exp Ther Med 2017; 14:141-146. [PMID: 28672905 PMCID: PMC5488428 DOI: 10.3892/etm.2017.4510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (SATMJ) is a rare entity that has only been reported a few dozen times worldwide. However, SATMJ is an acute infectious disease and associated with a high risk for misdiagnosis, which results in severe complications for patients. The present study reported a case of an 83-year-old female patient with severe pyogenic orofacial infections caused by right-side SATMJ, which was not cured by abscess incision drainage and anti-microbial treatment. Finally, the clinical signs were resolved by condylectomy and debridement of the erosive septic TMJ, after which the function of the TMJ was completely restored. In conclusion, a timely and correct diagnosis with early treatment is critical to preventing acute complications and late sequelae of SATMJ. In addition, literature associated with this topic was reviewed and discussed.
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