[Childhood septic temporomandibular arthritis]

OBJECTIVE

To report a clinical case of acute otitis media in a child, complicated by septic temporomandibular arthritis and to present a review of the literature.

PATIENT AND METHODS

We report a case of a 7-year-old boy who presented an altered general condition, major hyperthermia, associated with a left temporozygomatic mass in a context of recurrent bilateral acute otitis media lasting for 2 months. Emergency computed tomodensitometry (CT scan) showed left temporomandibular joint arthritis. Treatment consisted of a parenteral double antibiotic therapy and prevention of temporomandibula (TM) ankylosis.

RESULTS

After 20 months of follow-up, the child showed a normal ORL examination with no maxillofacial sequelae.

CONCLUSION

All temporozygomatic masses presenting in a septic context should suggest the diagnosis of TM arthritis; computed tomodensitometry should be done immediately.

[Deep cerebral venous thrombosis]

Deep cerebral venous system thrombosis is uncommon and is usually encountered in children, generally in the neonatal period. In adults, this pathology is even more exceptional. We report two cases in adults. Deep cerebral venous system thrombosis mainly affects women taking oral contraception. The most common clinical pattern combines headaches and confusion. A comatose state is rather exceptional. This pathology, formerly considered to have poor prognosis, has benefited from diagnostic and therapeutic progress. Favorable outcome has been achieved in several recent cases, as one of ours, without after-effects. Diagnosis, often suggested by the CT-scan, is based on MRI associated with MRA. Thrombus formation is easily diagnosed by MRI at the subacute stage, but far less easily at the acute and chronic stages as the low signal is identical to the normal flow void. MRA, in phase contrast or time of flight sequences, is highly interesting at the acute phase. In case of doubt, an angiography can be applied. Therapy is based on heparin. The contribution of local infusion of thrombolytic agents, recently used with success, remains to be determined.