Septic arthritis of the temporomandibular joint: case reports and review of the literature.
Septic arthritis of the temporomandibular joint: case reports and review of the literature.
复制标题
DOI：
10.1016/j.jemermed.2013.01.034
复制
发表时间：
2013-11
影响因子：
1.5
通讯作者：
McNaughton, Candace D.
中科院分区：
文献类型：
--
作者：
Gayle, Eryka A.;Young, Sean M.;McKenna, Samuel J.;McNaughton, Candace D.
脓毒性关节炎的颞下颌关节（TM）是罕见的，但它是相关的高风险显著发病率。我们回顾了有关TM关节感染性关节炎的表现、评估、治疗和临床病程的现有文献，重点关注与急诊医师相关的因素。在第一例病例中，一名健康的6岁男孩表现为发烧和咬牙；计算机断层扫描显示TM关节积液。经经验性静脉注射抗生素后，术中TM关节穿刺回絮状液1毫升，培养并生长泛敏感化脓性链球菌。他出院时服用阿莫西林/克拉维酸酯，症状完全缓解。在第二个病例中，一名18岁的女性在拔下第三颗磨牙三周多后出现面部疼痛、肿胀和牙关紧闭，并发现有一个局部脓肿，累及左侧咬肌和翼状下颌间隙，并延伸到左侧颞深区和颅底。她经历了一个复杂的术后过程，需要多次手术和静脉注射抗生素来治疗多种细菌的生长。一个多月后，因TM关节脓毒性关节炎行TM关节切开术，发现急性骨髓炎。她继续需要多种治疗方式；初次就诊20个月后，患者因颞下颌关节纤维强直接受左侧全颞下颌关节置换术。TM关节脓毒性关节炎可能是由于远端感染的血行扩散或咀嚼间隙深部感染的局部扩散引起的。患者可表现为急性或亚急性TM关节感染性关节炎。脓毒性关节炎的TM关节应考虑在鉴别诊断的患者谁表现为牙关和疼痛或发烧。
Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency medicine physicians. In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned one milliliter of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharge home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than three weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; twenty months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.
登录
查看更多内容
影响因子：
3.6
作者：
Viraraghavan, R;Kelly, L;Obeid, G
通讯作者：
Obeid, G
DOI：
10.1016/j.bjoms.2007.04.019
发表时间：
2008-04-01
影响因子：
1.8
作者：
Amos, M. J.;Patterson, A. R.;Worrall, S. F.
通讯作者：
Worrall, S. F.
影响因子：
1.9
作者：
Goldschmidt, MJ;Butterfield, KJ;Goldberg, MH
通讯作者：
Goldberg, MH
DOI：
10.1016/j.bjoms.2008.01.005
发表时间：
2008-09-01
影响因子：
1.8
作者：
Parmar, Jiten
通讯作者：
Parmar, Jiten
DOI：
10.1016/j.tripleo.2006.08.028
发表时间：
2007-02-01
期刊：
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY AND ENDODONTOLOGY
影响因子：
--
作者：
Sembronio, Salvatore;Albiero, Alberto Maria;Politit, Massimo
通讯作者：
Politit, Massimo