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Septic arthritis of the temporomandibular joint in adults: Systematic review
Milica Jovanović1, Marko Milosavljević1, Dejan Zdravković1
1University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia.
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.
Insights
Septic arthritis of the temporomandibular joint (SATMJ) is a severe infection. Early antibiotic treatment targeting Gram-positive bacteria, with adjustments based on susceptibility, is crucial for better outcomes and reduced long-term issues.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Microbiology
Background:
- Septic arthritis of the temporomandibular joint (SATMJ) is a serious bacterial or fungal infection of the temporomandibular joint (TMJ) space.
- This condition carries a high mortality rate and often results in residual joint dysfunction in survivors.
Purpose of the Study:
- To systematically review and summarize the existing literature on the etiology, clinical presentation, diagnosis, treatment, and prognosis of SATMJ in adults.
- To identify optimal management strategies and potential areas for improved patient outcomes.
Main Methods:
- A systematic review was conducted and reported following the PRISMA checklist.
- Searches were performed across multiple databases including MEDLINE, Scopus, and Google Scholar, including clinical studies with human participants.
Main Results:
- A total of 37 studies involving 91 patients were analyzed.
- Pain and trismus were the most common symptoms; fever was infrequent. Staphylococcus aureus and Streptococci were the predominant isolates.
- Antibiotic therapy was often prolonged, with a high rate of surgical interventions linked to poorer functional outcomes. Empiric treatment frequently lacked adequate coverage for S. aureus.
Conclusions:
- SATMJ necessitates prompt empiric antibiotic administration, prioritizing Gram-positive bacterial coverage.
- Tailoring antibiotic therapy based on isolate susceptibility and avoiding prolonged treatment durations can mitigate the risk of long-term functional deficits.
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