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Pediatric temporomandibular joint (TMJ) arthritis, an elusive complication of acute mastoiditis
Smadar Cohen Atsmoni1, Anusha Hennedige1, David Richardson1
1Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Introduction:
Septic arthritis of the Temporomandibular joint (TMJ) is a rare complication of acute middle ear infection. Presentation is elusive and could be easily missed. Often diagnosis is made only with consequential development of TMJ ankylosis. This study intends to characterize patients and course of disease and suggest a diagnostic and therapeutic strategy.
Methods:
Retrospective review of all children diagnosed with TMJ arthritis and/or TMJ ankylosis secondary to acute middle ear infection, treated in a tertiary pediatric medical center between the years 2005 and 2021.
Result:
Seven patients were identified with otogenic TMJ arthritis. Median age at presentation was 1.14 years (IQ range 1.1-1.5). All seven were diagnosed with acute mastoiditis. CT scans demonstrated TMJ related collections in 5/7 and intracranial complications in 3/7. Treatment included cortical mastoidectomy for 5/7. One patient had a concomitant surgical washout of the TMJ. Two patients had drainage only of subperiosteal collections. Six of the seven patients went on to develop TMJ ankylosis that presented within a median of 2.8 years (IQ range 2.6-3.9) after the episode of acute mastoiditis. All six patients presented with trismus and facial growth anomalies, and all but one required surgery to release the ankylosis.
Conclusion:
Otogenic TMJ arthritis develops mostly in young children with acute mastoiditis and intratemproal and/or intracranial suppuration. Imaging is helpful in making the diagnosis, with TMJ related collections on CT being the most common finding. TMJ ankylosis can develop within a few years and present with trismus and abnormal facial growth. Cortical mastoidectomy does not seem to prevent ankylosis. It remains unclear whether focused treatment to the TMJ or physiotherapy could be beneficial in that.
Insights
Septic arthritis of the Temporomandibular joint (TMJ) in children, often stemming from middle ear infections, frequently leads to TMJ ankylosis. Early diagnosis and targeted TMJ treatment are crucial to prevent long-term complications like trismus and facial deformities.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Infectious Diseases
- Pediatric Rheumatology
Background:
- Septic arthritis of the Temporomandibular joint (TMJ) is a rare but serious complication of acute middle ear infections.
- Early presentation can be subtle, often leading to delayed diagnosis until TMJ ankylosis develops.
- This study aims to define patient characteristics, disease progression, and optimal diagnostic and therapeutic strategies.
Purpose of the Study:
- To characterize the clinical presentation and disease course of otogenic TMJ arthritis in children.
- To identify key diagnostic findings, particularly on imaging.
- To evaluate treatment outcomes and propose a diagnostic and therapeutic strategy to prevent TMJ ankylosis.
Main Methods:
- Retrospective review of pediatric patients diagnosed with TMJ arthritis and/or ankylosis secondary to acute middle ear infection.
- Data collected from a tertiary pediatric medical center between 2005 and 2021.
- Analysis included patient demographics, clinical presentation, imaging findings (CT scans), and treatment interventions.
Main Results:
- Seven pediatric patients with otogenic TMJ arthritis were identified, all with acute mastoiditis.
- CT scans revealed TMJ collections in 5/7 patients and intracranial complications in 3/7.
- Six patients developed TMJ ankylosis within a median of 2.8 years, presenting with trismus and facial growth anomalies, often requiring surgical intervention.
Conclusions:
- Otogenic TMJ arthritis predominantly affects young children with acute mastoiditis and associated suppuration.
- CT imaging demonstrating TMJ collections is a key diagnostic indicator.
- TMJ ankylosis is a common sequela, and current treatments like cortical mastoidectomy do not prevent its development; further research into TMJ-focused therapies is needed.
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