Septic Temporomandibular Arthritis in Children: Rare but Disabling

By Reuters Staff

March 07, 2017

NEW YORK (Reuters Health) - Septic arthritis of the temporomandibular joint (SATMJ) rarely complicates pediatric middle ear infections, but it can lead to disabling and hard to treat TMJ ankylosis, researchers from France report.

Because only a handful of cases of pediatric SATMJ complicating middle ear infection have been published, Dr. Vincent Couloigner from Hopital Necker-Enfants Malades APHP in Paris and colleagues reviewed the symptoms, imaging characteristics, natural course, and treatment of otogenic SATMJ in nine children (ages, 6 months to 4.7 years).

The primary infection in most children was acute mastoiditis (seven children, 78%); the other two children had acute otitis media, according to the March 2nd JAMA Otolaryngology Head and Neck Surgery online report.

All nine children presented with fever. Five had preauricular swelling, and one had trismus. Complications included lateral sinus thrombosis in six children, epidural empyema in two children, and pneumocephalus and parapharyngeal abscess in one child each. Another child had both meningitis and epidural empyema.

Radiological anomalies of the TMJ were detected in four children during the initial middle ear infection, whereas radiological signs of SATMJ for the other five children were missed by the initial radiological interpretation (but clearly identified during a second review).

Fusobacterium necrophorum was isolated in four patients, but, surprisingly, cultures yielded no group A streptococcus.

The seven children with acute mastoiditis underwent mastoidectomy as their initial treatment, and three children diagnosed with SATMJ during the initial infection underwent physical therapy (jaw opening exercises) for several months.

Six patients went on to develop TMJ ankylosis within one to three years after the initial middle ear infection, and five of these children required surgery to relieve trismus and other symptoms.

“Because of the possibility of asymptomatic cases, the TMJ should be systematically and accurately analyzed on CT scans performed on children with acute mastoiditis,” the researchers conclude. “Further prospective studies that include larger cohorts will be necessary to determine the incidence and the optimal treatment of otogenic SATMJ.”

Dr. Couloigner did not respond to a request for comments.


JAMA Otolaryngol Head Neck Surg 2017.