Abstract
Septic arthritis of the temporomandibular joint (TMJ) is a rarely seen clinical condition. Such an infection may be encountered following infections in the head and neck region, with direct or haematogenous spread to the joint. This article presents the case of a patient with tonsillitis leading to septic arthritis of the TMJ and reports the results of a review of the literature.
Acute tonsillitis is a commonly encountered disease in daily practice. Despite the fact that most cases are treated effectively, clinicians may encounter certain complications. Peritonsillar abscess is the most commonly seen suppurative complication . This is usually a self-limiting condition and improves following drainage of the abscess and medical treatment. Rarely, inflammation may spread to the surrounding tissue.
Septic arthritis of the temporomandibular joint (TMJ) comprises a rare group of TMJ diseases and results from the spread of infection from another region to the joint by direct or haematogenous route. A small number of articles have been published reporting septic arthritis of the TMJ following infections in the head and neck region, including otitis externa, otitis media, and parotid gland infections ; septic arthritis of the TMJ after peritonsillar abscess does not appear to have been reported previously.
This article reports the case of a patient with septic arthritis of the TMJ after peritonsillar abscess.
Case report
A 55-year-old female patient was admitted to the clinic with a sore throat, fever, and pain on jaw movement, with restricted range of motion of the TMJ. She had been followed for 3 days by a primary care physician while taking analgesic and anti-inflammatory medications; after this period she had been prescribed an antibiotic due to ongoing fever. On the second day of antibiotic therapy, she started to complain of limitations in jaw movements and difficulty swallowing, accompanied by pain and discharge from her right ear. On physical examination, her general condition was fair and her body temperature was 39 °C. Further examination revealed a right-sided peritonsillar swelling, trismus, and tenderness and erythema of the TMJ on the right side. She also felt pain with every jaw movement and could only manage to open her lips to about 2 cm apart.
On otoscopic examination, there was granulation tissue on the anterior wall of the external ear canal. Laboratory findings included a white blood cell count of 23 × 10 9 /l with 72% neutrophils, C-reactive protein (CRP) of 14.2 mg/dl, and an erythrocyte sedimentation rate (ESR) of 46 mm/h.
The patient’s medical history was significant for poorly regulated non-insulin-dependent diabetes mellitus and her fasting blood glucose level was 350 mg/dl. She had no previous history of temporomandibular disease. She was hospitalized with a diagnosis of peritonsillar abscess.
The abscess was drained under local anaesthesia and a sample was obtained for bacterial culture. After debridement of the granulation tissue on the anterior wall of the external ear canal, erosion of the wall was observed, through which a purulent discharge was draining. Empiric antibiotics were administered. Computed tomography (CT) of the temporal bone revealed soft tissue density in mastoid cells, erosion of the anterior wall of the external ear canal, and a connection between the TMJ and external ear canal ( Fig. 1 ).
