Abstract：
BACKGROUND: 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.
RESULTS: 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.
CONCLUSIONS: 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.
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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：颞下颌关节（TMJ）化脓性关节炎是一种罕见的急性中耳感染并发症。演示文稿难以捉摸，很容易错过。通常仅随着TMJ强直的发展而进行诊断。这项研究旨在表征患者和病程，并提出诊断和治疗策略。
方法：回顾性回顾所有诊断为急性中耳感染继发的TMJ关节炎和/或TMJ强直的儿童，2005年至2021年期间在三级儿科医疗中心接受治疗。
结果：7例患者被确定为耳源性TMJ关节炎。演示时的中位年龄为1.14岁（IQ范围1.1-1.5）。所有7人都被诊断为急性乳突炎。CT扫描显示5/7的TMJ相关集合和3/7的颅内并发症。治疗包括皮质乳突切除术5/7。一名患者同时进行了TMJ手术冲洗。两名患者仅引流骨膜下集合。7例患者中有6例继续发展为TMJ强直，在急性乳突炎发作后的中位数为2.8年（IQ范围为2.6-3.9）。所有6名患者都出现了三联肌和面部生长异常，除了一个人之外，所有的人都需要手术来释放强直。
结论：耳源性TMJ关节炎主要发生在患有急性乳突炎和颞内和/或颅内化脓的幼儿中。影像学检查有助于诊断，与TMJ相关的CT收集是最常见的发现。颞下颌关节强直可在几年内发展，并表现为三端肌和面部异常生长。皮质乳突切除术似乎不能预防强直。尚不清楚对TMJ进行集中治疗或物理疗法是否有益。
方法：回顾性回顾所有诊断为急性中耳感染继发的TMJ关节炎和/或TMJ强直的儿童，2005年至2021年期间在三级儿科医疗中心接受治疗。
结果：7例患者被确定为耳源性TMJ关节炎。演示时的中位年龄为1.14岁（IQ范围1.1-1.5）。所有7人都被诊断为急性乳突炎。CT扫描显示5/7的TMJ相关集合和3/7的颅内并发症。治疗包括皮质乳突切除术5/7。一名患者同时进行了TMJ手术冲洗。两名患者仅引流骨膜下集合。7例患者中有6例继续发展为TMJ强直，在急性乳突炎发作后的中位数为2.8年（IQ范围为2.6-3.9）。所有6名患者都出现了三联肌和面部生长异常，除了一个人之外，所有的人都需要手术来释放强直。
结论：耳源性TMJ关节炎主要发生在患有急性乳突炎和颞内和/或颅内化脓的幼儿中。影像学检查有助于诊断，与TMJ相关的CT收集是最常见的发现。颞下颌关节强直可在几年内发展，并表现为三端肌和面部异常生长。皮质乳突切除术似乎不能预防强直。尚不清楚对TMJ进行集中治疗或物理疗法是否有益。
