A murine model for septic arthritis of the temporomandibular joint.

PURPOSE: This study was designed to establish a murine model of hematogenously acquired bacterial arthritis of the temporomandibular joint (TMJ) to investigate the pathogenesis of this rare TMJ infection. MATERIALS AND METHODS: One hundred forty mice were inoculated intravenously with 3 different staphylococcal suspensions. They were sacrificed at intervals between 1 day and 2 months. Bacterial cultures were obtained from peripheral blood, liver, kidney, TMJs, knees, and interphalangeal joints. The TMJs were collected for histopathological examination. RESULTS: Staphylococcus aureus, isolated from the joint fluid of a patient with septic arthritis of the TMJ, was recovered from the liver, kidneys, knees, interphalangeal joints, and TMJs of several animals. Blood cultures were negative. Acute septic arthritis of the TMJs was confirmed in several animals as soon as 4 days after inoculation. Histopathology showed severe damage to chondrocytes and collagen fibers in the condyles and discs, leading to extensive degenerative changes. All cultures were negative, and there were no histopathologic changes in animals inoculated with bacteria from the other sources. CONCLUSIONS: A murine model for hematogenous septic arthritis of the TMJ was successfully developed with S. aureus isolated from a patient with a TMJ infection. The bacteria induced multiple organ and joint infections. Septic arthritis of the TMJ occurred in 21% of the animals inoculated. Onset was rapid. It produced extensive degenerative changes. The study confirms the need for prompt diagnosis and treatment of patients with septic arthritis. The model may prove to be very useful in the study of this rare infection.

[A clinical study on septic arthritis of temporomandibular joint: culture and identification of pathogenic bacteria].

OBJECTIVE: To explore the pathogenic organism of septic arthritis of temporomandibular joint and the culture condition of the available bacteria. METHODS: Joint fluid was aspirated from 30 patients in recent 5 years. Smear and Gram stain of joint fluid were done immediately, then cultured in blood agar, bacteria-preserving culture medium, trypticase soy agar(TSA) or trypticase soy broth(TSB) under aerobic or anaerobic condition, respectively. Pathogen identification was performed with biochemical methods. RESULTS: Microorganism were found with Gram staining in 15 out of 30 cases, but the culture of bacteria only succeeded in 5 cases. Staphylococcus saprophyticus and Staphylococcus aureus were the bacteria isolated. Bacteria was isolated in TSB mostly. CONCLUSIONS: 2 kinds of microorganism were isolated from joint fluid, and S. saprophyticus was reported for the first time. However, the positive rate was low, and the better technique for culture was expected.

[A clinical study on septic arthritis of temporomandibular joint: characteristics and diagnosis].

OBJECTIVE: To investigate the clinical characteristics and the procedure of early diagnosis of septic arthritis of temporomandibular joint (TMJ). METHODS: 30 consecutive patients with TMJ septic arthritis were included in this clinical study between 1995 and 2001. Physical examinations, joint fluid analyses, radiographic imagings and laboratory studies were performed in all cases. Sequelae were evaluated. RESULTS: The clinical data showed 29 of the 30 patients were more than 18 years old. The infections of the TMJs were mostly through hematogenous route, and the original infectious sites could not be found in many cases. The obvious inflammatory symptoms in TMJ areas and severe morbidity were not detected in most of the cases (25/30), and a high level of polymorphonuclear cells, and some fibro-protein or cartilage fragments were seen in the synovial fluid. Microorganism were found with Gram staining in 15 of 30 cases, but the culture of bacteria only succeeded in 5 cases. S. saprophyticus and S. aureus were the common kinds of bacteria isolated. The sequelae were mild, and most of the cases had only postinfectious osteoarthritis. CONCLUSIONS: Nowadays TMJ septic arthritis has shown some new characteristics, such as occult original infectious sites, atypical and mild symptoms, and slight sequelae; Joint fluid analysis is necessary for diagnosis.

[A clinical study on septic arthritis of temporomandibular joint: treatment].

OBJECTIVE: To investigate the procedure and effect on treating septic arthritis of temporomandibular joint (TMJ). METHODS: 30 patients were treated by antibiotic therapy, resting of the jaw, and local therapies. The local therapies included arthrocentesis with single needle in 20 joints, arthrocentesis with double needles in 13, arthrocentesis accompanied by submandibular drainage of the infratemporal space abscess in 1, and arthroscopy in 4. The therapeutic effects were judged by joint cavity puncture, mouth opening, jaw pain, and jaw function, and so on. Sequelae were evaluated. RESULTS: The overall success rate of the treatment was 100% (30/30). The success rates of the 4 different management were: 14/20 in arthrocentesis with single needle, 9/13 in arthrocentesis with double needles, 1/1 in arthrocentesis combined with submandibular drainage, and 4/4 in arthroscopy, respectively. The sequelae were mild, and most of the cases had only postinfectious osteoarthritis. CONCLUSIONS: Low pressure arthrocentesis, antibiotic therapy and resting of the jaw were important components of treatment in acute septic arthritis. If infratemporal space abscess was found, submandibular drainage should be done. Arthroscopy could be recommended to those who haven't got good results by arthrocentesis or those who have already had some sequelae, such as TMJ fibrous ankylosis.