Submission Type
Case Report
Abstract
Introduction: Temporomandibular joint (TMJ) involvement is an uncommon but potentially important complication of pediatric otologic infection. Imaging findings may overlap with septic arthritis, mastoiditis, and intracranial inflammatory extension, creating uncertainty regarding the need for invasive intervention.
Clinical Findings: A 12-year-old female with recurrent otitis externa presented with 3 days of severe right otalgia, progressive facial and periauricular swelling, jaw pain, and trismus. Her examination results showed marked external auditory canal edema and tenderness that initially prevented visualization of the tympanic membrane.
Clinical Course: She was treated with intravenous ceftazidime and clindamycin, and initially improved; however, her facial swelling and trismus worsened on hospital day 4. Magnetic resonance imaging findings showed otomastoiditis, a large right TMJ effusion, temporalis inflammation, and right temporal pachymeningeal enhancement. Bilateral myringotomy was performed for decompression and sampling; staged right tympanostomy tube placement followed when canal edema improved. An external auditory canal culture grew Streptococcus pyogenes. TMJ aspiration and mastoidectomy were deferred after multidisciplinary evaluation because her symptoms resolved with antimicrobial therapy and otologic decompression. However, septic TMJ arthritis could not be definitively excluded without synovial sampling.
Conclusions: Otogenic TMJ involvement may produce imaging findings concerning for septic arthritis or intracranial spread. Serial clinical assessment, targeted imaging, microbiologic data, and multidisciplinary review are essential when determining whether an invasive TMJ or mastoid intervention is required.
Recommended Citation
Jones, Lacy and Bloom-Foster, Jessica
(2026)
"Otogenic Temporomandibular Joint Involvement with Intracranial Inflammatory Changes in a Child,"
Journal of Maine Medical Center: Vol. 8
:
Iss.
2
, Article 12.
Available at:
https://doi.org/10.46804/2641-2225.1270
