Ultrasound-guided temporomandibular joint aspiration: technique and results in six cases of suspected septic arthritis

• Published in: Skeletal radiology 2023-05, Vol.52 (5), p.1033-1038
• Main Authors: Symanski, John S., Gimarc, David, Chan, Brian, Stephenson, Jason, Markhardt, Brian K., Ross, Andrew B.
• Format: Article
• Language: English
• Subjects: Arthritis; Arthritis, Infectious; Arthritis, Infectious - diagnostic imaging; Arthritis, Infectious - surgery; Arthrocentesis - methods; Blood; Blood culture; Diagnosis; Graft-versus-host reaction; Health aspects; Humans; Imaging; Infectious arthritis; Medical examination; Medicine; Medicine & Public Health; Microorganisms; Nuclear Medicine; Orthopedics; Pathology; Patients; Radiology; Risk factors; Synovial fluid; Temporomandibular joint; Temporomandibular Joint - diagnostic imaging; Temporomandibular Joint Disorders - diagnostic imaging; Temporomandibular Joint Disorders - surgery; Ultrasonic imaging; Ultrasonography; Ultrasonography, Interventional; Ultrasound
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-022-04225-z

Objective The aim of this study is to describe an ultrasound (US)-guided temporomandibular joint (TMJ) arthrocentesis technique and determine its microbial yield in the workup of suspected TMJ septic arthritis. Materials and methods A retrospective review of US-guided TMJ arthrocentesis for the work-up of septic arthritis performed by radiologists at two institutions was performed. Patient demographics, risk factors for septic arthritis, blood culture results, and pre-procedural imaging findings were recorded. Procedural data included fluid aspirate quantity, needle gauge and length, and any immediate complications. Post-procedural data included synovial fluid analysis including culture, final diagnosis of TMJ disease, type of treatment, and any delayed complications from arthrocentesis. Results A total of six US-guided TMJ arthrocenteses were identified, all of which yielded at least 1 mL of synovial fluid. Five patients were subsequently diagnosed with septic arthritis, and one patient was diagnosed with GVHD arthritis. The synovial fluid in four out of five patients with a final diagnosis of septic arthritis produced positive cultures. There were no immediate or delayed complications from arthrocentesis. Conclusion Basic US-guided procedural skills are transferrable to TMJ arthrocentesis, which is a low-risk procedure with a high microbial yield in our small series of patients with septic arthritis.