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

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.