Case report rare complication of temporomandibular joint infection: Subgaleal abscess

Abstract

© 2020 The Authors Subgaleal abscess and temporomandibular joint infection are rare conditions only founded in the case report. The diagnosis of these conditions is straightforward consisting of clinical presentation, physical examination and imaging finding. However, delay diagnosis associates with high morbidity. Treatment strategies need surgical management and proper medical treatment with antibiotics. We report A 65-year-old female who was progressive supranuclear palsy, corticobasal degeneration and depressive disorder presented with scalp swelling right side 1 month prior to the hospital. Physical examination showed right scalp swelling at temporal area with fluctuation of cystic consistency size 5x8 cm. Contrast CT-scan revealed subgaleal abscess right temporal area about 8.7 × 3.5 × 7.7 cm in size with adjacent osteolytic lesion along right mandibular cortex could be an infection of TM joint and osteomyelitis. Our team performed incision and drainage subgaleal abscess and finding greenish color of pus with foul smell 150 ml right temporal area. We send pus for gram-stain and culture for bacteria that showed many gram-negative bacilli and moderate gram-positive cocci. The culture result grew many Staphylococcus aureus. Intravenous empirical-antibiotic (Ceftazidime and clindamycin) was given for 1 week and switched to oral antibiotics according to pus culture result (Clindamycin and ciprofloxacin). We planned to follow clinical and improvement after treatment at the OPD 2 weeks-later. However, the patient loss follows up after treatment. In conclusion, our report showed a rare case of subgaleal abscess with temporomandibular joint infection that has not been reported previously that required multimodality treatment including surgical management and proper antibiotics.