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Table 2 Review of the available literature

From: Acute arthritis of the right temporomandibular joint due to Lyme disease: a case report and literature review

Authors

Patient

Region

Symptoms

Diagnostic/therapy

Burkhard et al. [4]

31, f

Germany

Pain left TMJ radiating into the upper and lower teeth

Difficulty with mouth opening (32 mm)

Sensation swelling left side of face

Redness left cheek to chin

Bruxism

Fatigue

MRI: Idiopathic facial nerve palsy with inflammatory changes in the parotid and submandibular glands → Zovirax (5 × 800 mg/7 d)

ELISA serology positive IgM and IgG

Xie et al. [32]

16, m

United States

Left temporomandibular joint, right patella pain

Dislocation, bilateral forearm pain

Fatigue

Left-sided Bell’s palsy

Low grade fever

Left mandibular pain

Western blot: positive Lyme antibodies

Doxycycline

Bilateral TMJ diagnostic arthroscopy followed by arthrocentesis with joint lavage and intra-articular (IAC) corticosteroid injections of the TMJ’s

te Veldhuis et al. [27]

61, f

Netherlands

Facial pain

Restriction of mouth opening to 38 mm

Impaired speaking ability

Inability to close lips

Bilateral peripheral facial nerve paresis

Weakness of left arm

Laboratory testing: positive IgG and IgM antibodies

3-weeks intravenous ceftriaxone; 2 g per day

Wolanska-Klimkiewicz et al. [31]

50, f

Poland

Tick bite was noticed

Swelling of eyelids (upper and lower), cheek, neck after 12 h

? weeks after the bite, the condition worsened:

Pain in joints, muscles, conjunctivitis, hypersensitivity to light, dental symptoms, pain in the chest and heart area with increased blood pressure

5.5 months after tick bite: erythema on lower limb

Neurologic symptoms: paralysis of the left side face, numbness in the right neck

Antihistamine drugs

Compresses with aluminum acetotartrate (Altacet)

Synthetic corticosteroid (Elocom)

Oral heart supplements

Macrolide antibiotic

ELISA test: positive IgM and antibodies

Doxycycline (Unidox), Metronidazol

Amoxicillin (Amoksiklav)

Lee et al. [15]

8, m

United States

TMJ pain

Mouth opening difficulty (max. 10 mm)

Stiff neck

Frequent headache

Bilateral knee joint swelling

400 mg Ibuprofen every 6 h

Warm compresses

CT Scan: inflammatory sites in both TMJs

Western blot: High serum antibody: Amoxicillin for 21 days (50 mg/kg)

Lesnicar and Zerdoner [16]

59, f

Slovenia

Erythema migrans

Fatigue

Pain in shoulder, knee, hip joints

Pain in right TMJ

Difficulty with mouth opening (max. 20 mm)

Fever

Uneven surface of mandibular head TMJ

Swollen joints

ELISA serology positive IgM and IgG

Ceftriaxone for 3 weeks

52, m

Slovenia

Fatigue

Myalgia in the extremities

Pain in both TMJs

Pain in left arm

ELISA, Western blot

Serological positive Bb IgM and IgG antibodies

Ceftriaxone daily dosage of 2 g for 3 weeks

Vesper et al. [29]

49, f

Germany

Pain left TMJ

Fever

Swollen left TMJ

Difficulty with mouth opening (max. 20 mm)

Non-occlusion left side

Bonnet-protective posture

Left-sided TMJ arthritis without an indication of degenerative disease

Rocephin parenteral 2 g/d

Infection with Bb through tick bite was known → Diagnosis was only confirmed 5 years after tick bite by serological detection

Doxycycline for 7 d (twice in a period of 3 months)

Heir and Fein [11]

49, f

United States

14 months of neurological symptomology

Facial pain

Facial numbness

Left Eye pain

Numbness of extremities

Joint pain

Concentration problems

Oral amoxicillin, 2 years after the beginning of appearance of symptoms

Herxheimer reaction after antibiotic therapy

Inpatient admission to hospital: Intravenous ceftriaxone sodium

28, f

United States

Facial pain

Pain in the left TMJ

Migraine headache

Neck pain

Visual problems

Upper body numbness

Antibiotic therapy

34, f

United States

Pain of chin + forehead

Pain of right cheek

Paralysis of the right lower side of face

Lader [14]

33, w

United States

Headache

Paresthesia in posterior cervical region, hands

Stiffness and pain in neck

Pain in right TMJ + intermittent click

Pain masticatory muscles

Chiropractor: treatment failed

12 medications (e.g. Naproxen (Anaprox, Ibuprofen, Methocarbamol)

Dentist: Splint therapy

 → failed

Serology Test: first was Bb negative: Penicillin therapy, lidocaine injection → second test positive

Harris [9]

35, f

United States

Pain in right jaw

Right lateral pterygoid muscle slightly tender to palpation

Difficulty with mouth opening (max. 25 mm)

Recurrent episodes of arthralgia in shoulders, elbows, wrists

Red spots on chest

Positive LD diagnosis: wandering arthritis, erythema chronicum migrans

Hot compresses

Soft food diet

Medication: muscle relaxants

Bilateral tomograms of TMJ: normal left joint, irregularities with reactive sclerosis of articular surface right condylar

Tetracycline 500 mg for 2 weeks

ELISA serology positive IgM and IgG

  1. Review of literature of case reports who describe Lyme Disease with temporo-mandibular joint manifestation; Abbreviations: m = male; f = female