Septic Arthritis of the Temporomandibular Joint (SATMJ) in Adults: A Systematic Review of Case Reports and Case Series, Part I: Etiology and Epidemiology

<b>Background/Objectives:</b> Septic temporomandibular joint disease (STMJ) is a rare condition with a potentially dangerous course. Its etiology includes bacterial and fungal infections, systemic factors (e.g., diabetes, immunodeficiencies), and molecular mechanisms. <b>Methods</b>: Reports of SATMJ in adults, clinically and microbiologically confirmed, published up to the time of protocol registration (PROSPERO CRD42024613462), were included. ACM, BASE, CENTRAL, PubMed, ClinicalTrials.gov, Embase, Scopus, Google Scholar, and reference lists were searched. The search included strategies using the terms "temporomandibular joint septic arthritis" and related phrases. Two independent reviewers studied a selection of articles and extracted data (demographics, microbiology, risk factors, molecular mechanisms). Risk of bias was assessed using JBI tools, and the certainty of evidence was assessed using the GRADE tool. <b>Results</b>: The analysis included 59 cases of SATMJ. Anaerobic infections were found in 77%, Gram-positive infections in 72%, and fungal infections in only 7%. Diabetes and immunoincompetence were associated with SATMJ. <b>Conclusions</b>: The results highlight the predominance of Gram-positive and anaerobic infections. Systemic factors, such as diabetes, increase the risk of SATMJ. Limitations result from the heterogeneity and retrospective nature of the analyzed cases and possible publication biases.