Abstract
Patients: Fifty years old, male. The chief complaint was a pain in the jaw lasted for 10 years. Although he was treated at a university hospital for 5 years, he continued to improve and worsen. His symptoms gradually worsened, and he was unable to eat, so he was transferred to our department. Painless mouth opening range was 25mm and forced opening range was 37mm. Jaw opening and closing pain and spontaneous pain were observed in the masseter muscle. Palpation of the muscles revealed tender pain in the right temporal muscles and bilateral masseter muscles, myofascial pain in the bilateral masseter muscles, and severe pain in the right masseter muscle. The results of psychological testing were high positive for anxiety. The patient was diagnosed with intractable myofascial pain and started treatment. Although the general masticatory muscle pain treatment was ineffective, a stellate ganglion block provided good pain control.
Consideration: This case was intractable myofascial pain for which pain control was difficult for an extended period. Since the stellate ganglion block had an analgesic effect, the pathological condition of this case might be peripheral circulatory disorder of muscles and sympathetically maintained pain.
Conclusion: Stellate ganglion block may improve the pain condition of chronic refractory TMD, whose main condition is myofascial pain. Stellate ganglion block was a valuable treatment for intractable myofascial pain for which satisfactory results were not obtained with the initial treatment of general temporomandibular disorders as in this case.
