Abstract
Case Summary: A 76-year-old man presented with a bilateral temporal headache and bilateral masseter muscle pain. Intermittent swallowing difficulties and double vision were also noted. Although no trismus was present, hypertrophy and tenderness of the bilateral temporalis and masseter muscles were observed. He was diagnosed with temporomandibular joint disorder and was instructed to perform mouth-opening stretches and correct his tooth-contacting habit. Two weeks later, the patient sought consult due to the rapid deterioration of his headache and masseter muscle pain. Swelling of the bilateral superficial temporal arteries and hypopulsatility of the right superficial temporal artery were observed on physical examination. His masseter muscle pain was observed to worsen during mastication, and was relieved by rest. Blood tests were conducted under the suspicion of giant cell arteritis, revealing an increased erythrocyte sedimentation rate. Under close surveillance of the Department of Internal Medicine, he was admitted the following day and was initiated on pulsed steroid therapy. An arterial biopsy confirmed the diagnosis of giant cell arteritis. His temporal headache and jaw claudication promptly improved upon starting pulsed steroid therapy, and he was discharged after 10 hospital days. Since then, the patient has continued his oral steroid treatment, and no recurrence of symptoms were noted.
Discussion: Clinical symptoms similar to temporomandibular joint disorder may occur in the early stages of giant cell arteritis. Giant cell arteritis should be considered in patients with acute pain, swelling of the superficial temporal artery, and jaw claudication. A thorough physical examination should be done for these patients.
Conclusion: Giant cell arteritis may be misdiagnosed as a temporomandibular joint disorder. Dentists should understand the pathophysiology of giant cell arteritis to differentiate it successfully from temporomandibular joint disorder.
