口面疼痛是一个世界性的疼痛问题,许多患者无法找到适当的诊断和治疗方法。面部疼痛包括由头颈部区域的牙源性和非牙源性结构引起的疼痛。牙科临床医生需要有全面的知识和技能来诊断,管理和治疗牙源性疼痛患者,或将非牙源性疼痛的治疗患者转诊给口腔疼痛专家等专家,神经科医生,耳鼻喉科医生,风湿病专家,等。更多的时候,牙医诊断患者患有颞下颌关节紊乱病,当治疗无效时,术语“非典型面部疼痛”。有效治疗的首要要求是准确的诊断。牙科临床医生必须意识到巨细胞动脉炎(GCA),慢性大血管血管炎,主要影响50岁以上的成年人,因为它经常模仿并被误诊为“颞下颌关节紊乱病”。GCA与视力丧失有关,和中风,可能是一种危及生命的疾病。因此,GCA的诊断测试和鉴别诊断应该是所有牙科临床医生的医学常识.历史上,颞动脉活检被认为是GCA的最终诊断测试。颞动脉超声(TAUSG),一种安全和非侵入性的成像模式已经取代了以前的GCA诊断金标准,颞动脉活检,由于其增强的诊断能力和安全性。该病例报告描述了GCA患者以及TAUSG在诊断中的作用。一位72岁的女性,出现左侧面部疼痛,颌骨跛行,舌头的感觉障碍,和两年的间歇性视力丧失。她被诊断出患有,并治疗了无数的牙科疾病,包括牙髓和TMJ治疗,没有任何益处。彻底的病史和体格检查,结合血清学分析诊断为GCA和TAUSG,这证实了诊断。本文强调了TAUSG促进的GCA的鉴别诊断和早期识别在优化治疗结果方面的责任,非侵入性诊断工具。
Orofacial pain is a worldwide pain problem, with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage, and treat patients with odontogenic pain or refer patients for treatment of nonodontogenic pain to specialists such as orofacial pain specialists, neurologists, otolaryngologists, and rheumatologists. More often, dental practitioners diagnose patients with a temporomandibular disorder (TMD), and when treatment is ineffective, term it \"atypical facial pain.\" The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of giant cell arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as TMD. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians. Historically, temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and noninvasive imaging modality, has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. The present
case report describes a patient with GCA, and the role TAUSG played in the diagnosis.
Case report: A 72-year-old woman presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of 2 years\' duration. She was diagnosed with and treated for a myriad of dental conditions including endodontia and temporomandibular joint therapy with no benefit. A thorough history and physical examination, combined with serologic analysis, led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. Conclusion: This report underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, noninvasive diagnostic tool. (Quintessence Int 2024;55:336-343; doi: 10.3290/j.qi.b4938419).