C: 1.13 MANAGEMENT OF ORO-FACIAL PAIN INCLUDING TEMPOROMANDIBULAR JOINT DISORDERS Flashcards
Giant Cell Arteritis
Temporal Arteritis, Cranial Arteritis
Headache and can cause ischaemic pain in MoM in elderly patients. Should be considered in patients over middle age who complain of headache and pain on mastication. May start with malaise, fever, weight loss, night sweats.
>55yrs, F>M, Northern european/Scandinavian origin.
Severe throbbing headache. Temporal artery often becomes red, tender, firm, swollen, tortuous.
20% - ischaemic pain in MoM.
Opthalmic artery involvement more important - risk of blindness and visual disturbances. (due to ischaemia)
ESR - raised +++
Histo - inflammation of arterial media and intima. Infiltrated by mononuclear cells with multinucleate cells. Intimal damage leads to thrombi formation. Healing by fibrosis. Lesions skin short lengths, so biopsies should be 3cm long at least.
Early treatment essential (>50% complications if untreated)
40-60mg day prednisolone - continue until ESR normal. Then maintenance of 7.5-10mg daily. Many patients require treatment for 2 years or more.
Abnormal temporal arteries only in around 50% of cases.
Other manefestations - dental pain, facial nerve palso, chin numbness, dysphagia, dysarthria, submandibular mass, tissue necrosis of the scalp, lips, nasal septum, tongue. Facial swelling - puffiness zygoma, maxilla, around orbit.
