Jaw Dropping- The necessity of a history and biopsy in suspected Temporal Arteritis

Rahul Dubey MBBS (Hons) MMed
Jeanie Chui^1,2 B Med Sci (Hons), MBBS, PhD
John Langford-Smith,³ FRANZCO
Helen Danesh-Meyer,⁴ MD, FRANZCO
Ian C. Francis¹ FASOPRS, PhD

¹Prince of Wales Hospital, Sydney, Australia
²School of Medical Sciences, University of NSW, Sydney, Australia
³Lismore Eye Centre, Lismore NSW, Australia
⁴Auckland Hospital, New Zealand

Purpose: To describe presumed temporal arteritis (TA) in a 82 year old man who presented to an ENT surgeon with a twelve month history of jaw pain on mastication. The patient did not undergo a temporal artery biopsy. He developed major systemic and local complications from protracted treatment with systemic corticosteroids.

Method: Detailed case report and literature review, including documentation of multiple complications, and especially of mandibular arch necrosis. This was manifested by his mandible dropping off during his evening meal. The critical symptoms and signs of TA are highlighted. A differential diagnosis of jaw pain is provided.

Results: The diagnostic pathway in TA mandates a comprehensive and accurate history of the disorder, an assessment of its signs, and the performance of a temporal artery biopsy of minimum size 2.5cm. This may prevent life-threatening complications of unnecessary corticosteroid exhibition. The importance of multidisciplinary systemic management of TA is emphasized.

Conclusion: TA may present with a constellation of apparently unrelated symptoms and signs. Therapy of TA with systemic steroids carries with it significant risks. The definitive diagnosis of TA ensures that patients are protected from complications associated with its treatment.