Temporal artery ultrasonography for the diagnosis of giant cell arteritis: a case report.

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 non-odontogenic pain to specialists such as Orofacial pain specialist, neurologist, otolaryngologist, rheumatologist, etc. More often, dentists diagnose patients with a temporomandibular disorder 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 "temporomandibular disorders". 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 non-invasive imaging modality has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. This case report describes a patient with GCA and the role TAUSG played in the diagnosis. A 72-year-old female, presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of two years duration. She was diagnosed with, and treated for a myriad of dental conditions including endodontia and TMJ therapy with no benefit. A thorough history and physical examination, combined with serological analysis led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. This paper underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, non-invasive diagnostic tool.