顎関節痛は心筋梗塞の症状です

Temporomandibular Joint Pain Presentation of Myocardial Ischemia.

抄録

心血管系疾患は世界的な死因の上位を占めている。我々は，顎関節痛が唯一の初発症状であった心筋梗塞の1例を報告する．28歳の男性が顎関節の痛みを訴えて歯科医院を受診した．彼は，米国陸軍の現役歩兵隊員であり，それ以外は健康で体調も良好であった．彼は，3週間前から，特に運動時や重量挙げの際に，左の顎関節に強いズキズキした痛みがあると報告してきた．一般歯科医による診察では、血圧、心拍数、呼吸数、体温に異常はなかった。最大切歯開口は45mm以上あり，痛みもなく，偏位，クレピタス，全可動域を制限なく，また痛みを誘発することもなく実証された．症状はブラキシズムに関連した筋肉痛と考えられるため，ハードナイトガードを作製し，筋理学療法の指導を行った．さらに詳しい評価とセカンドオピニオンを求めて口腔顎顔面外科（OMS）へ紹介された。予約の前に，身体訓練中に心停止で倒れた．救急外来に運ばれ、蘇生に成功した。左前下行動脈が80％閉塞していることが判明し、1枝冠動脈バイパス移植で治療した。心臓手術後、OMSを受診し評価したところ、顎関節の症状は完全に消失していた。顔面痛の鑑別診断では，顔面以外の痛みの原因，特に顎関節痛，歯原性痛，筋筋膜性痛を模倣する心臓性疼痛を考慮する必要がある．

Cardiovascular disease is a leading cause of death worldwide. We report a case of myocardial infarction for which temporomandibular joint (TMJ) pain was the sole presenting initial symptom. A 28-year-old man presented to a dental clinic reporting TMJ pain. He was an active duty infantry solider in the US Army who was otherwise healthy and in excellent physical condition. He reported a 3-week history of intense throbbing to his left TMJ, specifically during physical activities and weight lifting. On examination by his general dentist, his blood pressure, heart rate, respiratory rate, and temperature were unremarkable. His maximal incisal opening was more than 45 mm without pain and demonstrated deviation, crepitus, and a full range of excursive movements without restrictions or provocation of pain. A hard night guard appliance was fabricated, and muscular physical therapy instructions were given, because his symptoms were thought to be related to muscle-related pain, possibly related to bruxism. He was referred to the oral and maxillofacial surgery (OMS) department for further evaluation and a second opinion. Before his appointment, he collapsed during physical training in cardiac arrest. He was brought to the emergency department and successfully resuscitated. He was found to have an 80% occlusion of his left anterior descending artery that was treated with a 1-vessel coronary artery bypass graft. After his cardiac surgery, he was seen and evaluated by OMS, and his TMJ symptoms had completely resolved. During the differential diagnosis of orofacial pain, clinicians should consider nonfacial sources of pain, especially referred cardiac pain that can mimic TMJ, odontogenic, and myofascial pain.