Jaw Claudication

What is jaw claudication?

Jaw claudication is associated with some serious underlying diseases. The onset of jaw claudication generates pain in the maxilla and mandible bone during mastication which may extend up to ear.

It is a symptomatic approach, but not a disease. In medical science, the jaw claudication is considered as a diagnostic aspect as it is not a common symptom and associated with some specific disorders.  It occurs due to occlusion of the carotid artery.

Image 1: Diagnosis of jaw claudication

The associated symptoms helps to distinguish the seriousness of the underlying cause in case of temporal artiritis, as the initial classic symptoms of temporal artiritis is headache. Sudden onset of pain, during chewing needs to immediate doctor advice for reduction of the complication.

Symptoms

The symptoms are:

• Facial pain
• Pain during mastication or facial exercise
• Sudden initiation of pain which cannot manage with usual therapy, emergency pain management can help to reduction of the discomfort.

Pain is a common symptom of this disorder, severe pain arising may be due to nerve impingement. Pain due to nerve impingement, where an intent facial nerve transmits pain signals during the movement o the jaw results to increased pressure on the nerve.

Causes

The different underlying disease conditions which compressed the external carotid artery often cause jaw claudication. The possible disease conditions are:

• Temporo-mandibular joint disorder, which is one of the resultant of temporal arteritis. This pain is quite similar with musculoskeletal pain. Maxillary artery become inflamed and damage which causes decrease oxygen supply and results in tissue necrosis of masticatory muscles.
• Rheumatoid Arthritis: It often associated with Giant Cell Arteritis. The upper body parts which include neck, upper limbs, spine and facial nerves become damaged due to the blockage of the temporal blood vessels and often affect other major blood vessels which include carotid, subclavian, and iliac arteries.
• Myasthenia gravis: Myasthenia gravis is an immune system dysfunctional disease that affects the neuromuscular junction mainly at the postsynaptic membrane and usually causes decrease muscle strength and frequent fatigue.
• Parotid tumours: Parotid gland is one type of salivary gland and malignant or benign tumour often causes jaw claudication.
• External carotid artery stenosis:  Jaw claudication could consequence from external carotid artery occlusive disease. Carotid artery stenosis deteriorates the disease in the external carotid artery.  Emboli originated in the external carotid artery develop neurologic symptoms.  This significantly exacerbates jaw claudication by increasing pressure in the carotid artery.
• Infection: Sometimes viral flue like infection may develop jaw claudication. Even sinusitis also a causative factors of jaw claudication.
• In rare cases, the proximal branches of facial and maxillary arteries become affected due to narrowing of the peripheral carotid artery which is arises due to atherosclerotic contraction. This manifest more severe complication which include cerebral infractions, transient ischemic attack, retinal arterial occlusions, amaurosis fugax, and ocular ischemic syndrome.

Treatment

The determination of underlying cause is most important parameter to treat the jaw claudication. Depending upon the underlying disease condition treatment procedure may vary and reduction of the developmental factors lessens the symptom automatically.

• For the treatment of inflammatory conditions such as Temporal Arteritis, Giant Cell Arteritis, Rheumatoid arthritis the usual prescription contains steroidal drugs which include corticosteroids, hydrocortisone, and prednisone. Prolong treatment with steroids often causes osteoporosis. The additional medicine such as vitamin D supplement, calcium supplements are added in prescription for preventive measures. Doctor also advice to do some weight-bearing exercise and quit smoking.
• Aspirin is also prescribed to liquefy blood and in maintenance of flow of the blood, to prevent occlusion.
• For rectification of the vasoconstriction, alpha and beta adrenergic blocking drugs are approved. These drugs are having contraindication with congestive heart failure patient.
• To control the myasthenia gravis, usual prescription contains anti-cholinergic drugs and immunosuppressant medication like azathioprine, plasmapheresis, cyclosporine, corticosteroids and intravenous immune globulin (IVIg)
• In case of tumour development in the parotid gland may radiotherapy, chemotherapy or surgery help to control the development of the malignant or benign tumour.
• Variety of operative interventions can be helpful to treat the external carotid artery stenosis. The effective and safer process to treat amaurosis fugax and a critical external carotid artery stenosis is angioplasty rather than endarterectomy. In endarterectomy, surgical correction and bypass is conducted in external carotid-to-internal carotid artery. The surgical risk is more with endarterectomy as it increases high stroke rate.
• Different infections are prescribed to control the infection in case of underlying infection control.

Unawareness of the seriousness of the incidence of the onset of symptoms often causes associated potential complications.

Individuals often take available analgesic OTC product to suppress the pain, but it is not advisable. Initial consultation with doctor is necessary as the reason varies and treatment aspects are conducted according to the underlying cause.

References

1. http://www.ncbi.nlm.nih.gov/pubmed/6823455
2. http://www.bmj.com/content/350/bmj.h1154/rr-0
3. Jaw claudication in the era of carotid stenting at http://www.jvascsurg.org/article/S0741-5214(11)00092-9/abstract
4. Endovascular repair of symptomatic external carotid artery stenosis at http://www.sciencedirect.com/science/article/pii/S0741521405011018