title: Undiagnosed myasthenia gravis owing to a very unusual primary presentation.
abstract: Myasthenia gravis (MG) is an uncommon autoimmune disorder presenting with fluctuating, progressive muscle weakness. The typical initial presentation includes ocular symptoms of ptosis, diplopia, or both. In the literature, other late symptoms have been described. The inability to close the jaws or difficulty in closing the jaws is an uncommon symptom of muscle weakness. Studies have found that only 4% of patients with MG ever complain of, or demonstrate, masticatory muscular weakness with an inability to close the jaws or difficulty in closing the jaws. In the present case, although the patient may have manifested other symptoms, his primary complaint was the inability to masticate as a result of muscular weakness and the difficulty in closing the jaw. The symptoms had reportedly been present for several months. The case is interesting in that the patient presented with an uncommon symptom as the primary complaint. The patient's recall and communication of his medical history was poor, and it is unclear as to all the factors that may have delayed the diagnosis. However, it is important for dentists to recognize these atypical symptoms of MG so that they can either order the initial tests or make the appropriate referral.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, IN, USA. Electronic address: khank@iupui.edu.
authors.forename: Khurram A
authors.initials: KA
authors.lastname: Khan
authors.affiliation: Professor and Chair, Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, IN, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bennett
mesh_terms: D000368:Aged; D015897:Comorbidity; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004576:Electromyography; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000503:physiopathology*; D013284:Stomatognathic System / Q000503:physiopathology*