Examination of other cranial nerves and limbs including motion, sensation, and reflex was normal.Ĭlinical examination showing his black teeth with enhancing accumulations of plaque calculus. His corneal reflexes and his bite force were normal. Anesthesia was present over his chin and lower lip bilaterally while the sensation over the rest of his face was normal. His general physical examination was unremarkable with no cervical lymphadenopathy. On physical examination, his teeth were black with enhancing accumulations of plaque calculus (Figure (Figure1). He smoked 20 cigarettes a day for 40 years and only drank a little alcohol occasionally. His past medical history was uncontrolled hypertension. He had no other symptoms such as headache, visual disorders, difficulties in swallowing, and speech, limb weakness, or numbness. To determine what exactly caused the trouble, he was then admitted to the neurology ward. Magnetic resonance imaging (MRI) of the trigeminal nerves revealed a small vessel riding across the left trigeminal nerve and multiple patchy abnormal signals in pons, bilateral frontal and parietal lobes. It was diagnosed as periodontitis and treated with antibiotics and analgesics, but the numbness and pain of the chin got worse. The pain became so acute to affect his sleep. Chewing or touch could increase the pain intensity. A month later, a throbbing pain with no trigger point attacked his chin, appearing several times every day, and lasting for hours. However, numbness on the left side of his chin occurred and progressed gradually to involve his entire chin and low lip. After a root canal treatment of teeth #42 to #32, his toothache relieved a little. In this paper, aimed to highlight that NCS might lead to severe conditions and to show how the diagnosis was made, we reported a case with an initial character of NCS that was finally confirmed as a mandible malignancy originating from salivary duct adenocarcinoma and reviewed the causes, the possible mechanism, the diagnostic approaches, and differential diagnosis of NCS.Ī 64-year-old man with a persistent pain in his lower front teeth, which made him dare not to chew for a few days, was diagnosed as pulpitis by his dentist. However, NCS, where mucosal findings are not present, is usually a single oral maxillofacial presentation induced by metastasis of remote malignancies and therefore requires a thorough examination to make prompt and accurate diagnosis ( 3– 5). A provisional suspicion of malignancy usually results from clinical presentation in most cases. Intraoral mucosal malignancies, such as squamous cell carcinoma of the oral mucosa or lip or cancer of the small salivary glands, are usually associated with typical mucosal signs, for example, ulceration with raised margins, lumps with abnormal vessels, or abnormal swellings. However, this innocuous complaint is sometimes considered as a “red flag” symptom of an incipient malignancy or an indication of the spread of an established tumor.Ĭompared to intraoral mucosal malignancies, NCS does relate more to metastatic tumors. Most cases are caused by odontogenic diseases such as trauma, dental extraction, dentoalveolar abscess, and osteomyelitis ( 1, 2). If you think you may have a medical emergency, call your physician or 911 immediately.Numb chin syndrome (NCS), often synonymously named as “mental nerve neuropathy,” is a sensory neuropathy characterized by numbness (hypoesthesia, paresthesia, dysesthesia, and anesthesia) or, very rarely, pain of the chin and lower lip within the mental or inferior alveolar nerve distribution. By using this Site you agree to the following Terms and Conditions. We offer this Site AS IS and without any warranties. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
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