Numb Chin Syndrome: Difference between revisions

From Face, Mouth and Jaw
Jump to navigation Jump to search
No edit summary
Line 14: Line 14:
* Patients with skull based metastasis can also present with other cranial nerve abnormalities
* Patients with skull based metastasis can also present with other cranial nerve abnormalities
* Patients with mandibular tumours may also present with swelling, loose teeth etc
* Patients with mandibular tumours may also present with swelling, loose teeth etc
==Differential Diagnosis==
* Differential Diagnosis


==Aetiology and Pathogenesis==
==Aetiology and Pathogenesis==
Line 38: Line 34:
*#* Antibodies may be directed against unknown antigens in the nervous system<ref>[https://doi.org/10.1007/s00415-005-0047-1 Raaphorst J, Vanneste J. Numb cheek syndrome as the first manifestation of anti-Hu paraneoplastic neuronopathy. Journal of neurology. 2006 May 1;253(5):664.]</ref>
*#* Antibodies may be directed against unknown antigens in the nervous system<ref>[https://doi.org/10.1007/s00415-005-0047-1 Raaphorst J, Vanneste J. Numb cheek syndrome as the first manifestation of anti-Hu paraneoplastic neuronopathy. Journal of neurology. 2006 May 1;253(5):664.]</ref>


* Aetiology and pathogenesis
===Causes===


==Investigations==
==Investigations==

Revision as of 12:00, 9 December 2021

  • Numbness/decreased sensation of the chin and lower lip
  • Easily underemphasised by clinicians and patients
  • Caused by a wide range of differentials - some associated with significant morbidity and mortality

Epidemiology

  • Epidemiology
  • ♀ > < = ♂

Clinical Features

  • Paraesthesia, dysaesthesia or anaesthesia to chin and lower lip (mental/inferior alveolar nerve region)
    • Malignancy tends to be associated with numbness (pain occurs in <10% of cases associated with malignancy)[1]
  • Patients with skull based metastasis can also present with other cranial nerve abnormalities
  • Patients with mandibular tumours may also present with swelling, loose teeth etc

Aetiology and Pathogenesis

Pathophysiology

  • Can occur from a lesion anywhere along the course of the trigeminal nerve (including as proximal as trigeminal ganglion and pons)
  • Lesions can be divided into:
    1. Peripheral lesions - involving mandible, direct nerve infiltration , inflammation or compression
    2. Central lesions - involving the base of skull, leptomeninges, or brainstem
  • Malignancy associated cases can occur through the following mechanisms:
    1. Direct infiltration of the nerve
      • Head and neck primary or metastasis from distant site to mandible
    2. Leptomeningeal seeding
      • May have no obvious mass in the mandible or skull base
      • These cases are thought to be due to leptomeningeal seeding[2][3][4]
    3. Cervical lymphadenopathy
      • Nodes in the deeper upper cervical region can exert pressure on the inferior alveolar nerve just before it enters the mandibular foramen[5]
    4. Paraneoplastic Phenomenon
      • Antibodies may be directed against unknown antigens in the nervous system[6]

Causes

Investigations

Laboratory Investigations

Imaging

Other

Management

  • Management

Prognosis and Complications

  • Prognosis and Complications

Follow-up

  • Follow-up

References

[[Category:]]