Limits...
Intractable Facial Pain and Numb Chin due to Metastatic Esophageal Adenocarcinoma.

Elahi F, Luke W, Elahi F - Case Rep Oncol (2014)

Bottom Line: Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief.We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging.Targeted treatment based on an accurate diagnosis is the foundation of pain management.

View Article: PubMed Central - PubMed

Affiliation: Center of Pain Medicine, University of Iowa, Iowa City, Iowa, USA.

ABSTRACT
The etiologies of facial pain are innumerable, thus facial pain misdiagnosis and resultant mismanagement is common. Numb chin syndrome presents with hypoesthesia and/or anesthesia in the dermatomal distribution of the inferior alveolar or the mental nerve. In this case report, we will discuss a case of intractable facial pain in a 57-year-old male with a history of esophageal adenocarcinoma who was initially misdiagnosed and treated as trigeminal neuralgia. During clinical examination, the loss of sensation in the inferior alveolar nerve distribution was identified and led to the diagnosis of mandibular metastasis. The details of the clinical presentation will be discussed in the context of accurate identification and diagnosis. Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief. This case report provides additional information to the current medical knowledge and it enhances the clinical vigilance of the clinicians when they encounter similar cases. We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging. Targeted treatment based on an accurate diagnosis is the foundation of pain management.

No MeSH data available.


Related in: MedlinePlus

Mandibular CT scan: the arrow shows the localized lytic lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4296230&req=5

Figure 1: Mandibular CT scan: the arrow shows the localized lytic lesion.

Mentions: On physical examination, the patient was in considerable distress due to the facial pain. He had a palpable trigger point over the left masseter muscle. The temporomandibular joint range of motion was within normal limits and with no associated pain. A sensory examination revealed a decreased sensation to light touch and pinprick over the left chin, the lower lip, and the lower oral mucosa, consistent with the distribution of the left inferior alveolar nerve. There was no facial asymmetry, and no other cranial nerve deficits were observed. We decided to perform a localized mandibular CT scan, on which we localized a metastatic lesion in the mandibular bone with the involvement of the inferior alveolar nerve (fig. 1).


Intractable Facial Pain and Numb Chin due to Metastatic Esophageal Adenocarcinoma.

Elahi F, Luke W, Elahi F - Case Rep Oncol (2014)

Mandibular CT scan: the arrow shows the localized lytic lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296230&req=5

Figure 1: Mandibular CT scan: the arrow shows the localized lytic lesion.
Mentions: On physical examination, the patient was in considerable distress due to the facial pain. He had a palpable trigger point over the left masseter muscle. The temporomandibular joint range of motion was within normal limits and with no associated pain. A sensory examination revealed a decreased sensation to light touch and pinprick over the left chin, the lower lip, and the lower oral mucosa, consistent with the distribution of the left inferior alveolar nerve. There was no facial asymmetry, and no other cranial nerve deficits were observed. We decided to perform a localized mandibular CT scan, on which we localized a metastatic lesion in the mandibular bone with the involvement of the inferior alveolar nerve (fig. 1).

Bottom Line: Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief.We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging.Targeted treatment based on an accurate diagnosis is the foundation of pain management.

View Article: PubMed Central - PubMed

Affiliation: Center of Pain Medicine, University of Iowa, Iowa City, Iowa, USA.

ABSTRACT
The etiologies of facial pain are innumerable, thus facial pain misdiagnosis and resultant mismanagement is common. Numb chin syndrome presents with hypoesthesia and/or anesthesia in the dermatomal distribution of the inferior alveolar or the mental nerve. In this case report, we will discuss a case of intractable facial pain in a 57-year-old male with a history of esophageal adenocarcinoma who was initially misdiagnosed and treated as trigeminal neuralgia. During clinical examination, the loss of sensation in the inferior alveolar nerve distribution was identified and led to the diagnosis of mandibular metastasis. The details of the clinical presentation will be discussed in the context of accurate identification and diagnosis. Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief. This case report provides additional information to the current medical knowledge and it enhances the clinical vigilance of the clinicians when they encounter similar cases. We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging. Targeted treatment based on an accurate diagnosis is the foundation of pain management.

No MeSH data available.


Related in: MedlinePlus