Abstract
Numb chin syndrome is an uncommon maxillofacial manifestation involving mental neuropathic complications of mandibular bone metastasis with prostate adenocarcinoma. We report a case of a male, 68 years, with a history of bone tibia and spinal metastatic prostate cancer, undergoing bilateral orchiectomy for hormonal blockade and chemotherapy; disease progression was confirmed by bone scintigraphy which noted no critical points but an increase in alkaline phosphatase; therapy with abiraterone and zoledronic acid quarterly was introduced 1 year after diagnosis. The patient attended a dental appointment after 10 months of bisphosphonate use, complaining of a “tingling” sensation in the right chin mental region, 6 months after tooth extraction, with diagnostic hypothesis of medication-related jaw osteonecrosis. Intra-oral exam showed edema in the right mandibular body region extending to the painless, hardened chin, with exudate drainage as compression. An incisional biopsy was performed and anatomopathological and immunohistochemical analysis showed positive staining for cytokines and NKX3, confirming the diagnosis of adenocarcinoma metastasis. The patient was referred to continue treatment with radiotherapy and, subsequently, Xofigo and zoledronic acid to improve symptomatology and control of the adenocarcinoma. Facial numbness should alert clinicians to the potential of metastatic disease in any patient who presents with chin or jaw numbness and has no other obvious cause for their complaint, and early differential diagnosis between jaw osteonecrosis and bone metastasis in the jaw is important for immediate management and improvement in treatment and quality of life.
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21 September 2021
A Correction to this paper has been published: https://doi.org/10.1007/s42399-021-01051-7
References
Shen ML, Kang J, Wen YL, Ying WM, Yi J, Hua CG, et al. Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature. J Oral Maxillofacial Surg. 2009;67:718–37. https://doi.org/10.1016/j.joms.2008.06.032.
Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumors to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol. 2008;44:743–52. https://doi.org/10.1016/j.oraloncology.2007.09.012.
Van der Waal RIF, Buter J, van der Waal I. Oral metastases: report of 24 cases. Br J Oral Maxillofac Surg. 2003;41:3–6. https://doi.org/10.1016/S0266-4356(02)00301-7.
Kim I-K, Lee DH, Cho HY, Seo JH, Park SH, Kim JM. Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report. J Korean Assoc Oral Maxillofac Surg. 2016;42:301–6. https://doi.org/10.5125/jkaoms.2016.42.5.301.
Pruckmayer M, Glaser C, Marosi C, Leitha T. Mandibular pain as the leading clinical symptom for metastatic disease: nine cases and review of the literature. Ann Oncol. 1998;9:559–64. https://doi.org/10.1023/A:1008286117771.
Lossos A, Siegal T. Numb chin syndrome in cancer patients: etiology, response to treatment, and prognostic significance. Neurology. 1992;42:1181–4.
Tejani N, Cooper A, Rezo A, Pranavan G, Yip D. Numb chin syndrome: a case series of a clinical syndrome associated with malignancy. J Med Imaging Radiat Oncol. 2014;58:700–5. https://doi.org/10.1111/1754-9485.12177.
Aerden T, Grisar K, Neven P, Hauben E, Politis C. Numb chin syndrome as a sign of mandibular metastasis: a case report. Int J Surg Case Rep. 2017;31:68–71. https://doi.org/10.1016/j.ijscr.2017.01.001.
Lu SY, Huang SH, Chen YH. Numb chin with mandibular pain or masticatory weakness as indicator for systemic malignancy. A case series study. J Formos Med Assoc. 2017;116:897–906.
Galán-Gil S, Peñarrocha-Diago M, Peñarrocha-Diago M. Malignant mental nerve neuropathy: systematic review. Med Oral Patol Oral Cir Bucal. 2008;13(10):E616–21.
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Nara Ielo—Concept and article writing, and data acquisition. Mariel Biancardi—article writing. Felipe Trevisan—data acquisition. Cezar Coimbra—data acquisition and article writing. Carlos Zelandi-Filho—data acquisition and article writing. Paulo Sérgio da Silva Santos—concept and final review.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the national ethical committee of Brazil number CAAE: 23798119.8.0000.824.
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Ielo, N., Biancardi, M., Trevisan, F. et al. Jaw Metastasis from a Prostate Adenocarcinoma Associated with Numb Chin Syndrome: Case Report. SN Compr. Clin. Med. 3, 1042–1046 (2021). https://doi.org/10.1007/s42399-020-00720-3
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DOI: https://doi.org/10.1007/s42399-020-00720-3