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Perez C, de Leeuw R, Escala P F, Fuentealba R, Klasser GD. Numb chin syndrome: What all oral health care professionals should know. J Am Dent Assoc 2023; 154:79-93. [PMID: 35644699 DOI: 10.1016/j.adaj.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/15/2022] [Accepted: 03/17/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Numb chin syndrome (NCS) is a rare sensory neuropathy involving the mental nerve. Symptoms of NCS are often overlooked because of their apparent innocent nature; however, owing to the frequent association of NCS with malignancies, the opposite should be the rule. Oral health care professionals may be the first to encounter patients with NCS and should be aware of its clinical characteristics in an effort to decrease patient morbidity and mortality. TYPES OF STUDIES REVIEWED A search in PubMed (MEDLINE) and the Cochrane Library was performed using the terms numb chin syndrome, numb chin, mental neuropathy, mental nerve neuropathy, and malignant mental nerve neuropathy, yielding 2,374 studies. After inclusion and exclusion criteria were applied, 102 studies remained. Descriptive statistics were performed, analyzing the etiology responsible for NCS, characteristics of NCS including associated symptoms, unilateral or bilateral nature, and information on professionals visited and examinations requested to make a diagnosis. RESULTS NCS was associated with malignancy in 29% through 53% of the published cases. Twenty-eight percent of patients initially consulted an oral health care professional with the symptom of a numb chin. Patients more likely to have NCS were those from the ages of 61 through 70 years; 74% were unilateral; and the most common symptoms reported were numbness (100%), paresthesia (18%), and pain (17%). Forty-seven percent of the NCS cases were associated with a recurrent malignancy, and the most prevalent associated diagnoses were breast cancer (32%) and lymphoma and leukemia (24%). CONCLUSIONS Oral health care professionals should be aware of the characteristics of NCS as they may be the first health care providers consulted for these symptoms. PRACTICAL IMPLICATIONS A thorough medical and dental history as well as a complete cranial nerve screening should be performed on all patients, especially those with numbness, as this may prevent misdiagnosis and allow a timely referral and a substantial improvement of treatment course and prognosis.
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Bedrouni M, Touma L, Sauvé C, Botez S, Soulières D, Forté S. Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review and Recommendations for Investigation and Management. Diagnostics (Basel) 2022; 12:diagnostics12122933. [PMID: 36552940 PMCID: PMC9776680 DOI: 10.3390/diagnostics12122933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Numb chin syndrome (NCS) is a rare sensory neuropathy resulting from inferior alveolar or mental nerve injury. It manifests as hypoesthesia, paraesthesia, or, rarely, as pain in the chin and lower lip. Several case reports suggest that sickle cell disease (SCD) could be a cause of NCS. However, information about NCS is scarce in this population. Our objectives were to synthesize all the available literature relevant to NCS in SCD and to propose recommendations for diagnosis and management based on the best available evidence. A systematic review was performed on several databases to identify all relevant publications on NCS in adults and children with SCD. We identified 73 publications; fourteen reports met the inclusion/exclusion criteria. These described 33 unique patients. Most episodes of NCS occurred in the context of typical veno-occlusive crises that involved the mandibular area. Radiological signs of bone infarction were found on some imaging, but not all. Neuropathy management was mostly directed toward the underlying cause. Overall, these observations suggest that vaso-occlusion and bone infarction could be important pathophysiological mechanisms of NCS. However, depending on the individual context, we recommend a careful evaluation to rule out differential causes, including infections, local tumors, metastatic disease, and stroke.
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Affiliation(s)
- Mahdi Bedrouni
- Department of Physiology, McGill University, Montréal, QC H3A 0G4, Canada
| | - Lahoud Touma
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Caroline Sauvé
- Library, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
| | - Stephan Botez
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Denis Soulières
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Stéphanie Forté
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence:
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Wu HW, Rahim N, Mbadiwe N, Khayat S, da Fonseca MA, Peters E, Hsu LL. Vaso-occlusive Pain Crisis Mimicking Mandibular Abscess in an Adolescent with Sickle Cell Disease. J Pediatr Hematol Oncol 2022; 44:e450-e452. [PMID: 35200222 DOI: 10.1097/mph.0000000000002274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
In people with sickle cell disease (SCD), oral abscesses are concerning clinical conditions and carry a high risk of postoperative sickle cell complications. We present an unusual case of a 14-year-old girl with SCD whose initial presentation of facial swelling, headaches, jaw pain, and paresthesia mimicked an odontogenic abscess. She was diagnosed with vaso-occlusive crisis in the mandibular bone and successfully managed noninvasively. This is among the youngest cases of paresthesia in the lower lip in SCD, which provided a clue that postponing invasive aspiration or biopsy was possible under empiric antibiotics and close observation.
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Affiliation(s)
| | | | | | | | | | | | - Lewis L Hsu
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL
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Poh F, Hlis R, Chhabra A. Upper limb peripheral neuropathy in sickle cell anemia: MR neurography appearances. Indian J Radiol Imaging 2021; 29:67-71. [PMID: 31000944 PMCID: PMC6467032 DOI: 10.4103/ijri.ijri_364_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Sickle cell anemia is an inherited disorder with many systemic complications. Peripheral neuropathy related to this disorder has been sparsely reported. We report an interesting case of upper limb peripheral neuropathy from sickle cell disease with emphasis on MR neurography appearances and electrophysiology correlation.
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Affiliation(s)
- Feng Poh
- Radiologic Clinic, Medi-Rad Associates Ltd, Mt Elizabeth Hospital, Singapore 228510.,Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Rocco Hlis
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX
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Orofacial manifestations of sickle cell disease: implications for dental clinicians. Br Dent J 2021; 230:143-147. [PMID: 33574535 DOI: 10.1038/s41415-021-2601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022]
Abstract
Sickle cell disease is a multisystem disease associated with episodes of acute illness and progressive organ damage. It is one of the most common severe monogenic disorders worldwide and is now the fastest growing genetic disorder in the UK. Dental awareness of orofacial manifestation varies geographically due to the inheritance pattern and patient population affected by the disease. This article details the epidemiology, pathophysiology and the orofacial manifestations in light of current literature.
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Ramsay Z, Gabbadon CH, Asnani M. Numb chin syndrome in sickle cell disease: a case series of Jamaican patients. Ann Hematol 2021; 100:913-919. [PMID: 33479847 DOI: 10.1007/s00277-021-04423-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
Numb chin syndrome is an uncommon presentation that has been reported as secondary to metastatic disease, trauma, and infections of the maxilla, mandible, or oral cavity. The hypoesthesia, paraesthesia, or pain are a result of injury to the inferior alveolar nerve, which is particularly vulnerable as it exits the mandible through the mandibular foramen as the mental nerve. In persons with sickle cell disease, it has been reported as a manifestation of mandibular vaso-occlusive crisis. This case series presents 13 patients with sickle cell disease who presented with numb chin syndrome, the largest number of cases that has been described in the literature to date. The report illustrates the wide variety of presentations and therefore possible differential diagnoses to consider. In this case series, the symptoms were associated with vaso-occlusive crises, allergic reactions, dental infections, malignancy, rheumatoid arthritis, and pregnancy. Most appeared to be self-limiting; however, one patient was having his second episode, and the numbness has persisted in three patients. The series illustrates that it is important not only to ensure that the source of the local vaso-occlusive crisis is treated, but also to not miss important differentials such as metastatic disease, where this can be the first presentation of malignancy and would represent a very poor prognosis. There is no reported successful treatment for the hypoesthesia in this case series, and this presents an area for further research.
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Affiliation(s)
- Zachary Ramsay
- Caribbean Institute for Health Research, Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
| | - Christine Hammond Gabbadon
- Caribbean Institute for Health Research, Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Monika Asnani
- Caribbean Institute for Health Research, Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
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Evidence-based dental management in the new era of sickle cell disease: A scoping review. J Am Dent Assoc 2020; 151:668-677.e9. [PMID: 32854869 DOI: 10.1016/j.adaj.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD. TYPES OF STUDIES REVIEWED Using a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations. RESULTS Systemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care. PRACTICAL IMPLICATIONS In SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.
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Evaluation of Mandible Fractures in Patients With Sickle Cell Anemia-A Nationwide Study. J Oral Maxillofac Surg 2019; 77:1418-1422. [PMID: 30707980 DOI: 10.1016/j.joms.2018.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Sickle cell anemia is the most commonly inherited blood disorder in the United States. Despite its prevalence, clinicians know little about the extent of its impact on orofacial manifestations. MATERIALS AND METHODS All patients with diagnoses of mandible fracture and sickle cell anemia admitted from 2004 through 2014 were identified using the National Inpatient Sample. Patient demographics, fracture regions, and complications were characterized by descriptive statistics. RESULTS Fifty-one of 48,464 patients admitted for mandible fracture had sickle cell anemia. The mean age of the identified patients was 25 years (range, 4 to 58 yr). Of all admitted patients, mandible angle fracture was the most common (19%), followed by fracture of the body of the mandible. Seventy-five percent of cases reviewed were treated with open reduction and internal fixation. CONCLUSIONS Most mandible fractures in patients with sickle cell anemia were located in the angle of the mandible. Complications were minimal and outcomes were satisfactory. Aseptic necrosis of the jaw was a frequent complication of mandible fracture in patients with sickle cell anemia. These results provide clinicians with a better understanding of the distribution and hospital course of patients with sickle cell anemia and facial fractures.
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Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016; 220:627-35. [DOI: 10.1038/sj.bdj.2016.444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/09/2022]
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Sugiyama M, Yokoi T, Kawakami N, Kikkawa M, Tokunaga Y, Chayama K. Chin Numbness and Pain in a Patient with Burkitt Acute Lymphoblastic Leukemia. J Pediatr 2015; 167:938-938.e1. [PMID: 26235665 DOI: 10.1016/j.jpeds.2015.06.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/23/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022]
Affiliation(s)
| | - Takehito Yokoi
- Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan
| | | | - Makiko Kikkawa
- Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan
| | | | - Kosuke Chayama
- Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan
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Zaheer F, Hussain K, Rao J. Unusual presentation of 'numb chin syndrome' as the manifestation of metastatic adenocarcinoma of the lung. Int J Surg Case Rep 2013; 4:1097-9. [PMID: 24240077 PMCID: PMC3860018 DOI: 10.1016/j.ijscr.2013.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/31/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Numb chin syndrome (NCS) is the presence of hypoaesthesia or paraethesia of the lip and chin over the distribution of the mental nerve. It is often caused by the presence of a metastatic tumour in the mandible or the base of skull and represents advanced malignancy. PRESENTATION OF CASE This paper presents an unusual case of NCS associated with metastatic adenocarcinoma of the lung, for which no obvious lesion was found in the mandible or base of the skull. DISCUSSION NCS can oftentimes present itself in the absence of mandibular or base of skull metastatic lesions. CONCLUSION NCS can be a sign of underlying advanced metastatic malignancy and therefore cannot be ignored and must be investigated fully.
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Affiliation(s)
- Faizan Zaheer
- University of Manchester, Room 1.03, Coupland 3 Building, Coupland Street, Manchester M13 5PL, United Kingdom
| | - Khurrum Hussain
- Heaton Mersey Dental Practice, Heaton Mersey, Stockport SK4 3BY, United Kingdom
| | - Jeethendra Rao
- Manchester Royal Infirmary, Oxford Road, M13 9WL, United Kingdom
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Abstract
BACKGROUND The aim of this study was to review the orofacial manifestations in patients with sickle cell disease (SCD). METHODS Indexed databases were explored using various combinations of the following keywords: "sickle cell anemia," "sickle cell disease," "oral health status" and "dental inflammation." RESULTS Hypoxia has been associated with osteomyelitis of the jaws, particularly the mandible in patients with SCD. Bone marrow hyperplasia in these patients causes depression of nasal bridge, midfacial overgrowth and malocclusion. Mental nerve neuropathy due to osteomyelitis of the mandible causes numbness in the lower lip and chin. A diminished blood supply to teeth causes necrosis of the dental pulp in patients with SCD. Dental caries is a common manifestation in patients with SCD, particularly in those with underprivileged living standards. The association between SCD and periodontal inflammatory conditions remains unclear. CONCLUSIONS Oral health problems in patients with SCD are rare and occur mainly as a result of the poor oral hygiene maintenance.
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Abstract
Sickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute painful episode at the prodromal phase could potentially prevent or minimize tissue damage. Our hypothesis is that managing these events with hydration, anti-inflammatory drugs, aggressive analgesia, and possibly vasodilators could abort the crisis and prevent or minimize further damage. Chronic pain syndromes are associated with or accompany avascular necrosis and leg ulcers. Neuropathic pain is not well studied in patients with sickle cell disease but has been modeled in the transgenic sickle mouse. Management of sickle cell pain should be based on its own pathophysiologic mechanisms rather than borrowing guidelines from other nonsickle pain syndromes.
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