Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome

Abstract

Background: Numb chin syndrome is an uncommon but well-recognized symptom in medical oncology. This condition can be related to metastatic neurological manifestation of malignancy, often with no clinically visible pathology. About 1% of oral cancers, which are located in the soft tissues and jaws, are metastases of primary tumors located elsewhere in the body. The posterior mandible is the most common site of metastasis of the oral region because of its rich blood supply in active areas of hematopoiesis. This article describes prostate carcinoma metastasis located in the mandible and temporomandibular joint of a 78-year-old male.

Case presentation: A 78-year-old male patient presented to our outpatient clinic with a complaint of numbness and pain on the left site of the mandible. The patient stated that he had been suffering from this numbness for 1 to 2 months. In the medical anamnesis, it was discovered that patient had prostate carcinoma (CA) 5 years previous, and since then, he had visited his doctor periodically for an annual examination. In these examinations and on the basis of tests carried out at the hospital 1 year previous, it was stated that no CA relapse traces were detected. The patient had visited his dentist 2 months previous for pain and numbness of the left molar region.

Conclusions: We report numb chin syndrome, which is an uncommon neurological manifestation of metastatic malignancy. The clinical course and rapid deterioration after the initial presentation of this syndrome is discussed. This clinical situation illustrates the importance of good medical history review prior to all procedures by the medical professions dealing with oncology patients. An awareness of this condition is crucial, especially in symptoms with unexplained facial pain and numbness.

Figure 1

Initial panoramic imaging taken by patient’s dentist 2 months ago and showing no apparent lesion.

Figure 2

Panoramic radiograph taken 1.5 months later and showing severe erosion on the left site of the mandible.

Figure 3

Coronal and sagittal cone beam computed tomography (CBCT) images showing erosion in the molar region through the temporomandibular joint (TMJ) area.

Figure 4

Axial cone beam computed tomography (CBCT) images showing erosion in relation to the mandibular nerve on the level of the lingula mandible.

Figure 5

Panoramic reconstructions and 3D cone beam computed tomography (CBCT) images showing severe moth-eaten shaped erosion in relation to the mandibular nerve.