PDF(Pubmed)
Abstract：
Numb chin syndrome (NCS) is hypesthesia of the mandible and lower lip caused by damage to the inferior alveolar or mandibular nerves, commonly due to dental treatment or osteomyelitis, but occasionally caused by malignant tumors. We report the case of a male in his 60s. He came to our hospital with a chief complaint of mandibular pain and paresthesia in the right side of the mental region. He had noticed swelling of the left mandible one month before the initial visit and strong hypesthesia of the right side of the mental region one week before the initial visit. Panoramic radiographs showed slight osteosclerosis of the left side mandible at the initial visit. Blood tests showed only a slight inflammatory reaction. The diagnosis of mandibular osteomyelitis and numb chin syndrome was made, and a contrast-enhanced CT scan was performed to investigate the possibility of neoplastic lesions, but no obvious cause was found. Osteosclerosis was minimal. A tissue biopsy was recommended, but the patient did not consent. Considering the possibility of NCS due to a hematologic disorder, the patient was referred to a hematologist, but no cause could be identified at the initial visit. With time, the markedly severe pain worsened, and the possibility of a neoplastic lesion was again suspected. Blood tests were performed, which revealed abnormally high levels of CA19 and CEA. He consulted a gastroenterologist, who found a tumor in the ileocecal region on contrast-enhanced CT, and multiple systemic metastases were found on a PET-CT scan the next day. Systemic chemotherapy was administered for multiple metastatic unresectable colorectal cancer (cT4N1aMc2 stage IVc).
摘要：
下巴麻木综合征（NCS）是下牙槽或下颌神经损伤引起的下颌骨和下唇的感觉减退，通常是由于牙科治疗或骨髓炎，但偶尔由恶性肿瘤引起。我们报道了一个60多岁的男性病例。他来到我们医院，主要主诉是精神区域右侧的下颌疼痛和感觉异常。他在初次探视前一个月注意到左下颌骨肿胀，在初次探视前一周注意到右侧的精神区域强烈麻木。首次就诊时，全景X光片显示左侧下颌骨轻度骨硬化。血液检查显示只有轻微的炎症反应。诊断为下颌骨骨髓炎和麻木下巴综合征，并进行了对比增强CT扫描以研究肿瘤性病变的可能性，但没有找到明显的原因。骨硬化很小。建议进行组织活检，但患者不同意。考虑到NCS可能是由血液病引起的，病人被转诊给血液学家,但是在初次访问时无法确定原因。随着时间的推移,明显剧烈的疼痛恶化，再次怀疑肿瘤病变的可能性。进行了血液检查，显示CA19和CEA水平异常高。他咨询了胃肠病学家,在对比增强CT检查中在回盲区发现了肿瘤，第二天在PET-CT扫描中发现了多个全身性转移。全身化疗用于多发性转移性不可切除的结直肠癌（cT4N1aMc2期IVc）。
