BMJ Case Reports 2018; doi:10.1136/bcr-2017-223586
  • Unusual association of diseases/symptoms

Numb chin syndrome: an ominous sign of mandibular metastasis

  1. Abd Jabar NAZIMI3
  1. 1 ENT, Hospital Muar, Muar, Johor, Malaysia
  2. 2 Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia Fakulti Perubatan, Kuala Lumpur, Malaysia
  3. 3 Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Jothi Raamahlingam Rajaran, jothiraamahlingam{at}
  • Accepted 28 March 2018
  • Published 14 May 2018


A 51-year-old woman a known case of stage 2 breast carcinoma in 2006 and underwent left mastectomy performed in the same year presented with bilateral lower limb pain suggestive of spinal pathology, and left chin numbness, both of 2 weeks’ duration. Examination revealed left mandibular hypoesthesia without any other sign or symptoms. Orthopantomogram was unremarkable apart from mild alveolar bone expansion at tooth 36 area, which was extracted 3 months earlier. Subsequently, a full-body positron emission tomography contrast enhanced computer tomography revealed hypermetabolic lesions of her axial (excluding skull) and appendicular skeleton. In the head and neck region, left mandibular foramen and oropharynx bilaterally showed increased metabolism suggestive of tumour metastasis. The diagnosis was numb chin syndrome secondary to mandibular metastasis. Apart from supportive treatment, she was started on palliative chemotherapy and radiotherapy. At the time of discharge, there were no active complaints other than the aforementioned hypoesthesia.


  • Contributors AR, BSG, JRR and MNAJ have contributed to the design and implementation of the idea, to the analysis of the clinical findings and to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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