Correspondence

Case 27-1994: The Numb Chin Syndrome

N Engl J Med 1994; 331:1460November 24, 1994

Article

To the Editor:

With regard to Dr. Lynch's discussion (July 14 issue)1 of the case of a 41-year-old woman with a lytic jaw mass, lymphadenopathy, splenomegaly, and a multifocal neurologic disorder, the patient's reports of numbness and impaired sensation on the right side of the chin is typical of mental neuropathy, also known as the numb chin syndrome. This clinical presentation, combined with the finding of a lytic jaw lesion, suggests that the chin numbness resulted from local involvement of the inferior alveolar nerve or the mental nerve.

This uncommon cranial neuropathy is mostly associated with neoplastic disorders.2 Its appearance in a 41-year-old woman with no history of smoking should have directed the evaluation toward metastatic breast cancer or high-grade malignant lymphoma, the two most common causes of the syndrome. Among the lymphomas, the numb chin syndrome occurs with notable frequency in American Burkitt's lymphoma3 and Burkitt's-cell acute lymphoblastic leukemia,4 providing an additional clue to the diagnosis.

Chin numbness may occur at presentation or with systemic dissemination of the basic disease. Its most frequent causes are compression of the mental nerve or the inferior alveolar nerve by jaw metastases and intracranial involvement of the mandibular nerve by lesions at the base of the skull.2 Leptomeningeal seeding may also cause chin numbness and should be excluded in patients with multifocal neurologic involvement, as was done in this case. Thus, we believe that the patient's presentation with the numb chin syndrome was highly suggestive of the presence of neoplastic disease, most likely a high-grade lymphoma.

Alexander Lossos, M.D.
Tali Siegal, M.D.
Hadassah University Hospital, Jerusalem 91120, Israel

4 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 27-1994). N Engl J Med 1994;331:107-113
   Full Text | Web of Science | Medline

2. 2

   Lossos A, Siegal T. Numb chin syndrome in cancer patients: etiology, response to treatment, and prognostic significance. Neurology 1992;42:1181-1184
   Web of Science | Medline

3. 3

   Sariban E, Donahue A, Magrath IT. Jaw involvement in American Burkitt's lymphoma. Cancer 1984;53:1777-1782
   CrossRef | Web of Science | Medline

4. 4

   Fenaux P, Lai JL, Miaux O, Zandecki M, Jouet JP, Bauters F. Burkitt cell acute leukaemia (L₃ ALL) in adults: a report of 18 cases. Br J Haematol 1989;71:371-376
   CrossRef | Web of Science | Medline

Citing Articles (4)

Citing Articles

1. 1

   Konstantinos Liapis, Ioannis Apostolidis, Themistokles Karmiris, Nikolaos Harhalakis. (2010) Numb chin syndrome as the initial manifestation of acute megakaryoblastic leukemia. Leukemia & Lymphoma 51:12, 2310-2311
   CrossRef

2. 2

   Mythili Kalladka, Noam Proter, Rafael Benoliel, Rakefet Czerninski, Eli Eliav. (2008) Mental nerve neuropathy: patient characteristics and neurosensory changes. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 106:3, 364-370
   CrossRef

3. 3

   John J. Kelly, Donald S. Karcher. (2005) Lymphoma and peripheral neuropathy: A clinical review. Muscle & Nerve 31:3, 301-313
   CrossRef

4. 4

   M.A. Marinella. (1997) Metastatic large cell lung cancer presenting with numb chin syndrome. Respiratory Medicine 91:4, 235-236
   CrossRef