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There are many causes of a persistent unilateral numbness of the lower lip. A case report of a 34-year-old normally fit and well male, whose symptoms of numbness of the mandibular division of the right trigeminal nerve represented the rare diagnosis of a primary B-cell lymphoma of the mandible, is presented here. The patient's presentation and management, reasons for the difficulty in ascertaining a definitive diagnosis, as well as invaluable points to be reflected on from this case, are discussed.
CPD/Clinical Relevance: Numbness should be treated with a high degree of suspicion, with urgent imaging, biopsy and specialist histopathology staining being carried out to exclude malignancy.
Article
A report of a 34-year-old male, whose symptoms of lip numbness were initially diagnosed as trigeminal neuralgia, is presented. A mandibular mass arose, and spontaneously resolved during the course of further investigations; this presented challenges regarding the patient's rare diagnosis of a primary B-cell lymphoma of the mandible, of which there are only a few cases reported in the literature.
A 34-year-old fit and well male presented initially to the Emergency Department complaining of pain from his ‘mouth, gums and ear’, and he had also observed a complete numbness of his right lip and chin. The Emergency Department staff attributed the cause to trigeminal neuralgia. The patient was discharged with analgesia, and advised to see his GMP to arrange for a prescription of carbamazepine and an outpatient MRI investigation.
The patient was first seen by Oral and Maxillofacial Surgery (OMFS) following an urgent referral from his dentist. He described pain and complete absence of sensation in the right mandibular division of the trigeminal nerve. An OPG radiograph was taken, which failed to demonstrate a clear cause of the patient's symptoms (Figure 1).
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