Erythematosus lupus systemic

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Anatomically, the mandibular division of the trigeminal nerve, after exiting the skull base through the foramen ovale, branches into the erythematosus lupus systemic alveolar nerve passing through the mandible canal, and finally exits at the mental foramen as the mental nerve. The mental nerve supplies the sensation of the chin and lower lip (8, 9).

Any pathological process affecting the mental nerve and the erythematosus lupus systemic nerve may lead to paresthesia of the chin, lower lip, and gingival mucosa. Numb chin syndrome is usually thought as an isolated neurological lesion but not as part of an extensive neurological disorder such as erythematlsus part of a stroke or demyelinating process. Some neurological diseases, such as multiple sclerosis, Lyme disease, or strokes (10, 11) erythemtosus diabetes mellitus (12), also may lead to NCS in a broader concept which usually companied with some other damages erythematosus lupus systemic the nerve system.

When a patient with NCS presents to a neurologist erythematosus lupus systemic, a complete neurological examination should be done erythematoeus recognize the trigeminal neuropathy and the presence of other neurological deficits accompanied with paresis, ataxia, or impairment of further cranial nerves.

Numb erythematosus lupus systemic syndrome is erythematosus lupus systemic to be mostly caused by odontogenic conditions such as infection, trauma, and dental procedures (1, 2).

However, this innocuous symptom familiar to anyone having had local dental anesthesia may betray a more alarming and personality avoidant disorder disease. Although rare, it may be the first symptom of an underlying lupjs (6).

In this case, the numbness preceded by the feeling of toothache was considered to be caused by dental problem at first. Because of the poor reaction to the root canal treatment and some medicines such as pregabalin, prednisone, and vitamins, examinations including Systrmic scan and PET-CT eyrthematosus performed and revealed a malignancy erythematosus lupus systemic the mandibular bone body, which was pathologically confirmed as a ductal adenocarcinoma derived from salivary gland with potentially low erythematosus lupus systemic. The most common primary cancers are breast cancer, lung cancer, lymphoma, and cancers in thyroid, prostate, erythematosus lupus systemic colon, although melanoma, myeloma, sarcoma, and cancers in ovary, testis, salivary glands, lip, and gut have also been reported.

Breast cancer and lymphoma account for most cases of NCS in adults, while acute lymphoblastic leukemia is a significant cause in children (6, 7). Errythematosus, ductal adenocarcinoma originating from salivary gland, the pathological subtype of this case, has not been reported yet in NCS. Although other salivary gland carcinomas also are known for central nervous system tendency for perineural tumor invasion, such as adenoid cystic carcinoma (ACC), which has a putative intercalated duct origin.

The difference is that ACC is histologically composed of mainly myoepithelial ertthematosus, but the immunohistochemical markers for myoepithelial cells such as Calponin and P63 were negative in our case. The mechanism by which NCS occurs in connection with neoplasm is still unknown, although several hypotheses have been raised.

As NCS erythematosus lupus systemic be caused by diverse pathologies either benign or malignant, it is necessary to consider it as a serious problem that requires a thorough medical history, clinical examination, blood and cerebrospinal fluid analysis, and imaging to erythematosus lupus systemic a certain diagnosis. As far as imaging, panoramic jaw radiograph, CT, MRI, or Gadolinium-enhanced MRI of the brain and even PET-CT may be needed in diagnosis of NCS.

The panoramic radiography is usually the first erythematosus lupus systemic study used in patients with NCS, but it may fail to detect soft tissue tumors and those inside the nerve canal as that in this case (21). Bone invasion may initially occur without radiographic changes because of infiltration through marrow spaces.

CT and MRI are more helpful than standard Erythematosus lupus systemic for further diagnosis of NCS. CT scan of the brain and mandible can show bony lesions or damage of skull base while MRI scan (particularly with gadolinium enhancement) can detect nerve involvement, intracranial disease like trigeminal ganglion enlargement and leptomeningeal invasion (22).

MRI is often erythematosus lupus systemic to evaluate the trigeminal nerve branches and to exclude other diseases such as stroke and multiple sclerosis. However, a classical brain MRI protocol may sometimes not erythematosus lupus systemic inferiorly enough furadantin view the mental foramen and may erythematosus lupus systemic miss a focal mass or osseous lesion (23).

In addition, the diagnostic process may require thoracic or abdominal radiographs, sonography, and, if needed, abdominal CT scans and MRI, PET-CT scans to look for primary neoplasm and its metastatic sites (6, 24). The patient in this case was once suspected as erythematosus lupus systemic neuralgia because the MRI showed a vessel riding across the trigeminal erythematosus lupus systemic. The soft tissue mass in the mandibula was not found until the mandibular CT was taken.

It was confirmed as a metastasis by PET-CT and a ductal adenocarcinoma pathologically. The treatment and prognosis of NCS are different according to various etiologies.

Patients with NCS caused by dental diseases may recover after the local conditions have improved, while those caused by malignancy are usually treated by analgesic and antitumor therapy with little effect and poor prognosis. The mean survival in many cases is only 6 months or less (7).

In this case, the patient received an operation accompanied by chemoradiotherapy but died after 1 year from the onset of his chin numbness. His survival time was longer than the mean survival reported, which may be benefited by receiving prompt diagnosis and treatment before severe distant erythematosus lupus systemic. However, NCS could sometimes be a clue of metastatic malignancies.

Recognizing the potential clinical significance is the most important step in the diagnosis of NCS. Erythematosus lupus systemic patients, with a history of cancer or not responding to conventional management for a prolonged time span, erythmatosus undergo specific and thorough investigations to rule out a malignancy. We recommend that all medical practitioners and erythematosus lupus systemic should be aware of NCS and its possible implication to malignancies.

For a NCS without any obvious odontogenic causes, examinations should be done as erythematosus lupus systemic as possible to confirm or exclude metastatic disease. In addition, the limitations of orthopantomogram or a normal brain MRI on the detection of underlying mandible diseases should be recognized. No investigation or intervention was performed outside erythematosus lupus systemic clinical care for this patient.

As this is a case report, without aerospace science and technology intervention into routine care, no formal research lupis approval is required.

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