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Comments, Opinions, and Brief Case Reports
June 28, 2004

The Numb Chin Syndrome: A Critical Sign for Primary Care Physicians

Arch Intern Med. 2004;164(12):No Pagination Specified. doi:10.1001/archinte.164.12.1347

Charles Bell initially described the numb chin syndrome (NCS) in 1830. Although the syndrome is frequently described in the dental, oncology, and neurology literature, its importance as a symptom of underlying, progressing, or relapsing malignant disease remains unrecognized by most primary care physicians. Below is a case of Burkitt cell acute lymphoblastic leukemia presenting with NCS as both an initial manifestation of the disease and its subsequent relapse.

A 33-year-old woman was well until 2 weeks prior to admission, when she noted the onset of fatigue, sweats, and chin and jaw numbness and paresthesias. She was evaluated by her physician and treated supportively. One week later her symptoms were worse. A complete blood cell count revealed pancytopenia, and she was admitted to the hospital. There was no preceding trauma to the jaw or teeth, and she found nothing that relieved her symptoms. Her medical history included depression, anxiety, and constipation. Her medications were desipramine hydrochloride, alprazolam, bisacodyl as needed, and an oral contraceptive. She did not use any herbal or other supplements, and the family medical history was unremarkable. Her temperature was 38.2°C and the other vital signs were normal. Examination results of the head, neck, oropharnyx, and teeth were normal, as was the remainder of the general physical examination. The sole neurological abnormality was impaired sensation in the distribution of the third division of the trigeminal nerve (V3) bilaterally.

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