Unilateral Facial Numbness
Possible causes of sudden onset:
- Trauma (including dental surgery)
- Acute infection (bacterial or viral [e.g., varicella-zoster virus])
- Vascular event (e.g., cerebral hemorrhage or infarction)
- Malignant disease
Possible causes of gradual onset:
- Local pathosis or metastatic disease
- Onset of systemic disease (e.g., multiple sclerosis (MS), diabetic neuropathy, severe anemia)
- Malignant disease
- More commonly occurs in middle-aged or elderly adults; however, can occur at any age.
- If caused by trauma/fracture:
- Mass or swelling
- Bruising, laceration or bleeding
- Step deformity of jaw
- Hyperesthesia (increased sensitivity to touch)
- Change in occlusion (malocclusion)
- If caused by infection:
- Fever, malaise
- Pain, tenderness at site
- If caused by tumour:
- Local: mass, bone destruction
- Metastatic: mass, bone destruction, lymphadenopathy, known primary or first sign of distant tumour (See Figs. 1 and 2)
- If caused by systemic malignancy (e.g., leukemia or lymphoma):
- Fatigue, bleeding, pallor, bruising, night sweats, lymphadenopathy, rapid weight loss, and infection
- Common primary cancers that may metastasize to the jaw are: breast, prostate, colon, lung, and kidney
- If caused by peripheral neuropathy due to medications:
- More commonly bilateral, but could present with unilateral symptoms (e.g., chemotherapy drugs associated with peripheral neuropathy include vinca alkaloids, taxanes, platinum-based drugs, dilantin, and thalidomide).
- If caused by vascular event:
- Disorientation, unusual behaviour (e.g., gait, speech, mannerisms, coordination)
- Asymmetric appearance (e.g., drooping)
- Altered speech (e.g., slurring, drooling)
- Early stage pain/numbness may be initially intermittent, then progressive and persistent.
- Pain can range from asymptomatic to severe.
- Rule out local dental/oral pathology (including dental procedural etiology, dental infection, local tumour):
- Obtain thorough medical and dental histories: inquire about onset, duration and progression over time, history of trauma, daily patterns (if episodic and cyclic), things that make symptoms better or worse (e.g., eating, swallowing, talking).
- Perform a comprehensive head and neck examination and intraoral examinations.
- Obtain appropriate radiographic imaging (dental films, CT, MRI, ultrasound, and plain films).
- Examine for local and systemic signs of infection (pain, swelling, erythema, lymphadenopathy, fever, etc.).
Diagnosis is based on a clinical exam, medical history, appropriate medical laboratory testing (that may include biopsy of identified lesions), and diagnostic imaging (that may include dental and medical imaging). If dental conditions are ruled out, refer to appropriate specialist to rule out infection, tumour, systemic disease, or distant malignancy.
- Severe acute infection (bacterial or viral)
- Local or metastatic tumour
- Systemic disease (e.g., MS, diabetes, severe vitamin deficiency, severe anemia). Systemic conditions generally have bilateral or multiple sites of involvement, although at onset may have asymmetrical localization.
- Cerebrovascular events
- Autoimmune disorders (e.g., AIDS, Sjögren syndrome)
- Genetic disorders (e.g., amyloidosis, hereditary sensory neuropathy)
- Occupational disorders (e.g., exposure to fertilizers, pesticides, solvents, heavy metals)
- Iatrogenic disorders (e.g., chemotherapeutic drugs)
- Poisoning (e.g., arsenic, thallium)
Often requires referral due to the significant nature of symptoms:
- Infection: Common initial treatment for potential dental/oral pathology: if fluctuant, open swollen area and drain.
- Trauma: Trauma care, pain management
- Tumour: Pain management, referral to experienced dental/medical health care worker
- D’Silva NJ Summerlin DJ, Cordell KG, Abdelsayed RA, Tomich CE, Hanks CT, et al. Metastatic tumors in the jaws: a retrospective study of 114 cases. J Am Dent Assoc. 2006;137(12):1667-72.
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