A 19 years old male patient feels muscle function loss on the right side accompanied by parasthesia to the right of the mandibula, which occurs for approximately 20 seconds. It relapses many times a day. In addition there is alveolar bone loss without tooth mobility and bleeding.
old root canal? there is not.
If there was,
1) an abscess in the palate does not affect n.mandibularis inferior (. parasthesia at lower lip occurs due to n.alveolaris inferior)
2) it can not explain muscle function loss at right esp. at hand.
I am thinking early phase of MS....I asked a mandibular CT to eliminate any kind of problem due to jaw.
Any history of viral infection?
There are some criteria for diagnosing MS as well such as the Shumacher, Poser or MacDonald Criteria.
There is not any information about medical history. I am not a neurologist and can not be sure to determine and evaulate the Poser&McDonald criteria.
But, symtoms remind me 2 syndromes: numb chin syndrome or MS.
I need brainstorming, that's why I add this case here.
Facial Palsy? https://en.wikipedia.org/wiki/Facial_nerve_paralysis
This requires a detailed history and neurological examination to answer the question 'where is the lesion' and then 'what is the lesion'. What is the distbution of the sensory loss on the chin? Is it in the distribution of the mental or mylohyoid nerves (terminal branches of the mandibular division of trigeminal) or in the distrbution of the cervical plexus? Is there really weakness in the muscles of mastication, also supplied by the trigeminal?
If there is dysfunction of both the sensory and motor branches of the mandibular division, any lesion is higher than the bifurcation into anterior and posterior trunks and possibly in the middle cranial fossa or brainstem. http://en.wikipedia.org/wiki/File:Mandibular_branches.PNG
The radiograph supplied does not show any obvious local cause within the mandible and I cannot see any periodontal bone loss of significance (which would not casue these symptoms anyway). However if there is motor disturbance you would not expect to find the cause within the mandible.
Having said all that consider a psychogenic cause. Intermittent muscle weakness and short duration repeated episodes of sensory loss are difficult to explain by a pathological lesion, usually infection, pressure effects from tumour or blood vessel, or primary neurological disorder such as MS.
M.R.I to rule out S.O.L of brain
vitality of teeth -in case acute osteomyelitis pressurizing on I.A.nerve.
also psychological counselling...
No lesion at trigeminal, medulla oblangata, etc...No sign for mystania gravis.. . I am still waiting for neurologist consultation. Thank u!
This patient need to scanned for any Infra temporal Fossa lumps that can affect the main trunk of mandibular division containing both sensory and motor fibres. I also seen a lady with same manifestation turned to have a nasopharyngeal Carcinoma.so do not lgnor these possibilities
Any history of trauma to that area of the face? There could be nerve entrapment in the fracture line.
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