Abstract
Referred orofacial pain as the first symptom of an otherwise silent distant, nonmetastatic
cancer has been reported, but there is sparse literature on the subject. Referred
pain may not be considered in the orofacial pain differential diagnosis because of
its rarity; however, this may delay a cancer diagnosis. The authors present a case
report and a review of the English literature. Peer-reviewed publications were identified
through a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Historic cases
were reviewed, and available data regarding demographics, pain characteristics, treatment,
cancer diagnosis, and outcome were extracted. Thirty-seven cases were identified.
All cancers were intrathoracic. The average age was 54.1 years with a slight female
predominance (3:2). Common pain characteristics were (1) diffuse location affecting
the ear (76%), jaw (46%), and temple (30%); (2) constant duration (65%); (3) aching
quality (74%); (4) severe intensity (94%); and (5) associated systemic symptoms (68%)
such as weight loss and digital clubbing. The average time from the onset of facial
pain to seeking medical attention was 9 months, and the average time from seeking
medication attention to cancer diagnosis was 8 months. Orofacial pain was often attributed
to odontogenic (35%) or neuropathic (25%) causes, and treatments for these conditions
were also common. The impact of referred orofacial pain on the cancer prognosis was
not possible because of the nature of the reviewed studies (case reports with no comparison
group). Cancer-associated referred orofacial pain as a first symptom is rare but should
be considered in cases with intractable pain and associated systemic symptoms.
Key Words
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Article info
Publication history
Published online: August 12, 2021
Identification
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Crown Copyright © 2021 Published by Elsevier Inc. on behalf of American Association of Endodontists.
