Oral medicine
Patients appearing to dental professionals with orofacial pain arising from intracranial tumors: a literature review

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Background

A small proportion of patients with orofacial pain appearing to dentists and dental specialists will have intracranial tumors as the underlying cause. These patients may undergo unnecessary dental interventions before the correct diagnosis is made.

Method

A search of the literature using the PubMed database was performed to identify case reports of this occurrence. Cases were analyzed for common characteristics or presenting features that may aid dentists in identifying patients with intracranial tumors.

Results

Twenty-eight cases were identified. Features consistent with the diagnoses of trigeminal neuralgia, persistent idiopathic facial pain, and temporomandibular disorders were the most common presentations. Fifty-nine percent of patients presented with sensory or motor function loss at their initial diagnosis.

Clinical Implications

Patients who present with symptoms that extend beyond the typical presentation of these entities are at highest risk for intracranial tumors and should be further evaluated.

Section snippets

Material and Methods

The PubMed electronic database was searched for all English-language case reports of orofacial pain that ultimately arose from intracranial tumors. A broad search strategy was employed using any combination of keywords from the following 2 groups: group 1—“oral pain,” “orofacial pain,” “dental pain,” and “dentist”; and group 2: “intracranial tumor,” “brain tumor,” “intracranial malignancy,” “acoustic neuroma,” “cerebellopontine angle lesion,” and “meningioma.” There were no constraints made on

Results

Our search queries produced 871 results with considerable overlap between the many combinations of search prompts.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Twenty-nine case reports were found that met our criteria. These cases are summarized in Table I. Ages ranged from 14 to 76 years, with the mean being 43.0 years (SD = 15.0). Sex distribution was slightly skewed toward females, with 59% female (17 of 29) and 41% male (12 of 29).

TN, persistent

Discussion

Our analysis suggests that symptoms of TN, PIFP, and TMD pain are the 3 most common presentations of patients with intracranial tumors. This partly corroborates the study of Bullitt et al.,1 who found that of 13 patients with tumor-induced facial pain, 5 had atypical facial pain (i.e., PIFP) and 8 had TN; however, they did not report any cases of TMD pain.

Conclusions

TN, PIFP, and TMD are 3 common misdiagnoses given to patients with orofacial pain arising from intracranial tumors. A detailed history and physical exam with particular attention to neurologic function, coupled with a comprehensive understanding of orofacial pain syndromes, are requisites for detecting abnormal signs and symptoms. Particular attention should be given to cranial nerve function, areas of unexplained sensory loss, concurrent atypical headaches, and distant neurologic symptoms.

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