LAUSR

BACKGROUND Referred orofacial pain as the first symptom of an otherwise silent distant, non-metastatic cancer has been reported but there is sparse literature on the subject. Referred pain may not be considered in the orofacial pain differential diagnosis due to its rarity, however, this may delay a cancer diagnosis. METHODS 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. RESULTS Thirty-seven cases were identified. All cancers were intrathoracic. The average age was 54.1yrs 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 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 cancer prognosis was not possible due to the nature of the reviewed studies (case reports with no comparison group). CONCLUSIONS Cancer-associated referred orofacial pain as a first symptom is rare but should be considered in cases with intractable pain and associated systemic symptoms.