Sir, following the 'numb chin syndrome' series of articles1,2 we would like to share our findings of the following case which was recently referred to the Oral Medicine Department at University of Manchester Dental Hospital.

A 37-year-old female patient presented to her general dental practitioner complaining of a numb lower right lip. She had a history of metastatic breast cancer affecting the liver which alerted a prompt referral to the Oral Medicine Department. Recent bone scans performed by the oncologist did not reveal any bony metastases in the pelvis and limbs. However, the bone scan failed to include the head and neck region. Dental radiographic examination (Fig. 1) confirmed the presence of a bony metastasis in the ramus of the mandible affecting the inferior alveolar nerve and lower right third molar. To confirm the radiological findings, she was referred to the maxillofacial department for a biopsy.

Figure 1
figure 1

Arrows indicate the presence of a bony metastasis in the ramus of the mandible

Full size image

The case demonstrates the importance of including metastatic disease in the list of differential diagnosis of a numb lip as failure to recognise such a finding will not only have serious impact on the prognosis of a disease but can lead to medico-legal consequences.