Referred orofacial pain as an initial symptom of distant, no
Referred orofacial pain as the first symptom of an otherwise silent distant, non-metastatic cancer has been reported. Referred pain may not be considered in the orofacial pain differential diagnosis due to 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 54.1yrs with a slight female predominance.

- Common pain characteristics were: (1) diffuse location affecting the ear, jaw, and temple, (2) constant duration, (3) aching quality, (4) severe intensity, and (5) associated systemic symptoms 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 or neuropathic 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.

Cancer-associated referred orofacial pain as a first symptom is rare but should be considered in cases with intractable pain and associated systemic symptoms.

Journal of Endodontics