title: Squamous cell carcinoma presenting with trigeminal anesthesia: An uncommon presentation of head & neck cancer with unknown primary.
abstract: BACKGROUND
  The differential diagnosis of facial anesthesia is vast. This may be secondary to trauma, neoplasm, both intracranial and extracranial, infection, and neurologic disease. When evaluating a patient with isolated facial anesthesia, the head and neck surgeon often thinks of adenoid cystic carcinoma, which has a propensity for perineural invasion and spread. When one thinks of head and neck squamous cell carcinoma with or without unknown primary, the typical presentation involves dysphagia, odynophagia, weight loss, hoarseness, or more commonly, a neck mass. Squamous cell carcinoma presenting as facial anesthesia and perineural spread, with no primary site is quite rare.
  
  
  METHODS
  Case presentations and review of the literature.
  
  
  CONCLUSIONS
  Trigeminal anesthesia is an uncommon presentation of head and neck squamous cell carcinoma with unknown primary. We present two interesting cases of invasive squamous cell carcinoma of the trigeminal nerve, with no primary site identified. We will also review the literature of head and neck malignancies with perineural spread and the management techniques for the two different cases presented.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, United States. Electronic address: Ashah5@tuftsmedicalcenter.org.
authors.forename: Ameer T
authors.initials: AT
authors.lastname: Shah
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, United States.
authors.forename: Walid I
authors.initials: WI
authors.lastname: Dagher
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, United States.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: O'Leary
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, United States.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Wein
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D006801:Humans; D006987:Hypesthesia / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009382:Neoplasms, Unknown Primary; D014276:Trigeminal Nerve / Q000473:pathology*
chemical_list: D003287:Contrast Media
keywords: Facial anesthesia; Perineural spread; Squamous cell carcinoma; Trigeminal nerve; Unknown primary