Nasopharyngeal carcinoma masquerading as TMJ orofacial pain

A 50-year-old white woman was referred to the emergency room of the University of Medicine and Dentistry of New Jersey with a major complaint of right facial pain of 3 months' duration. A comprehensive intraoral and extraoral examination was performed. She reported a limited mandibular opening and the need for a soft diet for approximately 1 month. Her medical history was noncontributory. The examiner, suspecting a lesion because of the lack of response to masseteric injection and the patient's ongoing report of facial numbness, referred the patient for imaging. A CT scan and MRI revealed a large mass in the right nasopharyngeal submucosa that extended into the nasopharyngeal space. The magnitude of the finding was not anticipated. This case demonstrates several important aspects relative to dental care: Orofacial pain is complex; evaluation of the history of a patient with orofacial pain is quite different from evaluating a patient with dental pain; and more training is required to treat patients with unusual oral and facial pain complaints.