title: Clinical manifestations and diagnostic approach to metastatic cancer of the mandible.
abstract: In a 12-month period, metastatic cancer was diagnosed in eight patients. Six of them presented with pain mimicking toothache, temporomandibular joint disorders or trigeminal neuralgia, while two showed osteopenic bone lesions in the panoramic radiography, and perimandibular swelling. Anesthesia of the lower lip was the only common clinical feature. In seven of the eight patients, a whole body bone scintigraphy and single photon emission computed tomography (SPECT) of the skull in combination with a whole body and SPECT anti-granulocyte (Tc-99m MAK 250/183) bone marrow scintigraphy was performed. One patient did not have combined scintigraphy performed secondary to severe systemic illness. In six of the seven, the results were conclusive for a metastatic bone lesion. Biopsies confirmed three patients to have a previously unrecognized primary cancer, one patient to have previously unrecognized recurrent cancer, and three patients to exhibit new metastatic spread of an already diagnosed cancer. Histology revealed breast, lung, renal cancer and a malignancy of inconclusive origin. In the remaining patient, combined scintigraphy suggested osteomyelitis, yet biopsy revealed a prostate cancer metastasis with acute inflammatory cell infiltration. Thus, the scintigraphy pattern of a hot spot in the bone scan and a cold lesion in the bone marrow scintigraphy is highly suggestive of a mandibular metastasis, if accompanied by anesthesia of the lower lip.
authors.affiliation: Clinic of Oral- and Maxillofacial Surgery, University of Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Glaser
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.forename: M
authors.initials: M
authors.lastname: Pruckmayer
authors.forename: W
authors.initials: W
authors.lastname: Millesi
authors.forename: M
authors.initials: M
authors.lastname: Rasse
authors.forename: C
authors.initials: C
authors.lastname: Marosi
authors.forename: T
authors.initials: T
authors.lastname: Leitha
mesh_terms: D000368:Aged; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D001853:Bone Marrow / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000473:pathology; D003937:Diagnosis, Differential; D004164:Diphosphonates; D004487:Edema / Q000175:diagnosis; D005260:Female; D006098:Granulocytes; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis; D007680:Kidney Neoplasms / Q000473:pathology; D008047:Lip Diseases / Q000175:diagnosis; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008336:Mandibular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary*; D008340:Mandibular Nerve / Q000503:physiopathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology; D011862:Radiography, Panoramic; D019275:Radiopharmaceuticals; D012886:Skull / Q000000981:diagnostic imaging; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis; D015899:Tomography, Emission-Computed, Single-Photon; D014098:Toothache / Q000175:diagnosis; D014277:Trigeminal Neuralgia / Q000175:diagnosis; D014915:Whole-Body Counting
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid