title: Mandibular pain as the leading clinical symptom for metastatic disease: nine cases and review of the literature.
abstract: BACKGROUND
  Metastases to the jaws are a rare phenomenon. Nevertheless, the appearance of non-specific symptoms such as toothache can signal the onset of neoplastic disease in some patients.
  
  
  METHODS
  In this article, we present details of a 74-year-old patient with a history of breast cancer to illustrate this point. Retrospectively, covering a time span of one year, we could identify nine patients (1.2%) with metastatic disease to the mandible out of a total of 763 patients referred to our Maxillofacial Surgery department with non-specific jaw pain.
  
  
  RESULTS
  Four patients were subsequently diagnosed as having breast cancer, two had lung cancer, one prostate cancer, one renal cell carcinoma and one adenocarcinoma of unknown primary site. Only three of these patients had documented tumor spread to bones before the onset of jaw pain. In the other patients, the dental symptoms were either the first sign of a generalized neoplastic disease, or indicated relapse of disease after long term disease free interval. However, further work up disclosed generalized tumor spread with additional organ- or bone-lesions in all patients, and the median survival was only six months (range 3.5(-)+22) from diagnosis.
  
  
  CONCLUSIONS
  Pain of uncertain origin in the jaws should alert clinicians to the potential of metastatic disease in patients with a history of cancer and a bone scintigraphy should be done to rule out metastatic involvement. Although metastatic lesions in this area usually herald generalized neoplastic spread according to our experience, prompt diagnosis nevertheless can lead to useful palliation and an enhanced quality of life.
authors.affiliation: University Clinics of Nuclear Medicine, University Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Pruckmayer
authors.forename: C
authors.initials: C
authors.lastname: Glaser
authors.forename: C
authors.initials: C
authors.lastname: Marosi
authors.forename: T
authors.initials: T
authors.lastname: Leitha
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008334:Mandible; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000556:secondary*; D010146:Pain / Q000209:etiology*; D011877:Radionuclide Imaging