title: Distant metastases and malignant cellular neoplasms encountered in the oral and maxillofacial region: analysis of 92 patients treated at a single institution.
abstract: Distant metastases to the oral cavity, the face or facial skeleton are rare and/in are usually found in such locations at a late stage of the malignancy. In the majority of cases, the malignancy is already known at the time of admission. However, a distant metastasis as the first sign of a cancer developing in other parts of body may occasionally be found. Malignant cellular neoplasms, in particular those derived from the haematopoetic system, are also rarely diagnosed first in the oral and maxillofacial (OMF) region. Therapy for these patients is difficult. Main parameters of therapy are type of tumour, general health condition and localization of the tumour. The aim of this study was to analyse the types of tumour, the treatment modalities and the outcome of patients who experienced a malignant disease in the OMF region under these conditions.
  
  
  METHODS
  A total of 92 patients were treated for distant metastases or cellular malignant neoplasms in the OMF region at a single institution (female: 45, male: 47, ratio 1:1.04; mean age: 61.4 years; range: 5 to 88 years).
  
  
  RESULTS
  In females, the most frequent primary tumour was breast cancer (40%), followed by malignant lymphoma (17.8%), malignant melanoma and hypernephroma (8.9% each). In males, the most frequent primaries were lymphomas (25.5%), followed by lung cancer and carcinoma of unknown primary site (CUPD syndrome; 17 each). Hypernephroma was the site of origin in 8.5%. Mean survival of patients with solid tumours was 1.28 years and 4.85 years in patients with cellular neoplasm. Survival rates differed significantly in both diagnostic groups (p=0.001). All patients with distant metastases died within 5 years. In patients with malignant cellular neoplasms, significant differences in survival rates were identified. Male survival was calculated to be 90% at 5 years' follow-up, but was poor for females (0%).
  
  
  CONCLUSIONS
  Prognosis is poor in patients with distant metastases from solid tumours of other body parts to the OMF region. Female patients with malignant cellular neoplasms becoming symptomatic in this region share the fate of patients with solid metastases. Males with this diagnosis have a better prognosis.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Nordwestdeutsche Kieferklinik), Eppendorf University Hospital, University of Hamburg, Hamburg, Germany. r.friedrich@uke.uni-hamburg.de
authors.forename: Reinhard E
authors.initials: RE
authors.lastname: Friedrich
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007573:Jaw Neoplasms / Q000473:pathology / Q000628:therapy; D008223:Lymphoma / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000628:therapy*; D009362:Neoplasm Metastasis; D016896:Treatment Outcome