Mandibular metastases in neuroblastoma: Outcomes and dental sequelae

Implementation of the American Society of Anesthesiologists 2022 paediatric guidelines in a child with mandibular metastasis

The 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway differ significantly from prior guidelines, particularly regarding paediatric patients. These guidelines place new emphasis on establishing a multidisciplinary team led by an anaesthetist trained in paediatric anaesthesia. Here, we demonstrate the clinical application of the new guidelines by presenting the case of a 16-month-old girl with a rapidly growing mandibular mass. The new guidelines stipulated the need for multidisciplinary team assembly; planning with indirect laryngoscopy; the availability of surgical tracheostomy and extracorporeal membrane oxygenation; and multiple 'time out' stops to confirm team members and plans. The patient tolerated induction of general anaesthesia and mask-ventilation and tracheal intubation was achieved uneventfully on the first attempt. Her trachea was extubated uneventfully 5 days later. We emphasise the importance of paediatric anaesthesia training and videolaryngoscopy and discuss components of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway with reference to a successful outcome in a paediatric difficult airway scenario.

Mandibular Metastasis in Neuroblastoma in a 3 Year-Old Child: A Case Report

Neuroblastomas commonly metastasize to the cranium and orbit, although other facial bones were less implicated. In this report we present a 3 years old child with metastatic neuroblastoma to the mandible that presented with swollen right jaw. The first assessment of the head with computed tomography revealed soft tissue mass with permeative lytic changes of the osseous structures centered on the right mandible, as well as osteo-meningitis metastases. These masses were proven to be metastatic lesions from intra-abdominal neuroblastoma of the right adrenal gland. Over the previous several years, only 29 cases of neuroblastoma metastasis to the mandible have been reported in the literature.

Metastatic cancer and endentulism: Exploring comorbidity to assist with differential diagnosis in a case from Vico nel Lazio (Fr, Italy), 13th-15th century CE

OBJECTIVE

To differentially diagnose cranial lesions noted on a medieval skeleton and explore the importance of comorbidity.

MATERIALS

A skull of an adult female with osteolytic and osteoblastic lesions, edentulism, and an ectopic tooth from an ossuary of the Church of Santa Maria in Vico del Lazio, Frosinone Italy, dating to the Middle Ages.

METHODS

Macroscopic observations of the remains, CT scan, and differential diagnosis was undertaken.

RESULTS

A diagnosis of metastatic cancer (potentially breast cancer) or metastatic neuroblastoma (NBL) is offered.

CONCLUSIONS

Considering the noted comorbidities, this case might represent a rare case of metastatic neuroblastoma.

SIGNIFICANCE

The exploration of comorbidity, in this case the presence of metastatic carcinoma and edentulism, has tremendous potential to expand our knowledge about cancer in the past.

LIMITATIONS

Lack of postcranial elements.

SUGGESTIONS FOR FURTHER RESEARCH

Clinical and paleopathological investigation of comorbidity in modern and archeological populations to develop an evolutionary perspective on the presence of cancer in the past.

Metastatic Neuroblastoma Presenting as a Submandibular Mass with Mandibular Bone Involvement in a Three-Year-Old Child

Although neuroblastoma is one of the most common extra-cranial tumors in the pediatric population, it is rarely seen as a metastasis to the mandibular bone. The following is a case report of a 3-year-old male who initially presented with a submandibular mass that was proven to be a poorly differentiated metastatic neuroblastoma through excisional biopsy. This report is one of the few case reports that demonstrates metastatic submandibular neuroblastoma with mandibular bone involvement in the pediatric population.