Pathologic fracture of the mandible caused by intraosseous metastasis of oesophageal squamous cell carcinoma: a case report

Case Report and Literature Review of a Pathologic Mandibular Fracture from Metastatic Esophageal Adenocarcinoma

Distant metastasis to the jaws, including the maxilla or mandible, is very rare. Although the mandible is the preferred sight of these rare metastases, it is extremely rare for oral cavity malignancies to present as pathological mandibular fractures. Here, we present a case of esophageal adenocarcinoma metastasizing to the mandible, and the first reported case presenting with a pathological mandibular fracture secondary to esophageal adenocarcinoma. We also review the 9 other reported cases of metastatic esophageal adenocarcinoma to either the maxilla or mandible.

Metastasis to the Jawbones: A review of 453 cases

The purpose of the present article was to review the characteristics of the jawbone metastases to analyze all variables. A relevant English Literature search in PubMed, Scopus, and Google Scholar was performed. All variables such as age, gender, primary and secondary tumor sites were analyzed. There were 453 metastatic cases. The male-to-female ratio was 1.2:1, and the mean age of the patients was 53.4 years. The lung was the most common primary site in men, and breast in women. The most common metastatic site was the mandible, and adenocarcinoma was the most frequent histological diagnosis. Metastases to the jaw bones occur in the advanced stages of a malignancy hence; a careful examination of patients with jaw bone lesions is strongly suggested. Dentists, as well as general physicians, should take into consideration the possible presence of jaw metastases in cases which present atypical symptoms, especially in patients with known malignant disease.

Pathological mandibular fractures: a review of the literature of the last two decades

Pathological mandibular fractures are rare, accounting for fewer than 2% of all fractures of the mandible. They could be defined as fractures that occur in regions where bone has been weakened by an underlying pathological process. Pathological fractures usually may follow surgical interventions such as third molar removal or implant placement, result from regions of osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis of the jaw, occur because of idiopathic reasons or be facilitated by cystic lesions, benign, malignant, or metastatic tumors. Pathological mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature

PURPOSE

The aim of this article was to obtain an overview of metastatic tumors to the oral and maxillofacial (OMF) region, especially the differences in the constituent ratios of primary cancers between the United States and China.

PATIENTS AND METHODS

Clinical findings of 19 cases encountered in West China Hospital of Stomatology were summarized and the English and Chinese literature were reviewed and analyzed. The main clinical features of OMF metastases were summarized, with an emphasis on primary cancers' constituents.

RESULTS

The lung, breast, kidney, liver, and prostate were the top 5 common primary sites of cancer. However, there was a significant difference in the primary cancers' constituents between United States and China (P < .001). The breast, kidney, prostate cancers, and melanoma of skin were more frequent primary cancers in United States than in China, whereas that of the lung, thyroid, liver, esophagus, and the stomach were more common in China than in United States. The proportions of the OMF metastatic lesions originating in the lung, kidney, liver, thyroid, and esophagus in all OMF metastatic tumors were higher than the corresponding primary cancers' prevalent proportions.

CONCLUSIONS

The frequency of developing OMF metastasis is not always consistent with primary cancers' prevalence, which suggests that different cancers have different potentiality to develop OMF metastasis. Cancers of the kidney, liver, lung, thyroid, and esophagus were more likely to spread to the OMF region. In general screening of primary cancer, it would be helpful to take into account the metastatic potentiality of different cancers and primary cancers' prevalence in different countries in the case of occult primary.

Mandibular pain as the leading clinical symptom for metastatic disease: nine cases and review of the literature

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.

PATIENTS

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.

CONCLUSION

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.