A rare case of breast carcinoma metastasis to mandible and vertebrae

Challenging Differential Diagnosis of Mandible Angle Metastasis from Breast Cancer

Breast cancer is the most common cancer in women and the second leading cause of cancer-related death. Breast cancer manifestations in the head and neck are relatively rare, and they are mostly bony metastasis to the mandible and maxilla. In this paper, we present a case report of a metastatic tumor in the mandibular angle originating from breast carcinoma. A 32-year-old female patient with a paresthesia/anesthesia in the left mandibular area was referred to us to aid in the differential diagnosis between osteonecrosis and metastasis. Her medical history revealed a radical bimastectomy 3 years ago for invasive lobular carcinoma of the breasts. Additionally, she received chemotherapy and radiotherapy 3 years ago, and intravenous zoledronic acid was administered every 3 weeks. Intraoral examination did not reveal any mucosal ulcer or fistula, and there was no radiological evidence of cyst. The patient demonstrated good oral hygiene. Palpable regional left submandibular lymph nodes and a few swellings on the lateral angular mandibular surface were observed. Cone-beam computed tomography (CBCT) and positron emission tomography (PET) were performed. CBCT showed small poorly diffused radiopacity in proximity to the mandibular angle on both medial and lateral surfaces. PET showed fluoro-2-deoxy-D-glucose uptake in the mandible in the left angle surface area. Based on the patient's clinical history, signs, symptoms, and tomographic evidence, we were able to diagnose mandibular metastasis. This case also highlights the importance of proficiency in reading tomographic examinations, which can be carried out in dental clinics for various purposes. In the absence of symptoms, misdiagnosis can occur, underscoring the significance of accurate interpretation and diagnosis.

TMJ pain as a presentation of metastatic breast cancer to the right mandibular condyle

Cancer metastasis to the oral and maxillofacial region is uncommon, and metastasis to the mandibular condyle is considered rare. We present a case of a 56-year-old woman with a history of invasive ductal cell carcinoma of the right breast, 10 years in remission, presenting with a 6-month history of symptoms typical of temporomandibular joint (TMJ) dysfunction. Imaging revealed an osteolytic lesion of her right TMJ and subsequent open biopsy confirmed the diagnosis of metastatic breast cancer. Despite the rarity of metastatic cancer to the head and neck region, it is still important for clinicians from both medical and dental backgrounds to consider this differential diagnosis, particularly in patients with a history of hormonal positive subtype of breast cancer. Given that bony metastasis can manifest even 10 years after initial diagnosis, surveillance which includes examination of the head and neck region is important, and may include routine plain-film imaging surveillance with an orthopantomogram (OPG).

Multidisciplinary Approach to Rehabilitation after Tumor Resective Jaw Surgery: A 9-Year Follow-Up

A 36-year-old male patient presented at the Department of Maxillofacial Surgery, University Hospital Clinic Zagreb in December 2010 due to a swelling of the left body of the mandible that was noticed 4 months earlier. The patient was referred regarding an atypical clinical and radiological finding in the form of a multicystic appearance in the corpus of the left mandible and teeth mobility in the same region. A probatory biopsy was performed under local anesthesia and sent for histopathologic examination which reported odontogenic myxoma. The tumor was removed with a marginal resection of the mandible from the left first incisor to the left second molar. Two years after surgery, in January 2013, the patient was referred to the oral surgeons for implant-prosthodontic rehabilitation. Two narrow implants were placed at positions 32 and 36, and three months afterwards, implant-retained denture was made using locator connections to compensate lost teeth and to correct the ratio of soft tissues and facial contours. The patient was followed-up for 9 years without any functional and aesthetic problems. Loosing function and aesthetic morbidity, after radical surgical treatment, often have compromised the quality of life of this group of patients. It is important to highlight the need for multidisciplinary collaboration for the complete rehabilitation of the patient after surgical oncology of the maxillofacial region.

The Rare Radiographic Sunburst Appearance of Odontogenic Myxomas: A Case Report and Review of the Literature

Odontogenic myxomas often have a distinctive radiographic presentation described as a "soap bubble", "tennis racket", or "honeycomb" pattern. Less frequently, examples of odontogenic myxomas with a "sunray" or "sunburst" pattern have been reported. Because malignant entities such as osteosarcomas more classically present with a sunray/sunburst appearance, odontogenic myxomas are rarely considered in the radiographic differential diagnosis of a sunburst lesion. The objective of this paper is to report a case of an odontogenic myxoma presenting with a sunburst appearance and to review similar reported cases in the literature. To the best of the authors' knowledge, this additional case of an odontogenic myxoma presenting with a sunburst appearance brings the total number of sunray/sunburst cases reported in the English language literature to 21.

Diagnostic Imaging of Malignant Tumors in the Orofacial Region

Though rare, malignancies of the orofacial region often have serious consequences. Malignancies of the orofacial region are typically discovered during a clinical examination or from a patient complaint. Initial discovery from a radiograph is rare. Three-dimensional imaging using advanced imaging techniques often provides adequate information about the aggressive nature of a lesion. Radiographically based imaging demonstrates mainly hard-tissue destruction and, rarely, bone deposition. MRI provides excellent visualization of soft-tissue densities without using ionizing radiation. Functional imaging is used to visualize increased metabolic activity associated with malignancies, and is excellent for determining the metastatic spread of a lesion.