Chané Nel1, André Uys2, Liam Robinson2, Christoffel J Nortjé3. 1. Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. chane.nel@up.ac.za. 2. Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. 3. Department of Diagnostics and Radiology, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa.
Abstract
OBJECTIVE: Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. METHODS: Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. RESULTS: Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. CONCLUSION: Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.
OBJECTIVE: Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. METHODS: Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. RESULTS: Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. CONCLUSION: Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.
Authors: A Andabak Rogulj; C Tomasovic Loncaric; D Muller; I Blivajs; M Andabak; V Vucicevic Boras; M Sekerija Journal: Br J Oral Maxillofac Surg Date: 2018-08-06 Impact factor: 1.651
Authors: Nisha J D'Silva; Don-John Summerlin; Kitrina G Cordell; Rafik A Abdelsayed; Charles E Tomich; Carl T Hanks; Dalbert Fear; Samuel Meyrowitz Journal: J Am Dent Assoc Date: 2006-12 Impact factor: 3.634