Mandibular metastasis of pulmonary adenocarcinoma: How unexpected could it be?

Abstract

ObjectiveMetastatic tumours of bone must be considered in all patients with unexplained bone pain and particularly in patients who present with a known cancer, localised pain at multiple sites, and radiographic findings suggestive of metastasis. The purpose of this report was to present a case of a pathological fracture of the mandible as a consequence of metastatic pulmonary adenocarcinoma.Materials and MethodsIn July 2018 a 68‐year‐old male patient was hospitalised because of pulmonary adenocarcinoma and attended our department for an oral maxillo‐facial evaluation. He complained of pain and swelling in the right temporomandibular region resulting in a reported functional limitation.An Orthopantomogram (OPG) demonstrated a right intracapsular condylar compound fracture associated with an osteolytic lesion at the condyle base with jagged margins. Subsequently, a CT scan with contrast of the maxillo‐facial complex and a fine‐needle aspiration of the lesion was performed.ResultsCT images showed the presence of a right mandibular condyle fracture associated with a large osteolytic lesion which confirmed the pathological nature of the fracture. Fine‐needle aspiration of the lesion confirmed its metastatic nature. It was not possible to proceed with a mandibular resection due to the critical clinical condition of the patient who died in September 2018.ConclusionLung cancer frequently produces lytic‐type metastasis, sometimes even in the jaw. In patients with an established diagnosis of lung cancer, any radiolucent lesion of the jaw or an unexplained painful symptomatology to the oro‐maxillo facial complex should be placed in differential diagnosis with metastasis of the primary tumour.