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

Abstract

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).

Association Between Temporomandibular Joint Disorders and Metastatic Breast Cancer—A Mapping Review

“…Duplicates (n = 114) and studies that did not address the focused question (n = 2,378) were excluded (Figure 1). In total, 14 case reports with a single case 12,19,20,[27][28][29][30][31][32][33][34][35][36][37] and one case report with two cases 38 were included and processed for data extraction. A supplemental file contains search tracking for several databases.…”

“…A vigilant review of pertinent indexed literature was performed with an expectation to retrieve longitudinal and retrospective studies with an adequate sample size that could help address the focused question. However, 14 case reports with a single case 12,19,20,[27][28][29][30][31][32][33][34][35][36][37] and 1 case report with two cases 38 fulfilled the eligibility criteria, in which all patients presented symptoms of TMD including LMO, PP, and preswelling around TMJ. The available evidence is solely based on case reports, which precludes confirming that cancer metastasis to the TM region elicits symptoms of TMD.…”

“…Females with age ranging between 32 and 78 years were examined in 13 case reports. 12,20,[27][28][29][30][31][32][33][34][35][36][37] In a study by Gonzalez-Perez et al, 19 a case of a 73-year-old male was presented. In a study by Webster, 38 cases of a 52-year-old female and a 54-year-old female were presented.…”

“…In one study, 36 a precise diagnosis of the type of breast carcinoma was not reported (Table 1). In all included studies, 12,19,20,[27][28][29][30][31][32][33][34][35][36][37][38] the duration since the diagnosis of MBC ranged between 1 month and 19 years.…”

“…Of the 16 cases presented in 15 case reports, 12,19,20,[27][28][29][30][31][32][33][34][35][36][37][38] 14 12,19,20,[27][28][29][30][31][32][33][34][35][36][37] had a low and one 38 had a moderate risk of bias (Table 3).…”