Mandible & maxilla
Other malignant tumors
Metastases
Last author update: 1 August 2016
Last staff update: 15 October 2021
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PubMed Search: Metastases to jaw
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Microscopic (histologic) images | Positive stains | Differential diagnosis | Additional referencesCite this page: Magliocca K, Martinez A. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillametstojaw.html. Accessed April 23rd, 2024.
Definition / general
- Metastases to the jaw and oral cavity are uncommon, ~ 1% of oral malignancies
- However, up to 25% of oral cavity metastases represent the first manifestation of disease
- Metastases to the jaw often indicate end stage disease, and are associated with poor survival
Epidemiology
- Uncommon, ~ 1% of all oral malignancies
- Most common in 5th to 7th decades; mean age ~ 54 years
- Common primary sites of origin:
- Males: lung, kidney, liver, prostate
- Females: breast, gynecologic, kidney, colorectum
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Distribution of common primary tumors
metastasizing to oral cavity
Sites
- Jaw bones are more frequently affected than oral soft tissue
- 2 : 1 ratio
- Mandible more common than maxilla
- The gingiva is the most common site of oral soft tissue metastases
Etiology
- Pathogenesis of oral metastases is not fully understood but current hypotheses include:
- A multistage process in which cells detach themselves from the primary tumor and are transported by lymphatic or blood vessels
- In the oral soft tissues, chronically inflamed mucosa, especially gingiva, has a rich capillary network, which can trap the malignant cells and cause metastases
- Possible role of Batson’s plexus, a valveless vertebral venous network that permits the retrograde movement of tumor cells from lungs towards the face
Clinical features
- Variable; symptoms include jaw pain, swelling, paresthesias, toothache, tooth abscess, non-healing tooth infection, tooth exfoliation
- May present with mental nerve neuropathy, also known as “numb chin syndrome”
- Characterized by facial numbness along distribution of mental branch of trigeminal nerve
- Most cases that are not dental in origin are associated with malignant tumors or diffuse metastatic disease
Diagnosis
- Dependent on clinical, radiologic and pathologic correlation
Radiology description
- Varies from well circumscribed to poorly circumscribed radiolucencies
- Most metastases to jaw tend to be expansile, lytic lesions with ill defined margins and cortical destruction
Radiology images
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Orthopantogram
(panoramic view)
CT
3D CT
Prognostic factors
- Metastases to the jaw often indicate end stage disease, and are associated with poor survival
- Mean time to death from diagnosis of jaw metastasis was 12 months versus 8 months for oral soft tissue metastasis (J Craniomaxillofac Surg 2016;44:1047)
Case reports
- 45 year old woman with pain and swelling in jaw for 3 months (J Clin Diagn Res 2015;9:ZD25)
- 58 year old man with three month history of unilateral anesthesia of chin and lip (Br Dent J 2010;208:283)
- 60 year old man with lung metastasis to mandible (J Oral Maxillofac Pathol 2015;19:385)
- 62 year old man with lung metastasis to gingiva (Iran J Med Sci 2015;40:287)
- 69 year old man with progressive hypoesthesia of corner of mouth and chin (Anticancer Res 2010;30:1819)
- 75 year old man with 3 week history of numbness over lower lip (BMJ Case Rep 2011 Apr 15;2011)
Treatment
- Depending on type of metastasis, treatment includes surgical resection, sometimes combined with radiation therapy or chemotherapy
Clinical images
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Well defined solitary swelling on right side of mandible
Swelling in lower third of face
Intra-oral view
Microscopic (histologic) images
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Lung metastases
Breast metastasis
Renal cell carcinoma metastasis
Thyroid metastasis
Positive stains
Differential diagnosis
- The differential is broad, mainly based on radiologic findings, and includes:
- Odontogenic cysts
- Benign and malignant odontogenic tumors
- Reactive / inflammatory processes related to odontogenic infection or inflammation
- Salivary gland neoplasms
- Other metastases such as lymphoma, melanoma, etc.
Additional references
