Investigation of the Internal Structure and Radiological Characteristics of Distant Metastases to the Jaws: A Retrospective Study

Abstract

Aim Distant metastases to the jaws are uncommon but carry a grave prognosis, with an average survival of only a few months. This study aimed to investigate the internal structure and radiological features of metastatic lesions in the jaws, as well as their clinical presentations, to better understand their diagnostic characteristics and guide appropriate management. Material and method Among 4,908 patients who underwent cone beam computed tomography (CBCT), 14 cases with histopathologically confirmed metastatic tumors to the jaws were identified. Clinical data, imaging modalities (orthopantomography, CBCT, magnetic resonance imaging, ultrasound), and histopathological findings were reviewed. The primary tumor sites, radiographic appearances (osteolytic vs. osteoblastic lesions), and histopathological patterns were examined. Results Thirteen lesions were located in the mandible and one in the maxilla. The most common primary tumors originated from the breast, prostate, lung, kidney, and colon. While breast and prostate metastases appeared mostly as sclerotic (radiopaque) lesions, lung, kidney, and colon metastases typically presented as osteolytic (radiolucent) defects. In some cases, pathologic fractures and cortical destruction were evident. Histopathological evaluation confirmed metastatic carcinoma in all cases, demonstrating characteristic osteoblastic activity in breast and prostate cancers. Conclusion Recognizing the radiological and histopathological features of distant metastases to the jaws is crucial for prompt diagnosis, accurate identification of the primary tumor, and appropriate treatment planning. Awareness of these lesions aids clinicians in differentiating metastases from other jaw pathologies and underscores the importance of multidisciplinary collaboration.

Keywords

• Cone-Beam Computed Tomography
• Diagnostic Imaging
• Jaw Neoplasms
• Neoplasm Metastasis
• Oral cancer

References

1. Spirito F, Ambrosino M, Morrone F, Duraccio R, Lo Muzio L, Della Valle A. Challenging Differential Diagnosis of Mandible Angle Metastasis from Breast Cancer. Case Rep Dent. 2024;2024:2667323.
2. Jadun S, Zebic L, Patel V. Jaw metastases and the general dental practitioner. Br Dent J. 2021;231(10):629-33.
3. Nawale KK, Vyas M, Kane S, Patil A. Metastatic tumors in the jaw bones: A retrospective clinicopathological study of 12 cases at Tertiary Cancer Center. J Oral Maxillofac Pathol. 2016;20(2):252-5.
4. Hirshberg A, Berger R, Allon I, Kaplan I. Metastatic tumors to the jaws and mouth. Head Neck Pathol. 2014;8(4):463-74.
5. Lawes KP, Danford M, Di Palma S. Delayed metastasis to the mandible of esophageal adenocarcinoma. Head Neck Pathol. 2013;7(4):416-20.
6. Daley T, Darling MR. Metastases to the mouth and jaws: a contemporary Canadian experience. J Can Dent Assoc. 2011;77:b67.
7. Muttagi SS, Chaturvedi P, D'Cruz A, Kane S, Chaukar D, Pai P, et al. Metastatic tumors to the jaw bones: retrospective analysis from an Indian tertiary referral center. Indian J Cancer. 2011;48(2):234-9.
8. Zhang L, Yang H, Zhang X. Metastatic renal cell carcinoma to the jaws: report of cases. World J Surg Oncol. 2014;12:204.

9. Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol. 2013;17(1):71-5.
10. Martins FMC, Neto TH, Martins SP, Mendes RB. Metastasis to the oral cavity and jaw bones - A literature review about a case. Oral Oncol. 2023;137:106276.
11. Unsal G, Soluk-Tekkesin M, Bektas-Kayhan K, Ozcan I. Radiological evaluation of the periosteal reactions in the jaws: a retrospective CBCT study. Oral Radiol. 2022;38(4):497-508.
12. Li S, Zhao T, Liu N, Li Y, Chen H, Tang C, et al. Global research on oral cancer: A bibliometric analysis based on 82 highly cited publications from 2014 to 2024. Oral Oncol. 2024;159:107094.
13. Kutuk T, Atak E, Villa A, Kalman NS, Kaiser A. Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy. Curr Oncol. 2024;31(4):2092-108.