RESUMEN
Metastatic carcinomas to the jaw bones are uncommon and comprise to about 1% of all malignant oral neoplasms. The purpose of this report is to present a rare case of metastatic breast carcinoma to bilateral mandibular ramus regions. The present case report is about a 40-year-old female patient with the complaints of a paresthesia in the right mandibular area of the last month duration. She was referred to our department by her oncologist with the differential diagnosis of osteonecrosis or metastasis. She had undergone modified radical mastectomy for invasive lobular carcinoma of the left breast. Oral cavity examination did not reveal the existence of any ulcer or fistula. Panoramic, cone-beam computed tomography (CBCT), and positron-emission tomography (PET) were used for diagnosing the lesions. In panoramic radiography and CBCT images, there were lytic lesions on the both of right and left coronoid, condyle, and ramus of the mandible. PET results showed us fluoro-2-deoxy-D-glucose uptake in the mandible and vertebrae. On the basis of the patient's medical history and paresthesia of the lower lip and chin, the metastatic disease was highly suspected. The patient was referred to her oncologist for further treatment since it was not amenable to the surgical management. The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease
RESUMEN
SUMMARY: The retromolar canal (RMC) is a collateral branch of the mandibular canal. This branch seems to be involved in the innervation of the third molar, retromolar trigon and part of the buccal mucosa and fibres of the buccinator and temporalis muscles. The prevalence of RMC in osseous and CBCT studies was reported between 1.7 %-72 %. This study aims to investigate the prevalence of RMCs in a Turkish population using cone beam CT. 340 CBCT images of hemimandibles of 170 patients, with a mean age of 37 (range, 16-80), that clearly identified the course of the mandibular canal in the posterior mandible were selected retrospectively from the archived records of our Oral and Maxillofacial Radiology Department. The sagittal, coronal, axial and pseudopanoramic images were used for assessing the RMCs. This variant was found in 19 out of 170 patients (11 %). Of the 340 CBCT examinations in 170 patients, 20 showed the presence of a RMC (5 %). It was present unilaterally in 18 patients (95 %) and bilaterally in one patient (5 %). There was no difference in the presence of RMCs with regard to sex and sides of the mandible (p>0.05). Clinicans should be aware of RMC and this anatomical variance should be taken into consideration while planning surgery around this region. When there is any suspicion of the RMC presence CBCT is the best imaging modality to visualize the three-dimensional structure of this variant.
RESUMEN: El canal retromolar (CRM) es una rama colateral del canal mandibular. Esta rama parece estar comprometida en la inervación del tercer molar, el trígono retromolar parte de la mucosa oral y de las fibras de los músculos buccinador y temporal. La prevalencia de CRM se ha reportado entre el 1,7 % -72 % en estudios óseos y de tomografía computarizada. Este estudio tuvo como objetivo investigar la prevalencia de CRM en una población turca utilizando tomografía de haz de cono. Se seleccionaron 340 imágenes TCHC de los registros de nuestro Departamento de Radiología Oral y Maxilofacial, de mandíbulas de 170 pacientes con una edad media de 37 años (rango, 16-80), las que identificaban el trayecto del conducto mandibular en la parte posterior de la mandíbula. Se utilizaron las imágenes sagital, coronal, axial y pseudo panorámica para evaluar los CRM. La variante se encontró en 19 de los 170 pacientes (11 %). De los 340 exámenes realizados con TCHC en 170 pacientes, en 20 de éstos se observó la presencia de un CRM (5 %); se observó unilateralmente en 18 pacientes (95 %) y bilateralmente en un paciente (5 %). No hubo diferencias en la presencia de CRM con respecto al sexo y los lados de la mandíbula (p> 0,05). Los clínicos deben considerar el CRM y tener en cuenta esta variación anatómica al planificar la cirugía en esta región. Cuando existe alguna sospecha de la presencia CRM, la TCHC es la mejor modalidad para visualizar la estructura tridimensional de esta variante.