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Objectives/hypothesis: Previous studies have reported variable results for the impact of bone invasion on survival in oral cancer. It is unclear whether bone invasion in small (≤4 cm) squamous cell carcinomas (SCC) of the oral cavity is an independent adverse prognosticator. Our objective was to investigate impact on survival of bone invasion in SCC of floor of mouth (FOM), lower alveolus (LA), and retromolar trigone (RMT) ≤4 cm in size., Study Design: Retrospective study of 96 patients with SCC of the FOM, LA, and RMT undergoing primary surgical treatment., Methods: Original pathology reports and slides were reviewed by three pathologists. Level of bone invasion was categorized as cortical or medullary. Main outcome measures were local control (LC) and overall survival (OS)., Results: Bone invasion was present in 31 cases (32%). On review of pathology slides, all cases of bone invasion demonstrated medullary involvement. Median follow-up was 36 months for all patients, and 53 months for patients not dying from cancer. Among tumors ≤4 cm, bone invasion was associated with significantly worse LC (P =.04) and OS (P =.0005). Medullary invasion (hazard ratio: 2.2, 95% confidence interval: 1.1-4.4, P =.03), postoperative radiotherapy (hazard ratio: 0.3, 95% confidence interval: 0.1-0.5, P <.001), and positive pathologic nodal status (hazard ratio: 4.1, 95% confidence interval: 1.9-8.6, P <.001) were independent predictors of worse OS among the entire cohort., Conclusions: Mandibular medullary bone invasion is a poor prognosticator in oral cancers, irrespective of small size of primary tumor. Such cases should be considered for postoperative radiotherapy., Level of Evidence: 4. Laryngoscope, 127:849-854, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Aims: To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables., Materials and Methods: A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type., Results: Mean age: 62.3+/-9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7+/-13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0-13.6]; no statistically significant difference with other oral locations was found by the Kaplan-Meier curves (log rank: 0.29; p>0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7%versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8%versus 22.2%; p<0.05; odds ratio=21; 95% CI=2.0-210.1). None of the variables considered had a prognostic value as indicated by the Kaplan-Meier test., Practical Implications: The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass., Conclusions: This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.

Introduction: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer., Material and Methods: The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion., Results: Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually., Conclusions: Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative.

Medulloblastoma is an infratentorial primitive neuroectodermal tumour. It is the most commonly occurring brain tumour of childhood, accounting for 15-20% of all paediatric tumours. Extracranial metastasis is rare, but may involve the skeleton. Jaw lesions, however, have never been described. A case is reported of metastases of a medulloblastoma to the jaw including the dental pulp.

Background: Tumors can metastasize to the jaws, oral soft tissues, or salivary glands. Metastasis from distant organs and tissues to the jaws or oral cavity is considered rare., Results: The mandible is the most common site of metastasis of the oral and maxillofacial region. Radiographically, there is usually an area of radiolucency with hazy outline. Such lesions are manifested as radiopaque or sclerotic areas., Conclusions: Radiographic view of a tumor in the present case mimicked a periodontal lesion with an osteolytic area around the roots.

Objectives: To study the accuracy of single positron emission computed tomography (SPECT) scanning and compare its results to clinical examination, Panorex, and computed tomography (CT) scanning with respect to determining mandibular invasion by oral cavity and oropharyngeal cancer, and to define the role of SPECT scanning in the preoperative assessment of oromandibular cancer., Study Design: Prospective study of 38 patients who underwent technetium 99m SPECT scanning as part of their preoperative clinical assessment for cancer at risk of invading the mandible. All patients underwent partial or segmental mandibulectomy as part of their surgical management., Methods: A data protocol was used to tabulate patient demographics, tumor characteristics and results of preoperative tests as patients were enrolled into the study. Following surgical treatment, these data were correlated with histopathological findings. Detailed analysis was performed to assess the tabulated data., Results: The SPECT scanning demonstrated an 87% overall accuracy in predicting bone invasion compared with 71% for clinical examination, CT scanning, and Panorex x-rays. The SPECT scanning was significantly more sensitive (95%) than either CT scans (55%) or Panorex x-rays (50%). Notably SPECT scanning demonstrated a considerable improvement in specificity (72%) compared with conventional radionuclide scanning. Although not as specific as CT scanning or plain films, SPECT scanning was significantly more effective in ruling out disease than was clinical examination., Conclusions: Preoperative SPECT scanning used in combination with clinical examination, CT scanning, and Panorex x-rays to assess patients at risk for mandible involvement by oral cavity cancer can improve the accuracy of predicting bone invasion and help in appropriate treatment planning so as to safely reduce the proportion of disease-free jaws resected.

An 82-year-old Caucasian man developed an ulcerated mass on the anterior mandibular gingiva. Five years previously he had been treated for a Merkel cell carcinoma (MCC) on his right cheek. Histopathologic examination showed small tumor cells with scanty cytoplasm, suggestive of malignancy. Immunohistochemical studies were performed with the use of nine antibodies. S-100 protein and leukocyte common antigen were helpful in ruling out melanoma and lymphoma. Pronounced reaction was shown for cytokeratin 20, a new histodiagnostic marker whose expression is almost entirely confined to Merkel cells, the gastric epithelium, and urothelium. The tentative diagnosis of metastasis of MCC was confirmed. Immunohistochemical studies are useful diagnostic aids in the establishment of the diagnosis of Merkel cell carcinoma.

A review of the English language literature revealed 390 well-documented cases of metastatic lesions to the jawbones. Most metastatic lesions were diagnosed in patients in their fifth to seventh decade. The primary site differed between the genders: for women, it was the breast followed by the adrenal, colo-rectum, female genital organs and thyroid; for men, it was the lung, followed by the prostate, kidney, bone and adrenal. The most common location of the metastatic tumors was the mandible, with the molar area the most frequent site involved. In about 30% of cases the oral lesion was the first sign of the malignant disease. The present data are compared with those of metastatic tumors to the oral mucosa and a view on the possible pathogenesis is presented.

Metastatic lesions to the mandible are rare, comprising less than 1% of all malignancies. Twenty-two cases of metastatic disease to the mandible were seen from 1938 to 1985. The records of 17 cases were available for detailed review. The age range was from 27 to 80 years with a female to male ratio of 12 to 5. A mandibular or paramandibular mass or swelling was the most common presenting sign. Three patients presented with mandibular metastasis prior to the discovery of the primary tumor. In the other 14 patients, the mandibular lesion appeared from 2 months to 20 years following discovery of the primary tumor. The mandibular lesion was the initial sign of distant metastatic disease in 11 of the 17 patients. Breast, lung, and colon cancer were the most common primary tumors. When presented with an isolated mandibular mass, a high index of suspicion is necessary to make the diagnosis of metastatic disease. Since plain x-rays may initially be normal, technetium or CT scan may be necessary to demonstrate osseous destruction. Inferior alveolar nerve anesthesia should be considered an indication of tumor until proven otherwise. Treatment is often of a palliative nature because of the presence of widespread metastatic disease; however, surgical resection may be considered in the rare patient with a well-documented, solitary mandibular metastasis.

Detecting mandibular bone involvement by oral carcinoma prior to definitive therapy poses a difficult problem for the head and neck surgeon. A retrospective study of 104 patients who underwent segmental mandibular resection for oral squamous cell carcinoma was undertaken to detect the incidence of mandibular bone involvement. Specimens from 23 patients (22%) demonstrated tumor invasion on decalcified histologic examination. Histologic evidence of bone involvement was correlated with the site of lesion, stage of the disease, the grade of tumor, the clinical impression of bone involvement, and the presence or absence of neck disease. Bone invasion on histologic examination was also compared with preoperative bone scans and radiographs. The data obtained demonstrates significant mandibular involvement with alveolar tumors and lesions clinically adjacent to the mandible. There was also a high incidence of histologic bone involvement in patients who had radiologic or bone scan evidence of tumor erosion. We support segmental mandibulectomy on the basis of providing adequate tumor margins for patients fulfilling these criteria.

Mandibular invasion alters the staging and treatment of oral cavity squamous cell carcinoma, and thus its detection is essential to the head and neck oncologist. There is little information assessing the accuracy of the radionuclide bone scan and the roentgenogram in determining mandibular invasion. The present study reports data on 40 patients with squamous cell carcinoma of the oral cavity for whom bone scans, mandibular roentgenograms, and histologic examination of the mandible were available. The bone scan correctly predicted mandibular invasion in 8 of 9 cases; the false positive rate was 53% as a result of mandibular inflammatory changes. The bone scan was more accurate than the roentgenogram in predicting tumor invasion of the mandible, but the bone scan had a higher false positive rate. A normal bone scan and roentgenogram virtually precluded tumor involvement of the mandible. We conclude that the bone scan is an important adjunct in the prediction of carcinomatous invasion of the mandible in squamous cell carcinoma of the oral cavity.

Gingival metastases from non-oral malignancies are very uncommon. The case is presented of a man with rectal adenocarcinoma, whose first clinical evidence of metastatic disease was a gingival metastasis. Although the prognosis of patients with gingival metastases is felt to be poor, prompt initiation of appropriate therapy may afford significant palliation. A 20-year literature review of uncommon metastatic sites for rectal adenocarcinoma and non-oral malignancies which can metastasize to gingiva is briefly presented. Gingival metastasis should be included in the differential diagnosis of a gingival lesion in a patient with prior or current malignancy.