Metastatic breast cancer to bilateral mandibular ramus regions.

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.

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study.

OBJECTIVE: The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging. METHODS: A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm3) and intraoral bitewing radiographs were compared with one another and with the gold standard values. RESULTS: The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p > 0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p > 0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p > 0.05). CONCLUSIONS: CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.