3rd Takao Forum of OMFS 2022: Emerging Dilemma in the Treatment of Mandibular Metastasis

Jehn-Shyun HUANG, DDS, PhD

The incidence of cancer is expected to continue to rise due to the rapid aging of the population and unhealthy lifestyles around the world. Although there is an increasing trend among cancer patients, due to the advancement of new medical technologies such as targeted drugs and immunotherapy, as well as the improvement of cancer care quality, the five-year survival rate for cancer has increased steadily. With the evolution of oncological treatments, which have led to increased survival of cancer patients, the incidence of bone metastases has increased. Besides primary tumors, metastasis causes more cancer death nowadays. Treating metastasis, therefore, remains a challenge. After lung and liver, bone is considered to be the third most common organ involved in metastases.

Oral and maxillofacial surgeons who face oral malignancies every day in their clinics will see oral metastasis in the mouth from other tissue sites more.

The cardinal signs and symptoms include jawbone swelling, facial asymmetry, tooth mobility or exfoliation, gum bleeding, pain, and lower lip paresthesia. The diagnosis will depend on the clinical examination, medical history, X-ray taking, CT or MRI scan, and PET. The definite diagnosis is based on the biopsy and pathological examination. Most metastatic lesions are rich in vascularity and prone to bleeding upon the biopsy procedure.

The treatment modalities—including radical en-bloc surgery, radiation therapy, cytokine therapy, molecular targeted therapy, and administration of anti-bone resorption agents, —seemed to contribute to favorable survival. The goals of the surgical approach are to reduce the pain or neurological deficit, reconstruct the continuity of the skeleton, restore function, and improve the life quality of cancer patients. Some survival prediction assessments, such as the 2013 SPRINGE model, could be applied to evaluate mandibular metastasis, but the effects need to be verified further.

Mandibular metastasis emerged as a dilemma in the treatment of skeletal-related diseases. We presented the preliminary results and experiences in the therapy for metastasis in the jawbone. These two patients with mandibular metastasis survived for more than 5 years after the surgery. The therapeutic modality for mandibular metastasis will be discussed in the presentation.