Menezes Alynne Vieira, Lima Mariela Pereira, Mendonca Joao Esmeraldo de Frota, Haiter-Neto Francisco, Kurita Lucio Mitsuo
Department of Oral Radiology, Piracicaba Dental School, FOP-UNICAMP, Piracicaba, SP, Brazil.
J Contemp Dent Pract. 2008 Jul 1;9(5):100-6.
The aim of this report is to present a case of a metastatic lesion in the mandible originating from a breast adenocarcinoma that was initially diagnosed as temporomandibular disorder (TMD). The role of the dental practitioner in the diagnostic phases is also discussed.
It is not uncommon to see a patient who complains of what seems to be a TMD but who in reality suffers from a systematic disease, dental infection, or neoplasia. Although metastases to the head and neck are uncommon, it should always be considered among the differential diagnoses of lesions.
A 42-year-old female presented with pain and swelling in the right temporomandibular joint (TMJ) previously diagnosed as TMD. Further clinical, radiological, and histological examinations coupled with a history of adenocarcinoma of the breast lead to a final diagnosis of a metastatic lesion in the right TMJ region.
In most patients who present with an oral metastasis the distant primary tumor has already been diagnosed and treated. Occasionally the discovery of an oral metastasis leads to the detection of an occult primary malignancy elsewhere in the body. Thus the dentist should be able to perform an adequate diagnosis and play an important role in the diagnostic phase of care that can lead to a useful palliation and an enhanced quality of the patient's life.
In order to avoid the pitfalls so common in evaluating patients with TMJ pain, the clinician must perform a complete and critical review of the medical history along with a comprehensive examination. The challenge is to know and evaluate the differential diagnosis. Failure to do so can result in a misdiagnosis which may lead to unnecessary care, long-term therapy without clinical resolution, or potentionally death.
本报告旨在呈现一例源自乳腺腺癌的下颌骨转移性病变病例，该病例最初被诊断为颞下颌关节紊乱病（TMD）。同时还讨论了牙科医生在诊断阶段的作用。
临床上，患者主诉为TMD但实际患有全身性疾病、牙齿感染或肿瘤的情况并不少见。虽然头颈部转移并不常见，但在病变的鉴别诊断中应始终予以考虑。
一名42岁女性因右侧颞下颌关节（TMJ）疼痛和肿胀就诊，此前被诊断为TMD。进一步的临床、影像学和组织学检查，结合乳腺癌病史，最终诊断为右侧TMJ区域的转移性病变。
在大多数出现口腔转移的患者中，远处原发肿瘤已被诊断和治疗。偶尔，口腔转移的发现会促使发现身体其他部位隐匿的原发性恶性肿瘤。因此，牙医应能够进行充分的诊断，并在诊断阶段发挥重要作用，这有助于有效缓解病情，提高患者生活质量。
为避免在评估TMJ疼痛患者时常见的失误，临床医生必须全面、审慎地回顾病史并进行综合检查。关键在于了解和评估鉴别诊断。否则可能导致误诊，进而引发不必要的治疗、长期治疗却无临床疗效，甚至可能导致死亡。
