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In the current report, we emphasize that mental neuropathy is often a sign of progressive or recurrent malignant disease, despite normal results of a mandibular radiograph in a diagnostic evaluation.
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BACKGROUND: The mandible is a very uncommon place for a metastasis of a gastric carcinoma. Normally the area of the temporomandibular joint (TMJ) remains unaffected. The separate vascularization is discussed as one reason among others. Primary reconstruction after resection of the condyle is often problematic because an early onset of adjuvant systemic therapy is required. In this case, the insertion of a Quinn joint prosthesis is presented after resection of a TMJ metastasis. CASE: We report a hematogenic metastatic gastric adenocarcinoma in a 51-year old male who initially presented with increasing disclusion in the left molar region. Suspecting a metastatic adenocarcinoma of the TMJ, a condylectomy with immediate replacement by a total joint prosthesis was performed via a preauricular approach. Corresponding to the clinically and radiologically suspected diagnosis, the decalcified histological specimen presented as a metastatic gastric adenocarcinoma within the intracapsular region. RESULTS: The healing period of the implanted modified Quinn prosthesis was fast and uncomplicated after resection of this, to our knowledge, first documented metastatic gastric adenocarcinoma of the intracapsular region. After early restoration of joint function and patient satisfaction, the required radiochemotherapy of further unresectable bony metastases could be started in time. DISCUSSION: This example of an extremely rare case of a metastasis shows that such a total joint prosthesis appears to be a very good alternative to extended autogenous reconstruction or an unsatisfactory primary resection. Due to the mating of the spherical condylar head and glenoid fossa, the modified Quinn prosthesis is very suitable for total joint replacement after extended resection or in multiply preoperated cases.
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Four patients representing four generations of one family suffered from the multiple nevoid basal cell carcinoma syndrome. These cases are described and the importance of examination and careful supervision of the progeny of such patients is discussed. A unique finding in this series was a large congenital lung cyst occupying the left thoracic cavity of 1 patient.
A young male had an assumed dentigerous cyst marsupialized and later a recurrent ameloblastoma resected. Eleven years later he was admitted with renal stones and hypercalcemia and metastases of the ameloblastoma in the left lung were discovered. Death occurred as a result of spinal and hepatic spread of his tumor and thrombosis of the renal veins. Renal calcification was demonstrated. The possible causes of the hypercalcaemia which was not associated with a raised serum parathormone or affected by parathyroidectomy is discussed.