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Mandibular metastasis from lung adenocarcinoma as the first sign of occult malignancy
Published in Baylor University Medical Center Proceedings, 2020
Cameron Johnson, Andrew Read-Fuller
Multiple theories exist regarding the metastatic pathway to the head and neck from distant primary tumors. The possible routes of metastasis include the bloodstream and the lymphatic system, although most occur hematogenously.3 The main mechanism of hematogenous metastasis to the oral cavity involves Batson venous plexus, the valveless prevertebral venous network that permits the retrograde path of tumor cells from the lungs to the face.4 Metastatic lesions can be found anywhere in the oral cavity, yet 90% are intraosseous and within the mandible and soft tissue localizations are rare.5 Metastatic foci in the jaw bones are mainly situated in the red marrow, where there is hematopoietically active bone marrow.6 The ascending ramus and angle of the posterior mandible as well as focal osteoporotic bone marrow defects are the most hematopoietically active sites that attract tumor cells, thus accounting for their higher tendency to seed within these sites.6 It has also been suggested that the posterior mandible is a common site of metastases due to abrupt angulation of the facial vessels at this site, causing slowing of vascular flow that may promote malignant cell deposition.2