Breast adenocarcinoma mimicking temporomandibular disorders: a case report

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.