Abstract
We describe a difficult-to-diagnose case of lung carcinoma with metastasis to the mandible, based on clinical course, site of occurrence, and image accuracy. The patient was a 66-year-old female. She complained of dull pain for 1 month in the 5 6 region. She underwent tooth extraction and abrasion with a diagnosis of paradentitis. On first examination, only tenderness at the tooth extraction socket and the sclerotic change around the socket on orthopantomogram were observed, and no other lesion related to pain was found. Conservative therapy with antibiotics under alveolar osteitis did not relieve the pain. About 1 month later, she gradually developed deep pain. MRI showed a neoplastic lesion with a high signal occupying the mandibular ramus and infiltrating into the masseter muscle and the medial pterygoid muscle. Bone scintigraphy revealed multiple metastases. The biopsy diagnosis was lung carcinoma with metastasis to the mandible. In this case, there were no clinical findings except for pain, even though the tumor occupied the mandibular ramus. In cases with pain, highly accurate diagnostic examination is needed taking the possibility of malignant tumor into consideration even if no obvious lesion is found.
