A Rare Case of Misdiagnosed Silent Lung Cancer with Solitary Metastasis to the Temporomandibular Joint Condyle

This article describes the case history of a 59-year-old female patient who sought advice for temporomandibular joint (TMJ) pain and sounds but who was actually diagnosed with a primary lung cancer with metastasis to the TMJ. The patient had a history of TMJ pain and deflection in jaw movement that progressively worsened over a few months and did not improve with the usual standard of care treatment provided by an orofacial pain practitioner. Magnetic resonance and computed tomography (CT) prescribed at a tertiary clinic showed an osteolytic bone mass within the right TMJ condyle. The neoformation was surgically removed and histologic assessment revealed it was a metastasis of a silent lung carcinoma. Thorax CT confirmed the presence of a formation within the apical segment of the right lung superior lobe. While this scenario of a silent lung cancer metastasis to the TMJ condyle mimicking classical symptoms of temporomandibular disorders (TMD) is rare, it does indicate that the path to differential diagnosis is often difficult in TMD and orofacial pain patients, and that practitioners managing such patients should be aware of the variegate spectrum of possible TMD-mimicking conditions to avoid dangerous diagnostic delays.

cancer; lung; neoplasm; temporomandibular disorders; temporomandibular joint

1. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research Diagnostic Criteria for Temporomandibular Disorders: A systematic review of Axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:453–462.

2. Goulet JP, Schiffmann EL, Manfredini D. Clinical examination and adjunctive laboratory tests for physical diagnosis. In: Sessle BJ (ed). Orofacial Pain: Recent Advances in Assessment, Management, and Understanding of Mechanisms. Washington, DC: IASP, 2014:99–120.

3. Clayman L. Surgical management of benign and malignant neoplasms. In: Laskin DM, Greene CS, Hylander WL (eds). Temporomandibular Disorders: An Evidence-Based Approach to Diagnosis and Treatment. Chicago: Quintessence, 2006: 509–532.

4. Kondoh T, Seto K, Kobayashi K. Osteoma of the mandibular condyle: Report of a case with a review of the literature. J Oral Maxillofac Surg 1998;56:972–979.

5. Cimino R, Steenks MH, Michelotti A, Farella M, PierFrancesco N. Mandibular condyle osteochondroma. Review of the literature and report of a misdiagnosed case. J Orofac Pain 2003;17: 254–261.

6. Guarda-Nardini L, Piccotti F, Ferronato G, Manfredini D. Synovial chondromatosis of the temporomandibular joint: A case description with systematic literature review. Int J Oral Maxillofac Surg 2010;39:745–755.

7. Spinzia A, Panetta D, Russo D, Califano L. Synovial cyst of the temporomandibular joint: A case report and literature review. Int J Oral Maxillofac Surg 2011;40:874–877.

8. Poveda-Roda R, Bagán JV, Sanchis JM, Margaix M. Pseudotumors and tumors of the temporomandibular joint. A review. Med Oral Patol Oral Cir Bucal 2013;18:e392–e402.

9. Singh S, Desai B, Laskin D. Metastatic melanoma misdiagnosed as a temporomandibular disorder: A case report and review of the literature. J Am Dent Assoc 2014;145:1052–1057.

10. Nomura F, Kishimoto S. Synovial sarcoma of the temporomandibular joint and infratemporal fossa. Auris Nasus Larynx 2014; 41:572–575.

11. Aksoy S, Orhan K, Kursun S, Kolsuz ME, Celikten B. Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome. World J Surg Oncol 2014;12:401.

12. Klasser GD, Echandi L, Shannon M. Hepatocellular carcinoma metastasis to the condyle: A case report and review of the literature. J Am Dent Assoc 2014;145:1063–1067.

13. Freudlsperger C, Kurth R, Werner MK, Hoffmann J, Reinert S. Condylar metastasis from prostatic carcinoma mimicking temporomandibular disorder: A case report. Oral Maxillofac Surg 2012;16:79–82.

14. Kruse Al, Luebbers HT, Obwegeser JA, Edelmann L, Graetz KW. Temporomandibular disorders associated with metastases to the temporomandibular joint: A review of the literature and 3 additional cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e21–e28.

15. Al-Jamali JM, Voss PJ, Bayazeed BA, Spanou A, Otten JE, Schmelzeisen R. Malignant tumors could be misinterpreted as temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e362–e367.

16. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

17. Manfredini D, Favero L, Gregorini G, Cocilovo F, Guarda-Nardini L. Natural course of temporomandibular disorders with low pain-related impairment: A 2-to-3-year follow-up study. J Oral Rehabil 2013;40:436–442.

18. Manfredini D, Guarda-Nardini L. Agreement between Research Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population. Int J Oral Maxillofac Surg 2008;37:612–616.

19. Petersson A. What you can and cannot see in TMJ imaging—An overview related to the RDC/TMD diagnostic system. J Oral Rehabil 2010;37:771–778.

20. Ernberg M, Hargreaves K, Schmidt B. Inflammatory and cancer-related orofacial pain mechanisms: Insights from human experimental studies. In: Sessle BJ (ed). Orofacial Pain: Recent Advances in Assessment, Management, and Understanding of Mechanisms. Washington, DC: IASP, 2014:393–414.

21. Viet CT, Schmidt BL. Biologic mechanisms of oral cancer pain and implications for clinical therapy. J Dent Res 2012;91: 447–453.

22. Hirshberg A, Leibovich P, Buchner A. Metastatic tumors to the jawbones: Analysis of 390 cases. J Oral Pathol Med 1994; 23:337–341.

23. Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity—Pathogenesis and analysis of 673 cases. Oral Oncol 2008;44:743–752.