Clinical features

Common signs and symptoms include loosening of teeth, swelling, failure to heal of a dental extraction socket {1101}, pathological fracture or nerve signs, particularly paraesthesia and anaesthesia in the mental region. Pain may be the only evidence of metastasis. After cortical perforation, a soft tissue mass may be present. Some metastases are asymptomatic chance radiographic findings. The majority of jaw metastases are radi-olucent and poorly defined but occasional lesions are circumscribed. A minority are osteosclerotic or mixed radiolucen-cies and these are usually breast or prostate carcinomas. Some show only subtle changes such as widening of the periodontal ligament or may be invisible on panoramic tomographic views and plain films. In such cases a bone scan may reveal the metastasis. Radiography has low diagnostic yield for metastases {1025}.

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