Metastatic Disease
- In adults, metastases to the jaws most commonly originate from primary carcinomas of the breast in women and of the lung in men. Other common primary sites in decreasing order of frequency are the prostate, gastrointestinal tract, kidney, colon, and rectum.
SCC
- Treatment of the N0 neck with elective neck dissection is indicated when an approximate 20-30% chance of spread to lymph nodes exists. Length of time, degree of differentiation, and margin STATUS at diagnostic biopsy are not reliable indicators of spread to neck lymph nodes. Tumor depth of invasion has been correlated with risk of positive nodes in a large number of reported studies and can be used as a guide in making clinical decisions for elective neck dissection in T1 and T2 lesions.
- A single positive neck lymph node well contained within the capsule decreases 5-year survival to 50%. If the patient had extracapsular spread associated with the node then this would have decreased survival by an additional 50% to about 25% 5-year survival.
Osteosarcoma
- Osteosarcomas of the jaws are ideally treated with initial (neoadjuvant) chemotherapy of about five cycles, followed by surgery, which is followed by two or three additional doses of chemotherapy (adjuvant). Radical neck dissection has no role to play in the management of osteosarcoma, as lymphatic dissemination is almost non-existent, while hematogenous dissemination is the rule. Some osteosarcomas of the facial skeleton may be treated by ablative surgery alone, however, this is not considered the best treatment.
Low Grade Mucoep
- Treatment (of LG mucoepidermoid CA) is normally mandibular resection; postoperative radiation therapy is often not required, particularly for low-grade tumors, making mandibular reconstruction a simpler proposition.
