Oral metastases from pulmonary carcinomas are uncommon and may occur either as the first manifestation of an occult primary tumor or during the course of previously diagnosed disease. We report two cases and present a narrative, case-based review of published oral metastases from pulmonary carcinoma. The first patient was a 42-year-old man with a history of pulmonary adenocarcinoma who developed an asymptomatic hard-palatal lesion ten years after treatment; biopsy showed metastatic adenocarcinoma, and subsequent PET/CT demonstrated pulmonary recurrence. The second patient was a 72-year-old man who presented with a rapidly progressive mandibular lesion associated with pain, swelling, ulceration, paresthesia, and osseous destruction. Histopathologic and immunohistochemical findings supported metastatic pulmonary adenocarcinoma, followed by rapid clinical deterioration. The narrative case matrix comprised 52 published patients (mean age, 64.7 years; range, 40–86 years), of whom 76.9% were male. Adenocarcinoma and its variants accounted for 69.2% of cases. Jawbone involvement occurred in 50.0%, oral soft-tissue involvement in 46.2%, and combined involvement in 3.8%. The mandible predominated among jawbone metastases, whereas the gingiva or alveolar mucosa predominated among oral soft-tissue lesions. Oral metastases from pulmonary carcinoma show substantial clinicopathologic heterogeneity and may mimic odontogenic, inflammatory, or primary oral malignant conditions. Timely biopsy and integration of clinical, imaging, histopathologic, and immunohistochemical findings are important for diagnosis and multidisciplinary oncologic management.
Bilateral fractures of the atrophic mandible in elderly patients pose a clinical challenge, particularly in the presence of systemic comorbidities and impaired healing capacity. In the present case, an elderly patient developed early, extensive postoperative wound dehiscence after surgical reduction and fixation. Initial management included debridement, systemic and topical antimicrobials, serial cleaning, and dressing changes. Because the dehiscence persisted, antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were incorporated into a multimodal conservative protocol that also included warmed saline irrigation and occlusive dressings. Progressive tissue repair was observed, with complete wound closure after 12 aPDT/PBMT sessions and no loss of fracture stability or need for additional surgery. Because several interventions were administered sequentially and in combination, and this is a single case, the independent contribution of aPDT or PBMT cannot be determined. This report supports the success of a multimodal conservative strategy in a carefully selected patient but does not establish the efficacy of any individual therapy.
Objective To report two cases of traumatic carotid-cavernous fistula (CCF) secondary to craniofacial trauma, successfully managed with conservative medical treatment instead of endovascular therapy. Methods Two young male patients developed CCF after high-energy facial trauma with orbital involvement. Diagnosis was established by clinical and neuro-ophthalmologic examination associated with imaging studies, and both were treated with monitored arterial hypotension using propranolol, intravenous corticosteroids, and antibiotics, with conservative management of associated fractures. Result Both patients showed rapid regression of periorbital edema, pain, and ophthalmoplegia, with recovery or preservation of visual function, and imaging at follow-up confirmed spontaneous closure of the fistula and restoration of normal anatomy without recurrence. Conclusion In selected traumatic CCF cases, conservative medical management may achieve spontaneous closure with excellent functional outcomes, representing a viable alternative when endovascular treatment is unavailable or contraindicated.
Fibrous dysplasia is a benign fibro-osseous developmental disorder that commonly presents as an intraosseous lesion causing gradual expansion of the craniofacial bones; however, an entirely peripheral soft-tissue presentation is exceptionally rare. To the best of our knowledge, this report describes the first documented case of peripheral fibrous dysplasia presenting as a localized, exophytic gingival mass in the posterior mandible. A 30-year-old female presented with a firm, exophytic soft-tissue lesion located in the left posterior mandibular gingiva. The lesion had been present for approximately one month and was initially misdiagnosed and treated as a dental abscess before specialist referral. Clinical, radiographic, and histopathological examinations were performed. Histopathological analysis demonstrated irregular, curvilinear osseous trabeculae embedded within an inflamed fibrous connective tissue stroma with a complete absence of peripheral osteoblastic rimming or malignancy, confirming the diagnosis of peripheral fibrous dysplasia. The lesion was successfully managed via complete surgical excision with safety margins along with the extraction of the involved adjacent teeth. The postoperative healing course was completely uneventful, demonstrating excellent local tissue recovery and no clinical or radiographic signs of recurrence. This case highlights the vital clinical importance of considering peripheral fibrous dysplasia in the differential diagnosis of exophytic gingival fibro-osseous lesions to ensure accurate diagnosis and appropriate definitive surgical management.
