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Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient’s medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease. RESUMO As metástases mandibulares podem ser confundidas com doenças inflamatórias ou infecciosas. Sendo assim, elas devem ser consideradas no diagnóstico diferencial de lesões desconhecidas na mandíbula. Esse relato de caso envolveu metástase de câncer de mama na mandíbula de uma mulher de 45 anos. O diagnóstico diferencial mais importante foi uma lesão reacional, em uma localização periapical incomum, associada a um dente não vital. No entanto, dado o histórico médico da paciente e uma vez que parestesia e dor foram observadas alguns dias após a realização da pulpectomia, a metástase de câncer de mama não foi descartada. Quando a cintilografia óssea sugeriu a metástase de um tumor ósseo maligno, uma biópsia incisional foi realizada. O exame histopatológico e a reação imunohistoquímica confirmaram o diagnóstico de metástase do câncer de mama, e a quimioterapia foi então realizada. Infelizmente, a paciente morreu 2 anos após o diagnóstico. Portanto, dentistas e médicos generalistas devem considerar a presença demetástases oral em casos que envolvam sintomas atípicos, principalmente em pacientes com doença maligna conhecida.

An 18-year-old white woman was referred to our service with complaint of “ulcerations on the tongue.” The lesions worsened in the last 6 months when the orthodontic appliance was placed. The patient was vegetarian, and she reported a prolonged menstrual period. Oral examination revealed multiple symptomatic ulcerations with irregular shape with pseudomembrane involving the lower lip, tongue, and buccal mucosa bilaterally. Laboratory tests were requested, which showed sickle cell trait of anemia with presence of microcytic red blood cells as well as iron deficiency and ferritin. The diagnosis was of major aphthous ulcerations associated with anemia exacerbated by the use of the orthodontic appliance. The patient was advised regarding the feeding and constant use of wax use for mucosal protection and was prescribed topical steroid. The patient was referred to the hematologist, gynecologist, and nutritionist because of anemia manifestation. She is being followed up in our service with sporadic episodes of ulcerative lesions.

Carotid stenosis usually results from the accumulation of atherosclerotic plaque in the carotid artery wall and is an important risk factor for ischemic cerebral vascular accident (CVA). A male patient was referred to a dental radiology clinic to perform panoramic radiography (PR) and cone beam computed tomography (CBCT) for dental evaluation. In the PR and CBCT, a radiopaque image was observed above the hyoid bone and adjacent to the cervical spine, on the right side, suggestive of atheroma in the extracranial carotid artery and the diagnosis was confirmed by color Doppler ultrasonography. In the CBCT, the presence of calcification in the intracranial internal carotid artery was also observed. Diagnostic imaging exams used in dentistry allow the identification of asymptomatic individuals, facilitating early intervention and consequent reduction in the risk of ischemic CVA.