Mucoepidermoid Carcinoma of the Mandible

David Goldfarb, DO, Diran Mikaelian, MD, and William M. Keane, MD

(Editorial Comments: Mucoepidermoid carci­noma may rarely present as an intraosseous focus in the mandible. The authors discuss the three main theories used to explain this tumor location. Wide local excision produced good results in this case.)

Mucoepidermoid carcinoma is made up of epithelial and mucin-producing cells. The le­ sion originates most frequently in major sali­vary glands, usually the parotids.1 The lesion rarely appears as a central lesion in the jaw bone. The predominant locations in the man­dible are the posterior alveolus, angle, and ra­mus.

The purpose of this paper is to discuss the clinical entity of mucoepidermoid carcinoma of the mandible, and illustrate it with a case presentation.

Case Presentation

A 49-year-old white man developed pain in the right lower mandible several years prior to seeking medical attention. He had recently been examined by his dentist and found on panorex film to have a lytic lesion of the mandible (Fig 1). He was referred to an oral surgeon. The third molar from the right side of the mandible was removed and biopsy re­sults from adjoining tissue were remarkable for in­termediate-grade mucoepidermoid carcinoma. The patient was referred for further evaluation and treatment. Metastatic work-up including bone scan, liver/spleen scan, and chest x-ray were all negative. His past medical history was remarkable for hypertension and an atretic right ear. The pa­tient had no known allergies. The patient reported no tobacco use and only occasional alcohol con­sumption.

The physical examination showed a well­ developed, well-nourished man in no apparent dis­ tress. His vital signs were stable. His mouth was clear and no lesions were noted. The right lower third molar had been extracted and the overlying soft tissue had healed. There was some minimal swelling in the retromolar trigone region. On bi­manual examination no palpable soft tissue masses were appreciated in the floor of the mouth region, base of tongue, or tonsillar fossas. A neck exami­nation was negative for palpable masses. The rest of the patient's physical examination was unre­markable with the exception of an atretic right au­ricle.

The pathology slides were reviewed by our pa­thologist who concurred with the diagnosis of in­termediate-grade mucoepidermoid carcinoma of the mandible.

The patient was taken to the operating room and underwent an initial tracheotomy followed by a right modified radical neck dissection and resec­tion of the angle of the right mandible with recon­struction using the right sternocleidomastoid mus­cle. The postoperative course was uncomplicated and he was discharged home on the eighth postop­erative day.

Contents of the neck dissection were negative for metastatic tumor (15 nodes and submandibular glands were all normal). The hemimandibulectomy specimen was embedded in formalin and measured

7.0 x 3.5 x 2.2 cm in greatest dimension. There was no gross evidence of tumor on the exter­nal surface. A focus of mucoepidermoid carcinoma was found in the area adjacent to the socket of the extracted molar tooth (Figs 3 and 4). The anterior and posterior margins of resection were negative for disease. Extensive fibrosis and reactive bone formation was also noted.

No postoperative radiation therapy was given. The patient is now 2 years postsurgical resection and is free of tumor.

Discussion

There is no pathognomonic radiologic pic­ture which distinguishes mucoepidermoid carcinoma of the mandible from other bone lesions. On x-ray examination a unilocular or multilocular radiolucent lesion is usually seen. Diagnosis is made only by biopsy.

54 American Journal of Otolaryngology, Vol 15, No 1 (January-February), 1994: pp 54-57

From the Department of Otolaryngology-Head and Neck Surgery, Medical Center at Princeton, Princeton, Nj; and the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.

Address reprint requests to David Goldfarb, DO, De­partment of Otolaryngology-Head and Neck Surgery, Medical Center at Princeton, Princeton, NJ 08540.

Copyright© 1994 by W.B. Saunders Company 0196-0709/94/1501-0008