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Clinical Problem Solving
April 2014

Incidental Mandibular Lesion in a Patient With Head and Neck Cancer

Author Affiliations
  • 1Morsani College of Medicine, University of South Florida, Tampa
  • 2James A. Haley Veterans Affairs Hospital, Tampa, Florida
JAMA Otolaryngol Head Neck Surg. 2014;140(4):377-378. doi:10.1001/jamaoto.2014.9

A man in his early 80s with a 45-pack-year history of smoking presented with a 2-month history of an enlarging skin lesion on the left side of his neck that was not painful but frequently drained scant yellow fluid. The patient reported that while shaving, he frequently shaved off the top portion of the lesion. This was excised under local anesthesia, and pathologic findings showed poorly differentiated cutaneous squamous cell carcinoma with positive margins. Computed tomographic (CT) imaging of the neck was performed that showed no lymphadenopathy concerning for metastasis. There was, however, an incidental finding of a circumscribed left mandibular lingual wall defect with thinning of the buccal cortical bone and a small amount of soft tissue and fat within the cavity (Figure, A-C). This was located in the posterior mandible and inferior to the inferior alveolar canal. The patient did not have any symptoms related to this lesion.

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