An Unlikely Cause of Headaches and TMJ Pain in a Young Woman
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A woman in her 20s underwent chemoradiation therapy for FIGO (International Federation of Gynecology and Obstetrics) stage IB2 cervical carcinoma. Six weeks following treatment she presented with headaches and right-sided TMJ pain. (MRI) revealed a 4 × 4-cm mass in the right temporal bone, extending into the middle cranial fossa. Fine-needle aspiration findings were consistent with metastatic squamous cell carcinoma. Positron emission tomographic scan showed this as an isolated skull base metastasis.

The patient then received additional chemotherapy and stereotactic radiosurgery. Following this treatment, skull base disease persisted, and she received additional radiosurgery. One month following her second radiation treatment she developed osteoradionecrosis and osteomyelitis of the temporal bone and condyle of the mandible. Given her favorable response at the primary cervical site and lack of additional metastasis, immunotherapy was planned if her infection could be controlled.

Temporal bone resection and debridement with a partial mandibulectomy was performed with reconstruction using a temporalis muscle flap. No residual tumor was identified at the time of surgery. The initial postoperative course was uncomplicated. One month following surgery she was given 1 cycle of pembrolizumab. Two weeks later she developed complete wound dehiscence. She was discharged to hospice and died shortly thereafter, 12 months after developing isolated SBM.

Metastatic cervical carcinoma carries a poor prognosis, with 5-year survival rates of less than 20%. Although prior reports of SBM have occurred in late-stage, widely metastatic disease, this case highlights that isolated SBM may occur at any stage. In these patients, life expectancy is often less than 12 months.