Jaw mets

[Omc64]

Hi my husband was referred to a dental specialist because he had numbness to part of his jaw and lip. The specialist thinks it's a metastasis in his jaw bone and has referred him back to the oncologist for a pet scan to confirm. He has had one go of lu177 in December and is scheduled for the next one on Jan 26th. Just wondering does anyone know if it could be stopped given the salivary gland involvement with lu? I'm hoping not as he's improved so much with just one go.

[noahware]

Is the numbness to part of his jaw and lip just on one side, or both? I am curious because I recently experienced a minor version of that on my left side only (along with minor headache, also left side only).

The assumption was not mets in the actual jaw, but nerve interference (with the mandibular nerve, the third division of the trigeminal nerve) because I have known mets both on the upper left side of my skull and in the area at the base of my skull where the trigeminal nerve exits the cranium.

I tend to doubt it has to do with the salivary gland involvement from Lu177, but I'm no expert. I can tell you I was extremely good (until my 5th and final Lu infusion) about being well-hydrated on the day before, of, and after receiving Lu177. In addition, I either chewed gum or sucked on a little piece of dried ginger to stimulate saliva flow in the hopes to remove radiation more quickly.

So I experienced no dry mouth. I did experience nausea, and so I went another step and tried to spit out as much saliva as possible (AFTER the infusion, not during!) as well as taking Zofran... no more nausea. To all getting Pluvicto: please load up on water.

Good luck with continued Lu177 success!

[Omc64 in reply to noahware]

It's just on left side. Xray and exam showed no other issues. He has this since September. He has no pain just no feeling. He was biting his lip and gum as he couldn't feel it but he seems to have adjusted to it.

[middlejoel in reply to Omc64]

Just wondering, is he taking a med to strengthen bones such as Prolia?

[Omc64 in reply to middlejoel]

Hi middlejoelYes he was on zometa for a few years with no issues but had to stop to go to dentist in September. His oncologist stopped it to get this dental issue sorted.

[middlejoel]

I've read that similar symptons occur or are caused by bone strenthening drugs like denosumab or prolia. It usually starts with similar symptons and progresses to Jaw bones being exposed and subject to infection. The issue is called Oesteonecrosis of the Jaw (ONJ).

[Shahbazahmedazm]

Hi..My father also had same Symptoms after multiple cycle of Lu177..In case of my father, our Oncologist said its Numb Chin Syndrome..

Have an eye on his Bone Marrow..Lu177 and other Chemotherapy do cause Bone Marrow suppression..

More strength to him and you..

[Omc64 in reply to Shahbazahmedazm]

Hi there

Bone marrow is already suppressed as he is getting transfusion every three weeks since chemo.

Hmg hovers around 8.5. Which I know is not very low either. RO decided to go with one go of lu but warned if hmg tanked that's it. Meeting him today for bloods and transfusion.

[Doseydoe]

Sounds like a blocked saliva gland which an ultrasound could confirm. DD 😎

[Shamrock46]

Is he on med like bisphosphonate therapy? My husband declined anything like that because it can cause necrosis of the jaw. The MO said if that happened he'd be referred to yet another specialist and he wanted no part of that. Good luck.

[dentaltwin]

I was looking for any reference to possible neurotoxicity of Lu 177, but found none. No reason to believe that salivary gland involvement with tumor would cause numbness you're reporting, as it is consistent with involvement of the inferior alveolar nerve. As noahware mentions, this does not need to be within the jaw--it may be anywhere along the trunk of the trigeminal nerve. I'd be inclined to agree with the specialist suggesting a PET.

S. Bornfeld, DDS

[Omc64 in reply to dentaltwin]

Thank you for your replies 🙏

[21cakes]

In the weeks preceding diagnosis I experienced double vision and numbness on the right side of my face. Scans revealed small tumors pressing on the 5th and 6th cranial nerves. Site specific radiation of the tumors shrunk them and within a relatively short time the symptoms disappeared. The treatments were in the Spring of 2021 and the symptoms have not recurred. My oncologist explained that the longer the pressure on the nerves lasted, the more risk of irreparable damage to the nerve. In my case, I dodged a bullet because my GP was less than competent, my optometrist even worse. As a consequence, the symptoms persisted for months until my visit to emergency as a consequence of extensive bone metastasis and oncology became involved. Bottom line, push for the appropriate cranial scans ASAP. Wishing the best for your husband and yourself.

[SeosamhM]

Interesting post, Omc64. I can only relate my experience: I've had jaw pain and a recognized potential for this pain to be associated with metastases in my right upper maxilla (molar region). I can affirm that, whatever bone scan I've had for the last 6 years (F-18 NaF PET, F18-FDG PET, Ga-68 PSMA PET, Tc-99m scintigraphy), there has always been a "hot spot" in this area. However, my dentists have agreed that there was something odd in that area via x-ray read, but every radiologist has commented along the lines of "Increased uptake in the area of the maxilla/mandible is nonspecific but may be secondary to dental disease..."

I did have eventually have a root canal rework of one molar, but the occasional pain has persisted in that area...until I started Lu177 (I am having my 3rd injection tomorrow). I think it an interesting coincidence given Pluvicto's tendency to accumulate in salivary glands.

If there is a metastasis associated with your husband's symptoms, my thinking is that there should be some indication in a past scan (unless it is extremely new). It simply may not have been called out by the radiologist. - Joe M.

[Omc64]

Thank you for your reply Joe M