Primary intraosseous mandibular carcinoma arising from an odontogenic cyst
Keywords:
maxillomandibular neoplasms, squamous cell carcinoma, osseous cysts, mandible.Abstract
Introduction: primary intraosseous squamous cell carcinoma is an infrequent malignant neoplasm.
Objective: present a clinical case of primary intraosseous carcinoma arising from an odontogenic cyst in body regions to the left mandibular branch.
Clinical case: a 68-year-old male patient presented with "discomfort" in his mandible. Oral examination revealed cortical expansion at the level of 37. Orthopantomography showed a radiolucent area with definite borders. Curettage and histological testing confirmed the preliminary diagnosis of residual cyst. Some four months later the patient presented again with very intense pain in the mandibular angle region with slight paresthesia of the left lower lip area associated on physical facial examination with lower and submandibular genian edema, and on oral examination with abnormal left mandibular bone mobility. Orthopantomography revealed a radiolucent image of irregular, imprecise borders and pathological mandibular fracture. It was decided to immobilize and take a sample for biopsy, which reported moderately differentiated epidermoid carcinoma. Therefore, radical surgical treatment was performed with neck management plus postoperative radiotherapy and chemotherapy.
Conclusion: evolution of a residual cyst into a primary intraosseous carcinoma is an infrequent condition in the maxillofacial region. In the case herein presented diagnosis was made by exclusion. The symptoms of intense pain and paresthesia were crucial to the preliminary diagnosis. Application of an oncological approach based on radical surgery with neck management and radio- and chemotherapy resulted in local-regional control.
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