Dados do Trabalho

Título

ORAL SQUAMOUS CELL CARCINOMA ADJACENT TO DENTAL IMPLANT - A DIAGNOSTIC PITFALL

Introdução

Head and neck cancers are malignant diseases with a high global prevalence. In this context, oral squamous cell carcinoma (OSCC) is one of the most common. The main risk factors include tobacco and alcohol use. In specific oral regions, such as the gums, OSCC may mimic benign inflammatory reactions, which can delay the diagnosis and impact the prognosis.

Objetivo

The aim of this case is to report a patient who developed squamous cell carcinoma in the right maxilla, adjacent to the dental implant, where the delay in diagnosis had a direct impact on the treatment and prognosis.

Métodos

A 74-year-old male patient was referred for evaluation of a lesion in the posterior region of the right maxillary gingiva, with approximately 4 months of evolution. The patient had been previously treated with topical corticosteroids and antiviral drugs, without success. The patient reported being a former smoker and social drinker, and had no comorbidities or associated pain complaints. On physical examination, a single ulcerated lesion was noted in the posterior maxillary gingiva, adjacent to the region of fixed prostheses and the dental implant, with a fibroelastic consistency, and measuring about 1.5 cm in diameter. In the panoramic radiograph it was observed a radiolucency associated with intense bone loss at the apex of the metallic implant (tooth 12) and bone rarefaction at the apex of the roots of the teeth 14 and 15. Thus, the hypotheses of squamous cell carcinoma were formulated.

Resultados

An incisional biopsy was performed, and diagnosis of SCC was established. The patient was referred for oncological treatment, which was based on extensive surgical resection of the tumor encompassing the right hemi-maxillary bone superficial segment and adjacent soft tissues, as well as supra-omohyoid neck dissection. Microscopical analysis of the surgical specimen revelead tumor-free margins and no lymph node involvement. The surgical defect was reconstructed with a microsurgical graft obtained from the left forearm skin. The patient posteriorly underwent rehabilitation with new implant-supported prostheses. He was in regular basis, and in the seventh year, a whitish lesion close to the graft was observed. A new incisional biopsy was performed and showed hyperkeratosis and acanthosis compatible with oral leukoplakia diagnosis. The patient is in follow-up for 13 years without evidence of recurrences or metastases.

Conclusões

Oral SCC (OSCC) is a highly prevalent tumor and affect more frequently tongue and floor of mouth. However, when occur in areas adjacent to dental implant may mimic benign inflammatory lesions. Therefore, dental surgeon should always consider OSCC hypothesis in the diagnosis of dental implant associated lesions that do not respond to conventional treatments for peri-implant inflammatory lesions. Early diagnosis of OSCC and appropriate treatment are associate to a better prognosis and quality of life.

Palavras-chave

Oral squamous cell carcinoma; Peri-implantitis; Oral cancer