Odontogenic carcinoma is rare group of malignant epithelial odontogenic neoplasms with characteristic clinical behavior and histological features, which requires an aggressive surgical approach. The pathogenesis of this rare group remains still controversial and there have been many varied opinions over the classification of this rare group of lesions. As there have not been many reviews on odontogenic carcinoma, the existing knowledge is mostly derived from the published case reports. This review is discussing the pathogenetic mechanisms and is updating the knowledge on nomenclature system of less explored odontogenic carcinomas. This review might throw light on the pathogenesis and nomenclature system of odontogenic carcinoma and this knowledge may be applied therapeutically.

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A 61-year-old male patient came to the Department of Oral and Maxil lofacial Surgery, with complaints of painful, non healing extraction site in relation to right upper posterior teeth region, of 3 months duration. Patient's history revealed that there was pain in right maxillary first molar tooth region since the last 4 months. Due to the ignor ance of the local physician and lack of optimum medical care, the patient had undergone repeated extractions of regional teeth and biopsy of local soft tissue, which revealed non specific infection with lots of inflammatory cells. The patient was referred to us for further evaluation and treatment. On clinical examination, a large area of exposed bone which extended from right maxillary first premolar to second molar region [Table/ Fig-1] was found. Laboratory investigation revealed fasting blood sugar-350 mg/dl, postprandial blood sugar -470 mg/dl and elevated neutrophil and total leucocyte counts. Panoramic radiograph demonstrated diffuse radiolucencies extending from the periapical region of right maxillary second molar to left premolar region, with interradicular bone loss [Table/ Fig-2]. Although clinically there was unilateral exposure of bone on the right side, the radiological features suggested diffuse radiolucencies in the left maxilla. Therefore, a provisional diagnosis of extensive bilateral maxillary osteomyelitis which was complicated with diabetes was made. A swab from the junction area of exposed bone and mucoperiosteum site was taken and it was sent for culture and antibiotic sensitivity. The patient was referred to an endocrinologist for controlling his blood sugar. The culture report revealed E.coli growth and the bacteria was resistant to most of the commonly used antibiotics, except amikacin and gentamycin. After the patient was stable, sequestrectomy under general anaesthesia was planned. Mucoperiosteal flap was reflected and necrotic bone pieces from deeper site were taken and sent for culture sensitivity. A wide area of necrotic bone, starting from right side second molar to left side second premolar region, was found. With slightest pressure from periosteal elevator, the premaxilla and right side posterior part of the maxilla got downfractured and came out [Table/ Fig-3]. Almost entire palatal bone from right side and most part on left side (upto first molar) had to be removed because of necrosis. Buccally, root of the zygoma, anterolateral wall of the maxillary sinus (upto infraorbital foramen) on right side, left anterolateral wall of maxillary sinus and pyriform fossa on both sides were also found to be necrosed. So, they were excised, as was evident in post operative panoramic radiograph [Table /Fig-4]. Antral packs were given with ribbon gauge soaked in soframycin and brought to vestibule through a separate stab incision. The patient was given inj. Amikacin 250mg i.m. 12 hourly and inj. clindamycin 600 mg i.v. 8 hourly for seven days. Ryles tube feeding was started from immediate postoperative day and it was kept for seven days, to avoid sec...

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