An Unusual Case of Mandibular Squamous Cell Carcinoma in Intimacy with an Impacted Wisdom Tooth

Abstract

Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting with symptoms mimicking odontogenic infections should receive vigilant attention by clinicians with regard to the disease history, clinical signs, radiographic evidence, and decision for histopathological analysis. This is especially true in the context of impacted dentition, where malignancy must be considered when formulating a differential diagnosis.

Oral Squamous Cell Carcinoma of the Mandible with Management of Wide Excision, Right Hemimandibulectomy, Mandibular Reconstruction, and Pectoralis Major Myocutaneus Flap: A Rare Case Report

“…Cheung et al reported a case of oral SCC in which signs, symptoms, and initial radiographic findings were compatible with an odontogenic infection associated with impacted wisdom teeth. However, after further analysis, the patient's condition proved to be SCC of the oral cavity [2].…”

“…It most commonly occurs on the tongue (40% of cases) and the floor of the mouth (30%). Other sites include the buccal mucosa, gingiva, palate, and retromolar area" [1][2][3]. "Less commonly involved is the gingiva, which comprises about 10% of all OSCCs" [4].…”

Are third molars associated with orofacial pain? Findings from the SHIP study

“…They are the most frequently impacted teeth, and many are associated with cystic changes (up to 50% in some studies), periodontal damage (impacted third molars increased the risk more than 4‐fold) and caries of the distal surface of second molars (up to 12%) 14‐16 . There are conflicting estimates of the frequency of neoplastic lesions associated with third molars, 17‐19 thus casting doubts on claims of necessity to remove third molars to prevent pathological changes 20,21 . This has led to opposing opinions among oral surgeons and general dentists on the indications for third molar removal when presented with periapical radiographs of the same patient 22 .…”