A Squamous Cell Carcinoma Presenting As A Persistent OAC

Introduction: Squamous cell carcinoma (SCC) is the most commonly occurring malignancy of the oral cavity. Those which involve the sinus are a rare entity with poor prognosis. We present a case of an 88-year-old woman who was referred with a persisting oroantral communication (OAC) of approximately five weeks. Case Description: Our patient presented with a non-healing socket following extraction of her upper right first molar.On presentation, ulceration of the buccal sulcus was noted, and a defect of 30mm was seen clinically. The CBCT visualised a defect of the right maxillary sinus cortical floor measuring 30mm. There was mucosal thickening and a fluid level within the right maxillary sinus. The patient was scheduled for closure of the OAC under general anesthesia. Intraoperative findings raised suspicions beyond an OAC, and a sample was taken from the area. Histology revealed fibrous stroma with squamous proliferation and a moderately differentiated SCC was diagnosed. Discussion: Post-operative symptoms can be expected following extractions; however, it is important for the treating practitioner to consider what presentation is acceptable given the clinical context.SCC's can mimic general dental pathology; with pain, swelling and a persisting OAC all being potential symptoms of a maxillary tumour. Early referral is key in management and ensuring the best prognosis for the patient. Conclusion/Clinical Significance: SCC of the maxilla often presents late and with symptoms that can mimic toothache and oroantral communications. For this reason, it could be overlooked at these crucial stages. Therefore, it is essential that clinicians must ensure follow-up with patients and refer early if unusual or unexplained symptoms persist.

Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to examine more recent data to determine the extent of lingual nerve injury (LNI) following the surgical extraction of mandibular third molars (M3M). A systematic search of three databases [PubMed, Web of Science and OVID] was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria encompassed studies on patients who underwent surgical M3M extraction using the buccal approach without lingual flap retraction (BA-), buccal approach with lingual flap retraction (BA+), and lingual split technique (LS). The outcome measures expressed in LNI count were converted to risk ratios (RR). Twenty-seven studies were included in the systematic review, nine were eligible for meta-analysis. Combined RR for LNI (BA+ versus BA-) was 4.80 [95% Confidence Interval:3.28-7.02; P<0.00001]. The prevalence of permanent LNI following BA-, BA+ and LS (mean%±SD%) was 0.18±0.38, 0.07±0.21, and 0.28±0.48 respectively. This study concluded that there was an increased risk of temporary LNI following M3M surgical extractions using BA+ and LS. There was insufficient evidence to determine whether there is a significant advantage of BA+ or LS in reducing permanent LNI risk. Operators should use lingual retraction with caution due to the increased temporary LNI risk